Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve.
Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve.
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DOI：
10.1016/j.jcmg.2014.11.002
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发表时间：
2015-01
影响因子：
14
通讯作者：
Min, James K.
中科院分区：
文献类型：
--
作者：
Park, Hyung-Bok;Heo, Ran;Hartaigh, Briain O.;Cho, Iksung;Gransar, Heidi;Nakazato, Ryo;Leipsic, Jonathon;Mancini, G. B. John;Koo, Bon-Kwon;Otake, Hiromasa;Budoff, Matthew J.;Berman, Daniel S.;Erglis, Andrejs;Chang, Hyuk-Jae;Min, James K.
关键词：
我们通过冠状动脉 CT 血管造影 (CT) 评估了动脉粥样硬化斑块特征 (APC) 与通过血流储备分数 (FFR) 评估的病变缺血之间的关联。 FFR是判断病变缺血的金标准。虽然 CT 检测的 APC（包括聚集斑块体积百分比 (%APV)、正性重塑 (PR)、低衰减斑块 (LAP) 和点状钙化 (SC)）与未来的冠状动脉综合征相关，但它们与病变缺血的关系尚不清楚。 252 名患者（5 个国家、17 个中心）[平均年龄 63 岁，71% 男性]接受了 CT 扫描，并对 407 个冠状动脉病变进行了 FFR。 CT 被解释为 < 和 > 50% 狭窄，后者被认为是阻塞性的。 CT APCs定义为：（1）PR，病灶直径/参考直径>1.10； (2) LAP，任何体素<30 HU； (3) SC，结节性钙化斑<3mm。分析了 APC 治疗病变缺血的比值比 (OR) 和净重分类改善 (NRI)，定义为 FFR <0.8。根据 FFR，151 个病变（37%）存在缺血。每增加 5% 的 APV，%APV 与缺血风险增加 10% 相关。 PR、LAP 和 SC 与缺血相关，其患病率比非缺血性病变高 3-5 倍。在多变量分析中，观察到 1 个 [OR 4.5，p<0.001)] 和 ≥2 个 (OR 13.2，p<0.001) APC 的缺血风险逐步增加。这些结果依赖于 APC，PR（OR 5.4，p<0.001）和 LAP（OR 2.2，p=0.028）与缺血相关，但与 SC 无关。当根据狭窄严重程度进行检查时，PR 仍然是所有病变缺血的预测因子，而 %APV 和 LAP 仅与 >50% 的缺血相关，但与 <50% 的狭窄无关。 CT 的 %APV 和 APC 可以提高对引起缺血的冠状动脉病变的识别。 PR 与所有引起缺血的病变相关，而 %APV 和 LAP 仅与 >50% 的引起缺血的病变相关。
We evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary CT angiography (CT) and lesion ischemia by fractional flow reserve (FFR). FFR is the gold standard for determining lesion ischemia. While APCs by CT—including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP) and spotty calcification (SC)—are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. 252 patients (17 centers, 5 countries) [mean age 63 years, 71% males] underwent CT, with FFR performed for 407 coronary lesions. CT was interpreted for < and >50% stenosis, with the latter considered obstructive. APCs by CT were defined as: (1) PR, lesion diameter/reference diameter >1.10; (2) LAP, any voxel <30 HU; and (3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement (NRI) of APCs for lesion ischemia, defined by FFR <0.8, were analyzed. By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 10% increased risk of ischemia per 5% additional APV. PR, LAP and SC were associated with ischemia, with a 3-5 times higher prevalence than in non-ischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 [OR 4.5, p<0.001)] and ≥2 (OR 13.2, p<0.001) APCs. These findings were APC-dependent, with PR (OR 5.4, p<0.001) and LAP (OR 2.2, p=0.028) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, while %APV and LAP were associated with ischemia for only >50% but not for <50% stenosis. %APV and APCs by CT improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, while %APV and LAP are only associated with ischemia-causing lesions >50%.
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影响因子：
120.7
作者：
CLARKSON, TB;PRICHARD, RW;KLEIN, KP
通讯作者：
KLEIN, KP
影响因子：
37.8
作者：
De Bruyne, B;Hersbach, F;Wijns, W
通讯作者：
Wijns, W
DOI：
10.1136/hrt.2009.166017
发表时间：
2009-09
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Lavi S;Bae JH;Rihal CS;Prasad A;Barsness GW;Lennon RJ;Holmes DR Jr;Lerman A
通讯作者：
Lerman A
影响因子：
2.4
作者：
Masoli, O;Baliño, NP;DiCarli, MF
通讯作者：
DiCarli, MF
影响因子：
24
作者：
Motoyama, Sadako;Sarai, Masayoshi;Narula, Jagat
通讯作者：
Narula, Jagat