Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia
Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia
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DOI：
10.1016/j.jcmg.2021.02.026
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发表时间：
2021-08-02
影响因子：
14
通讯作者：
Knaapen, Paul
中科院分区：
文献类型：
--
作者：
van Diemen, Pepijn A.;Bom, Michiel J.;Knaapen, Paul
目的：本研究旨在评估冠状动脉周围脂肪组织计算机断层扫描衰减（PCATa）在定量冠状动脉计算机断层扫描血管造影（CCTA）衍生斑块体积和正电子发射断层扫描（PET）确定缺血的预后价值。炎症在动脉粥样硬化中起着至关重要的作用。PCATa已被证明可评估冠状动脉特异性炎症，并对疑似冠状动脉疾病（CAD）患者具有预后价值。方法539例疑似冠心病行CCTA和[O-15]H2O PET灌注显像的患者。影像学评估包括冠状动脉钙化评分（CACS）、阻塞性CAD（50%狭窄）和高危斑块（HRPs）的存在、斑块总体积（TPV）、钙化/非钙化斑块体积（CPV/NCPV）、PCATa和心肌缺血。终点是死亡和非致死性心肌梗死的复合终点。确定定量CCTA变量的预后阈值。结果：在中位随访5.0年（四分位数间距：4.7至5.0）期间，发生了33例事件。> 59 Agatston机电单位,阻塞性CAD、合,冠捷> 220毫米(3),CPV > 110毫米(3),NCPV > 85毫米(3),和心肌缺血与短时间的端点未经调整的风险比率(小时)为4.17(95%可信区间[CI]: 1.80 - 9.64), 4.88(95%置信区间CI: 1.88 - 12.65), 3.41(95%置信区间CI: 1.72 - 6.75), 7.91(95%置信区间CI: 3.05 - 20.49), 5.82(95%置信区间CI: 2.40 - 14.10), 8.07(95%置信区间CI: 3.33 - 19.55),和4.25(95%置信区间CI: 1.84 - 9.78),分别(p < 0.05)。右冠状动脉（RCA） PCATa高于扫描仪特定阈值与较差的预后相关（未经调整的HR: 2.84; 95% CI: 1.44至5.63;p = 0.003），而左前降支和旋支PCATa与预后无关。保留高于扫描仪特定阈值的RCA PCATa是根据影像学变量和与终点相关的临床特征调整后的预后价值（调整后风险比：2.45;95% CI: 1.23至4.93;p = 0.011）。结论与动脉粥样硬化负荷和缺血相关的参数与预后的相关性比RCA - PCATa更强。尽管如此，RCA - PCATa的预后价值超过了临床特征、CACS、阻塞性CAD、HRPs、TPV、CPV、NCPV和缺血。(C) 2021年由美国心脏病学会基金会发布。
OBJECTIVES This study was designed to assess the prognostic value of pericoronary adipose tissue computed tomography attenuation (PCATa) beyond quantitative coronary computed tomography angiography (CCTA)-derived plaque volume and positron emission tomography (PET) determined ischemia.BACKGROUND Inflammation plays a crucial role in atherosclerosis. PCATa has been shown to assess coronary-specific inflammation and is of prognostic value in patients with suspected coronary artery disease (CAD).METHODS A total of 539 patients who underwent CCTA and [O-15]H2O PET perfusion imaging because of suspected CAD were included. Imaging assessment included coronary artery calcium score (CACS), presence of obstructive CAD ($50% stenosis) and high-risk plaques (HRPs), total plaque volume (TPV), calcified/noncalcified plaque volume (CPV/NCPV), PCATa, and myocardial ischemia. The endpoint was a composite of death and nonfatal myocardial infarction. Prognostic thresholds were determined for quantitative CCTA variables.RESULTS During a median follow-up of 5.0 (interquartile range: 4.7 to 5.0) years, 33 events occurred. CACS >59 Agatston units, obstructive CAD, HRPs, TPV > 220 mm(3), CPV >110 mm(3), NCPV >85 mm(3), and myocardial ischemia were associated with shorter time to the endpoint with unadjusted hazard ratios (HRs) of 4.17 (95% confidence interval [CI]: 1.80 to 9.64), 4.88 (95% CI: 1.88 to 12.65), 3.41 (95% CI: 1.72 to 6.75), 7.91 (95% CI: 3.05 to 20.49), 5.82 (95% CI: 2.40 to 14.10), 8.07 (95% CI: 3.33 to 19.55), and 4.25 (95% CI: 1.84 to 9.78), respectively (p < 0.05 for all). Right coronary artery (RCA) PCATa above scanner specific thresholds was associated with worse prognosis (unadjusted HR: 2.84; 95% CI: 1.44 to 5.63; p = 0.003), whereas left anterior descending artery and circumflex artery PCATa were not related to outcome. RCA PCATa above scanner specific thresholds retained is prognostic value adjusted for imaging variables and clinical characteristics associated with the endpoint (adjusted HR: 2.45; 95% CI: 1.23 to 4.93; p = 0.011).CONCLUSIONS Parameters associated with atherosclerotic burden and ischemia were more strongly associated with outcome than RCA PCATa. Nonetheless, RCA PCATa was of prognostic value beyond clinical characteristics, CACS, obstructive CAD, HRPs, TPV, CPV, NCPV, and ischemia. (C) 2021 by the American College of Cardiology Foundation.