CT血流储备分数联合斑块特征预测冠心病患者发生主要不良心脏事件的价值  

Value of fractional flow reserve derived from coronary CT angiography combined with plaque features in predicting major adverse cardiac events in patients with coronary heart disease

作　　者：尹小花 徐荣 李春晨 黄茂盛 梁凯轶 YIN Xiaohua;XU Rong;LI Chunchen;HUANG Maosheng;LIANG Kaiyi(Department of Radiology,Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 201800,China;Department of Ultrasound,Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 201800,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院放射影像科,上海201800 [2]上海健康医学院附属嘉定区中心医院超声影像科,上海201800

出　　处：《中国中西医结合影像学杂志》2024年第6期647-653,共7页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：上海市嘉定区科学技术委员会科研项目(JDKW-2020-0022);上海市卫生健康委员会科研项目(201940315);上海市嘉定区卫生健康委员会科研项目(2021-KY-02);上海市嘉定区医学重点专科项目(2020-jdyxzdzk-02);上海市卫健委智慧影像重点实验室。

摘　　要：目的:探讨基于冠状动脉CTA(CCTA)的冠状动脉(冠脉)斑块特征、狭窄程度和CT血流储备分数(FFR_(CT))预测冠状动脉粥样硬化性心脏病(冠心病)患者发生主要不良心脏事件(MACE)的价值。方法:对339例轻中度冠脉狭窄的冠心病患者行CCTA检查,计算综合CCTA评分,分析狭窄血管段的FFR_(CT)值及高危斑块特征,随访MACE发生情况。建立预测MACE发生的模型:模型1,基于综合CCTA评分危险分级;模型2,基于综合CCTA评分危险分级联合高危斑块危险分级;模型3,基于综合CCTA评分危险分级、高危斑块危险分级、FFR_(CT)危险分级三者联合。绘制ROC曲线评估3个模型对MACE的预测效能。结果:随访期间,87例发生MACE。综合CCTA评分危险分级、高危斑块危险分级、FFR_(CT)危险分级预测MACE发病风险的HR值分别为25.17、15.52、22.08,高于各临床危险因素。模型3预测MACE的AUC为0.801,大于模型1和模型2(均P<0.05)。结论:CCTA可从管壁斑块特征、管腔狭窄程度及血流动力学多方面评估冠脉,对冠心病患者MACE的发生具有良好的预测价值,联合高危斑块特征、FFR_(CT)能进一步提高对MACE的预测效能。Objective:To investigate the predictive value of coronary artery plaque features,lumen stenosis and fractional flow reserve derived from coronary CT angiography(FFR_(CT))for major adverse cardiac events(MACE)in patients with coronary heart disease.Methods:A total of 339 patients with mild-moderate coronary stenosis were examined by coronary CTA(CCTA).According to the plaque location and degree of stenosis,the comprehensive CCTA score was calculated and graded,the FFR_(CT)value and high-risk plaque features were analyzed.The occurrence of MACE was monitored.Three models for predicting MACE were established,Model 1 based on CCTA score risk classification,Model 2 based on CCTA score and high-risk plaque feature risk classification,Model 3 based on CCTA score,high-risk plaque features and FFR_(CT)risk classifications.The predictive efficacy of the three models for MACE was compared with ROC curve analysis.Results:By the end of follow-up,87 MACE cases were identified.The HR values of the CCTA score,high-risk plaque and FFR_(CT)risk classifications for predicting the risks of MACE were 25.17,15.52 and 22.08,respectively,and higher than the clinical risk factors.AUC of Model 3 in the prediction for MACE was 0.801,superior to Model 1 and Model 2(both P<0.05).Conclusions:CCTA can evaluate the coronary artery from the aspects of plaque features,degree of vascular stenosis and hemodynamics with high predictive value for the occurrence of MACE.The combination of CCTA and high-risk plaque features,FFR_(CT)can further improve the predictive efficacy for MACE.

关 键 词：冠状动脉血管造影术 动脉粥样硬化斑块 主要不良心脏事件 血流储备分数 高危斑块 体层摄影术 X线计算机 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]