CCTA与ICA评估冠心病患者冠状动脉斑块特征及其与心肌缺血性损伤的相关性  

Characteristics of coronary artery plaques in patients with coronary heart disease evaluated by CCTA and ICA and their correlation with myocardial ischemic injury

作　　者：杨喆[1] 叶刚[2] 王高生 YANG Zhe;YE Gang;WANG Gaosheng(Department of Emergency,The First Affiliated Hospital of USTC,Division of life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Imaging,The First Affiliated Hospital of USTC,Division of life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院·安徽省立医院急诊科,安徽合肥230001 [2]中国科学技术大学附属第一医院·安徽省立医院影像科,安徽合肥230001

出　　处：《西部医学》2023年第7期1083-1088,共6页Medical Journal of West China

摘　　要：目的 使用冠状动脉CT造影(CCTA)与侵入性冠状动脉造影(ICA)分析评估冠心病患者冠状动脉斑块特征,并探究其与冠心病患者心肌缺血性损伤的相关性。方法 选取2018年6月—2020年12月我院收治的70例临床疑似或确诊冠心病患者,患者均接受CCTA与ICA检查,比较两种检查方法诊断冠状动脉狭窄情况的差异,并根据ICA检查血流储备分数(FFR)值分为心肌缺血性损伤组(FFR<0.8,n=39)和无心肌缺血性损伤组(FFR≥0.8,n=31),比较两组CCTA检查斑块特征参数指标钙化积分、斑块总体积、钙化斑块体积、斑块负荷、重建指数和病变长度的差异,并采用Logistic回归分析CCTA斑块特征参数指标与心肌缺血性损伤的关系。结果 检出的556段冠状动脉节段中,CCTA诊断冠状动脉轻度、中度和重度狭窄分别为147段、52段和28段,ICA诊断轻度、中度和重度狭窄分别为94段、57段和54段,CCTA与ICA诊断冠状动脉狭窄一致性良好(Kappa值=0.864,P>0.05);CCTA在冠状动脉节段水平诊断冠状动脉狭窄的准确性、敏感度、特异度、阳性预测值和阴性预测值分别为93.53%(520/556)、96.59%(198/205)、91.74%(322/351)、87.22%(198/227)和97.87%(322/329);心肌缺血性损伤组患者钙化积分、斑块总体积、斑块负荷、重建指数和病变长度均明显高于无心肌缺血性损伤组患者,差异有统计学意义(P<0.05),两组患者钙化斑块体积比较,差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示,钙化积分、病变长度是影响心肌缺血性损伤的危险因素(P<0.05)。结论 CCTA能有效评估冠心病患者冠状动脉狭窄程度,分析冠状动脉斑块特征,各斑块特征参数可在一定程度上反映心肌缺血性损伤情况,钙化积分、病变长度是影响心肌缺血性损伤的危险因素,对于指导临床筛选高危患者具有重要意义。Objective To use coronary CT angiography(CCTA)and invasive coronary angiography(ICA)analyze and evaluate the characteristics of coronary artery plaques in patients with coronary heart disease and explore the correlation with myocardial ischemic injury in patients with coronary heart disease.Methods 70 patients with clinically suspected or confirmed coronary heart disease admitted to the hospital were selected from June 2018 to December 2020.The patients received CCTA and ICA.The differences in the diagnosis of coronary artery stenosis between the two examination methods were compared.According to the fractional flow reserve(FFR)value by ICA examination,the patients were divided into myocardial ischemic injury group(FFR<0.8,n=39)and non-myocardial ischemic injury group(FFR≥0.8,n=31).The CCTA examination plaque characteristic parameters of calcification score,total plaque volume,calcification plaque volume,plaque load,reconstruction index and lesion length were compared between the two groups.Logistic regression analysis was used to analyze the relationship between plaque characteristic parameters of CCTA and myocardial ischemic injury.Results Among the 556 coronary artery segments detected,CCTA diagnosed mild,moderate,and severe coronary artery stenosis at 147,52,and 28 segments respectively,and ICA diagnosed mild,moderate,and severe stenosis at 94,57 and 54 segments respectively,CCTA and ICA had good consistency in diagnosing coronary artery stenosis(Kappa value=0.864,P>0.05).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of CCTA in diagnosing coronary artery stenosis at the coronary segment level were 93.53%(520/556),96.59%(198/205),91.74%(322/351),87.22%(198/227)and 97.87%(322/329)respectively.The calcification score,total plaque volume,plaque load,reconstruction index and lesion length in myocardial ischemic injury group were significantly higher than those in non-myocardial ischemic injury group(P<0.05).There was no statistically significant difference in calcif

关 键 词：冠状动脉CT造影 侵入性冠状动脉造影 冠心病 冠状动脉粥样硬化斑块 心肌缺血性损伤 

分 类 号：R814.43[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]