CT-Based Coronary Plaque Feature Detection for Predicting Myocardial Ischemia

基于 CT 的冠状动脉斑块特征检测预测心肌缺血

• 批准号: 8091166
• 负责人: Victor Cheng
• 金额: $ 17.11万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-18 至 2012-02-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8091166
• 关键词: Adenosine; Affect; Angiography; Angioplasty; Appearance; Arterial Fatty Streak; Blood flow; Bypass; Calcium; Caliber; Catheters; Cells; Cholesterol; Chronic; Clinical; Clinical Research; Computer-Assisted Image Analysis; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Diagnosis; Diagnostic tests; Disabled Persons; Drops; Exhibits; Functional disorder; Future; Image; Injury; Ischemia; Link; Lipids; Liquid substance; Measurable; Measurement; Measures; Myocardial; Myocardial Ischemia; Myocardial perfusion; Myocardium; Names; Necrosis; Operative Surgical Procedures; Patients; Performance; Pharmaceutical Preparations; Population; Positron; Positron-Emission Tomography; Process; Radioisotopes; Radionuclide Imaging; Recommendation; Recruitment Activity; Research; Rest; Risk; Rubidium; Rupture; Scanning; Severities; Signal Transduction; Smoking; Stenosis; Stress; Techniques; Testing; Time; Vasodilation; Vasodilator Agents; Work; attenuation; base; cohort; handicapping condition; heart imaging; improved; in vivo; non-diabetic; novel; pressure; prospective; response

DESCRIPTION (provided by applicant): Doctors often rely on two pieces of diagnostic testing information when making recommendations regarding angioplasty or surgical bypass to treat coronary artery blockage: How severely a coronary artery is narrowed by plaque (plaque is a build-up of cells, cholesterol, and debris), and how much reduction in blood flow to the heart muscle ("myocardial hypoperfusion") is caused by this narrowing.1 There is evidence showing that even severely blocked coronary arteries frequently do not produce significant myocardial hypoperfusion,2 indicating that processes other than blockage severity are at work. One possible contributing process handicaps the normal ability of the coronary artery to dilate in response to blood flow. Triggers for this process also create certain changes in plaque appearance (termed "adverse features") visible on coronary computed tomographic angiography (CCTA)3-11 - a noninvasive, low-risk test that directly images coronary arterial plaque. The objective of this project is to evaluate whether finding adverse features in plaques causing severe blockage increases the patient's chances of having significant myocardial hypoperfusion. Our hypothesis is that finding any adverse plaque feature by CCTA will predict greater myocardial hypoperfusion. We will study 56 non-diabetic patients who have just been diagnosed with severe coronary artery blockage on CCTA and will be proceeding to catheter-based coronary angiography for possible angioplasty. Plaque findings on CCTA will separate the population into 2 groups: 28 will show no adverse features, and 28 will show at least 1 adverse feature. Prior to catheter-based angiography, each patient will undergo heart imaging with positron-emission tomography to measure blood flow to the heart muscle supplied by the affected coronary artery at rest and during medication-induced "stress". At the time of catheter-based angiography, each patient will undergo direct measurement of fluid pressure drop caused by the plaque. Positron-emission tomography results and pressure drop measurements will be compared between the 2 patient groups to determine the relationship between presence of adverse features and myocardial hypoperfusion. Performance of this project is intended to expand the current understanding of how to identify important coronary artery blockages, explore why certain plaques cause more myocardial hypoperfusion than others, and improve both clinical and research use of CCTA. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE (RELEVANCE) In the treatment of severe chronic coronary artery disease, the greatest benefit for angioplasty and surgical bypass are in patients whose atherosclerotic plaque build-up causes significant limitation of blood flow to the heart muscle. Although reduced blood flow is often assumed when coronary artery blockage is severe, many severe blockages do not actually cause demonstrable blood flow limitation, and the reason is not known. One potential explanation is the amount of damage to the arterial wall, which can handicap the coronary artery's ability to maintain blood flow. This project will evaluate whether certain changes in plaque appearance related to arterial wall injury, as detected by a noninvasive and safe coronary artery scan, enhance the identification of coronary artery blockages that cause significant reduction in blood flow. Improving our understanding of this relationship will help direct future efforts in researching mechanisms that cause reduced blood flow to the heart muscle and increase the efficiency of diagnostic testing for patients with coronary artery disease.

