Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT
Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT
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DOI：
10.1016/j.atherosclerosis.2007.07.002
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发表时间：
2008-04-01
期刊：
影响因子：
5.3
通讯作者：
Min, James K.
中科院分区：
文献类型：
--
作者：
Lin, Fay;Shaw, Leslee J.;Min, James K.
背景资料：多排螺旋CT（MDCT）的动脉粥样硬化成像检测冠状动脉斑块的范围、分布、位置和组成。相比之下，单光子发射计算机断层扫描（SPECT）的功能成像识别灌注缺陷，已知预测冠心病（CHD）的预后。我们试图确定是否解剖措施的斑块MDCT预测功能措施的冠心病SPECT，因此，作为措施的不良心血管projective.Methods和results：连续低到中等风险的症状患者没有已知的冠心病（n = 163）进行了两个应力SPECT和MDCT。MDCT斑块范围和分布分别通过节段硬化评分（所有冠状动脉节段中管腔阻塞的总和）和节段受累评分（显示任何斑块的节段总和）进行分级。斑块位置用危险节段评分（斑块范围按邻近程度加权）和改良的杜克CAD指数进行评估。斑块成分分为非钙化、钙化和混合型。单变量分析中，节段狭窄评分（p = 0.006）、危险节段评分（p = 0.002）、杜克CAD指数（p = 0.02）和混合斑块评分（p = 0.01）预测SPECT严重异常。与最低四分位数混合斑块评分相比，最高四分位数混合斑块评分预测较高的SSS（8.1 +/- 10.3 vs 3.5 +/- 5.7，p < 0.001）、SRS（3.2 +/- 7.7 vs 0.9 +/- 3. 1，p = 0.008）和SDS（4.9 +/- 6.4 vs. 2.6 +/- 3.9，p = 0.012）。相反，较高的节段受累评分、钙化和非钙化斑块评分并不能预测较高的缺血SPECT测量值。在多变量分析中，比较最高和最低四分位数，高节段狭窄评分的个体[比值比（OR）1.97（1.22-3.39），p = 0.008]，风险节段评分[OR 1.71（1.24-2.58），p = 0.005]、最高风险杜克CAD指数分类[OR 2.25（1.12-4.4 1），p = 0.021]和混合斑块评分[OR 1.64（1.10-2.43），p = 0.01]的SPECT扫描异常更严重。结论：在无已知CHD的低至中等风险患者中，MDCT冠状动脉斑块评估成功识别了SPECT心肌灌注缺损范围、严重程度和可逆性增加风险较高的患者。解剖MDCT的结果，包括斑块的范围，位置和组成，是功能性缺血和严重冠心病的SPECT的独立预测因子，因此，代表不良心血管预后的标志物发生临床心血管事件之前。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Background: Atherosclerosis imaging by multidetector computed tomography (MDCT) detects coronary artery plaque extent, distribution, location and composition. In contrast, functional imaging by single-photon emission computed tomography (SPECT) identifies perfusion defects known to predict prognosis of coronary heart disease (CHD). We sought to determine whether anatomic measures of plaque by MDCT predict functional measures of CHD by SPECT and thus, serve as measures of adverse cardiovascular prognosis.Methods and results: Consecutive low-to-intermediate risk symptomatic patients without known CHD (n = 163) underwent both stress SPECT and MDCT. MDCT plaque extent and distribution were graded by a segment sterrosis score (summation of luminal obstruction in all coronary segments) and segment involvement score (summation of segments exhibiting any plaque), respectively. Plaque location was assessed with a segments-at-risk score (plaque extent weighted by proximity) and a modified Duke CAD index. Plaque composition was graded as noncalcified, calcified and mixed. SPECT findings-summed stress (SSS), rest (SRS) and difference (SDS) scores-were compared to MDCT plaque scores.In univariate analyses, segment stenosis score (p = 0.006), segments-at-risk score (p = 0.002), Duke CAD index (P = 0.02), and mixed plaque score (p = 0.01) predicted severely abnormal SPECT. Highest compared to lowest quartile mixed plaque scores were predictive of higher SSS (8.1 +/- 10.3 versus 3.5 +/- 5.7, p < 0.001), SRS (3.2 +/- 7.7 versus 0.9 +/- 3. 1, p = 0.008), and SDS (4.9 +/- 6.4 versus 2.6 +/- 3.9, p = 0.012). In contrast, higher segment involvement scores, calcified and non-calcified plaque scores did not predict higher SPECT measures of ischemia. In multivariable analyses, comparing highest to lowest quartiles, individuals with high segment stenosis scores [odds ratio (OR) 1.97 (1.22-3.39), p = 0.008], segments-at-risk scores [OR 1.71 (1.24-2.58), p = 0.005], highest risk Duke CAD index category [OR 2.25 (1.12-4.4 1), p = 0.021, and mixed plaque scores [OR 1.64 (1.10-2.43), p = 0.01] had more severely abnormal SPECT scans. Conclusions: In low-to-intermediate risk patients without known CHD, MDCT coronary artery plaque assessment successfully identify patients at higher risk of increased extent, severity and reversibility of myocardial perfusion defects by SPECT. Anatomic MDCT findings, including plaque extent, location and composition, are independent predictors of functional ischemia and severe CHD by SPECT and thus, represent markers of adverse cardiovascular prognosis prior to the occurrence of clinical cardiovascular events. (c) 2007 Elsevier Ireland Ltd. All rights reserved.