Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia
Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia
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DOI：
10.1016/j.jcmg.2018.05.019
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发表时间：
2019-07-01
影响因子：
14
通讯作者：
Arbab-Zadeh, Armin
中科院分区：
文献类型：
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作者：
Bakhshi, Hooman;Meyghani, Zahra;Arbab-Zadeh, Armin
目的 本研究旨在调查各种心脏计算机断层扫描 (CT) 衍生的动脉粥样硬化斑块指标在预测诱发性心肌缺血方面的表现。 背景 冠状动脉直径狭窄与心肌缺血的相关性不大，但心脏 CT 提供了其他几种现成的动脉粥样硬化指标，可能具有增量价值。 方法 该研究分析了 873 条未置入支架的冠状动脉及其心肌灌注区域。 356 名患者（平均年龄 62 岁）参加了 CORE320（使用 320 排多探测器计算机断层扫描血管造影和心肌灌注进行冠状动脉评估）研究。静态 CT 灌注成像中的心肌灌注缺陷在静息时和腺苷注射后使用 4 点量表对 13 个心肌节段进行分级。通过从总压力分数中减去总休息分数来计算总差异分数。可逆性缺血定义为差异评分总和 >= 1。在敏感性分析中，还使用单光子发射计算机断层扫描 (SPECT) 作为参考标准提供结果。基于血管的预测变量包括最大直径狭窄百分比、病变长度、冠状动脉钙评分、最大横截面钙弧、动脉粥样斑块体积百分比(PAV)、低衰减动脉粥样硬化斑块体积、正性(外部)血管重塑和“易损斑块”的主观印象。该研究使用逻辑回归模型来评估斑块指标与心肌缺血的关联。 结果在单变量分析中，所有斑块指标均与可逆性缺血相关。在调整后的逻辑模型中，只有最大直径狭窄百分比（1.26；95% 置信区间：1.15 至 1.38）仍然是独立的预测因子。以 SPECT 作为结果变量，PAV 和“易损”斑块在调整后仍然具有预测性。在中等狭窄（40％至70％）的血管中，没有任何单一指标具有临床意义的增量值。结论通过心脏CT获得的各种斑块指标通过CT灌注成像与最大狭窄百分比的关联来预测诱发性心肌缺血，但没有一个指标具有显着的增量值。以 SPECT 作为参考标准，PAV 和“易损斑块”在调整后仍然是缺血的预测因子，但单独对狭窄评估增加的预测价值很小。 (C) 2019 年，美国心脏病学会基金会。
OBJECTIVES This study sought to investigate the performance of various cardiac computed tomography (CT)-derived atherosclerotic plaque metrics for predicting provocable myocardial ischemia.BACKGROUND The association of coronary arterial diameter stenosis with myocardial ischemia is only modest, but cardiac CT provides several other, readily available atherosclerosis metrics, which may have incremental value.METHODS The study analyzed 873 nonstented coronary arteries and their myocardial perfusion territories in 356 patients (mean 62 years of age) enrolled in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) study. Myocardial perfusion defects in static CT perfusion imaging were graded at rest and after adenosine in 13 myocardial segments using a 4-point scale. The summed difference score was calculated by subtracting the summed rest score from the summed stress score. Reversible ischemia was defined as summed difference score >= 1. In a sensitivity analysis, results were also provided using single-photon emission computed tomography (SPECT) as the reference standard. Vessel based predictor variables included maximum percent diameter stenosis, lesion length, coronary calcium score, maximum cross-sectional calcium arc, percent atheroma volume (PAV), low-attenuation atheroma volume, positive (external) vascular remodeling, and subjective impression of "vulnerable plaque." The study used logistic regression models to assess the association of plaque metrics with myocardial ischemia.RESULTS In univariate analysis, all plaque metrics were associated with reversible ischemia. In the adjusted logistic model, only maximum percent diameter stenosis (1.26; 95% confidence interval: 1.15 to 1.38) remained an independent predictor. With SPECT as outcome variable, PAV and "vulnerable" plaque remained predictive after adjustment. In vessels with intermediate stenosis (40% to 70%), no single metric had clinically meaningful incremental value.CONCLUSIONS Various plaque metrics obtained by cardiac CT predict provocable myocardial ischemia by CT perfusion imaging through their association with maximum percent stenosis, while none had significant incremental value. With SPECT as reference standard, PAV and "vulnerable plaque" remained predictors of ischemia after adjustment but the predictive value added to stenosis assessment alone was small. (C) 2019 by the American College of Cardiology Foundation.