描述（由申请人提供）：医生在提出关于血管成形术或外科搭桥术治疗冠状动脉阻塞的建议时，通常依赖两条诊断测试信息：冠状动脉因斑块而变窄的严重程度（斑块是细胞、胆固醇和碎片的堆积），以及流向心肌的血流量减少了多少（“心肌灌注不足”）是由这种狭窄引起的。1有证据表明，即使是严重阻塞的冠状动脉通常也不会产生明显的心肌灌注不足，2表示除堵塞严重程度之外的过程正在起作用。一个可能的作用过程阻碍了冠状动脉响应血流而扩张的正常能力。这个过程的触发因素也会导致冠状动脉计算机断层扫描血管造影（CCTA）3-11上可见的斑块外观发生某些变化（称为“不良特征”）-这是一种直接对冠状动脉斑块进行成像的无创、低风险测试。本项目的目的是评估在斑块中发现导致严重阻塞的不良特征是否会增加患者发生显著心肌灌注不足的机会。我们的假设是，发现任何不利的斑块特征CCTA将预测更大的心肌灌注不足。我们将研究56名非糖尿病患者，他们刚刚在CCTA上被诊断为严重冠状动脉阻塞，并将继续进行基于导管的冠状动脉造影术，以进行可能的血管成形术。CCTA上的斑块结果将人群分为2组：28例未显示不良特征，28例至少显示1个不良特征。在基于导管的血管造影术之前，每个患者将接受正电子发射断层扫描的心脏成像，以测量静息时和药物诱导的“应激”期间受影响的冠状动脉向心肌供应的血流量。在基于导管的血管造影术时，每名患者将接受由斑块引起的流体压降的直接测量。将比较2个患者组的正电子发射断层扫描结果和压降测量值，以确定不良特征的存在与心肌灌注不足之间的关系。该项目的实施旨在扩大目前对如何识别重要冠状动脉阻塞的理解，探索为什么某些斑块比其他斑块导致更多的心肌灌注不足，并改善CCTA的临床和研究使用。 公共卫生相关性：在严重慢性冠状动脉疾病的治疗中，血管成形术和外科搭桥术的最大受益者是动脉粥样硬化斑块积聚导致流向心肌的血流明显受限的患者。虽然当冠状动脉阻塞严重时，通常假设血流减少，但许多严重阻塞实际上并不引起明显的血流限制，原因尚不清楚。一个可能的解释是动脉壁的损伤程度，这会阻碍冠状动脉维持血流的能力。该项目将评估通过无创和安全的冠状动脉扫描检测到的与动脉壁损伤相关的斑块外观的某些变化是否增强了对导致血流量显著减少的冠状动脉阻塞的识别。提高我们对这种关系的理解将有助于指导未来研究导致心肌血流量减少的机制，并提高冠状动脉疾病患者诊断测试的效率。

项目成果

Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses.

• DOI: 10.1016/j.atherosclerosis.2011.07.128
• 发表时间: 2011-12
• 期刊: ATHEROSCLEROSIS
• 影响因子: 5.3
• 作者: Shmilovich, Haim;Cheng, Victor Y.;Tamarappoo, Balaji K.;Dey, Damini;Nakazato, Ryo;Gransar, Heidi;Thomson, Louise E. J.;Hayes, Sean W.;Friedman, John D.;Germano, Guido;Slomka, Piotr J.;Berman, Daniel S.
• 通讯作者: Berman, Daniel S.