The feasibility and limitation of coronary computed tomographic angiography imaging to identify coronary lipid-rich atheroma in vivo: Findings from near-infrared spectroscopy analysis
The feasibility and limitation of coronary computed tomographic angiography imaging to identify coronary lipid-rich atheroma in vivo: Findings from near-infrared spectroscopy analysis
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DOI：
10.1016/j.atherosclerosis.2021.02.019
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发表时间：
2021-03-08
期刊：
影响因子：
5.3
通讯作者：
Yasuda, Satoshi
中科院分区：
文献类型：
--
作者：
Kitahara, Satoshi;Kataoka, Yu;Yasuda, Satoshi
背景：冠状动脉计算机断层扫描血管造影术（CCTA）无创显示富脂斑块。然而，这种能力并没有在体内得到充分验证。方法：对35例冠心病患者95处冠状动脉病变（罪犯/非罪犯= 51/44）进行CCTA和近红外光谱（NIRS）成像。由两名独立的医生分析CT密度、阳性重构、点状钙化、纳金环征和NIRS衍生的最大4 mm脂质核心负荷指数（maxLCBI 4 mm）。结果：CT密度中位数为57.7 Hounsfield单位（HU），最大LCBI 4 mm为304。CT密度（r =-0.75，p < 0.001）和重构指数（r = 0.58，p < 0.001）分别与maxLCBI 4 mm显著相关。尽管napkin-ring征（p < 0.001）显示maxLCBI 4 mm> 400的患病率高于无napkin-ring征的患者，但斑点状钙化的患病率并不高（p = 0.13）。多变量分析显示，CT密度[比值比（OR）= 0.95，95%可信区间（CI）= 0.93？0.97; p < 0.001]和正性重塑[OR = 7.71，95%CI = 1.37？43.41，p = 0.02]独立预测的maxLCBI 4 mm> 400。受试者工作特征曲线分析表明，CT密度1.08（AUC = 0.83，灵敏度= 74.3%，特异性= 85.0%）是maxLCBI 4 mm> 400的最佳截止值。值得注意的是，只有52.6%的病变具有这些斑块特征之一表现出maxLCBI 4 mm> 400，而maxLCBI 4 mm> 400的频率在具有两种特征的病变中最高（88.5%，趋势p < 0.001）。我们的研究结果强调了CT密度和正性重构在CCTA检测富脂斑块中的协同价值。
Background: Coronary computed tomography angiography (CCTA) non-invasively visualizes lipid-rich plaque. However, this ability is not fully validated in vivo. The current study aimed to elucidate the association of CCTA features with near-infrared spectroscopy-derived lipidic plaque measure in patients with coronary artery disease.Methods: 95 coronary lesions (culprit/non-culprit = 51/44) in 35 CAD subjects were evaluated by CCTA and NIRS imaging. CT density, positive remodeling, spotty calcification, napkin-ring sign and NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI4mm) were analyzed by two independent physicians. The association of CCTA-derived plaque features with maxLCBI4mm > 400 was evaluated.Results: The median CT density and maxLCBI4mm were 57.7 Hounsfield units (HU) and 304, respectively. CT density (r = -0.75, p < 0.001) and remodeling index (RI) (r = 0.58, p < 0.001) were significantly associated with maxLCBI4mm, respectively. Although napkin-ring sign (p < 0.001) showed higher prevalence of maxLCBI4mm > 400 than those without it, spotty calcification did not (p = 0.13). On multivariable analysis, CT density [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.93?0.97; p < 0.001] and positive remodeling [OR = 7.71, 95%CI = 1.37?43.41, p = 0.02] independently predicted maxLCBI4mm > 400. Receiver operating characteristic curve analysis demonstrated CT density 1.08 (AUC = 0.83, sensitivity = 74.3%, specificity = 85.0%) as optimal cut-off values of maxLCBI4mm > 400. Of note, only 52.6% at lesions with one of these plaque features exhibited maxLCBI4mm > 400, whereas the frequency of maxLCBI4mm > 400 was highest at those with both features (88.5%, p < 0.001 for trend).Conclusions: CT density 1.08 were associated with lipid-rich plaque on NIRS imaging. Our findings underscore the synergistic value of CT density and positive remodeling to detect lipid-rich plaque by CCTA.