基于冠状动脉CT血管成像的斑块进展参数在预测非阻塞性冠心病预后中的价值  

The value of coronary artery plaque progression parameters based on coronary CT angiography in predicting prognosis of non-obstructive coronary artery disease

作　　者：陈瑞 贾涵 冯长静 董思廷 刘王琰 林澍莘 朱晓梅[1] 徐怡[1] 祝因苏 Chen Rui;Jia Han;Feng Changjing;Dong Siting;Liu Wangyan;Lin Shushen;Zhu Xiaomei;Xu Yi;Zhu Yinsu(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,the Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210021,China;Department of Diagnostic Imaging of Siemens Healthineers,Shanghai 201318,China;Department of Radiology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,Nanjing Medical University Affiliated Cancer Hospital,Nanjing 210009,China)

机构地区：[1]南京医科大学第一附属医院放射科,南京210029 [2]首都医科大学附属北京朝阳医院放射科,北京100020 [3]南京医科大学附属明基医院放射科,南京210021 [4]西门子医疗系统有限公司影像诊断部,上海201318 [5]南京医科大学附属肿瘤医院,江苏省肿瘤医院,江苏省肿瘤防治研究所影像中心,南京210009

出　　处：《中华放射学杂志》2024年第12期1408-1416,共9页Chinese Journal of Radiology

基　　金：江苏省研究生实践创新计划(JX12313977)。

摘　　要：目的探讨基于冠状动脉CT血管成像(CCTA)斑块进展参数在预测非阻塞性冠心病患者发生主要不良心血管事件(MACE)中的价值。方法纳入2010年9月至2022年12月在南京医科大学第一附属医院行CCTA检查的非阻塞性冠心病患者临床、影像资料及预后(MACE)信息。根据是否发生MACE将患者分为MACE阳性组和MACE阴性组,并比较临床资料、斑块基线及进展参数在2组之间的差异。采用单因素及多因素Cox回归分析,筛选出能有效预测患者发生MACE的影响因素。利用斑块基线参数、斑块进展参数及二者联合分别构建预测模型,采用一致性指数-时间曲线、综合判别改善指数、净重新分类指数评估模型预测效能。结果共有258例患者纳入研究,其中62例患者在随访期间发生MACE。与MACE阴性组相比,MACE阳性组患者表现出更长的病变长度,更重的狭窄率,更大的斑块总体积、钙化斑块体积、非钙化斑块体积、纤维斑块体积、总斑块负荷、脂质斑块负荷,更高的冠状动脉周围脂肪衰减指数(FAI)及狭窄率变化率(ΔDS/y),更多的冠状动脉疾病报告和数据系统分级的升级及非阻塞进展为阻塞(P均<0.05)。多因素Cox回归分析显示FAI、ΔDS/y及非阻塞进展为阻塞是MACE发生的独立预测因素。一致性指数-时间曲线结果显示,二者联合模型对非阻塞性冠心病患者发生MACE的预测效能优于斑块基线参数模型和斑块进展参数模型。结论基于CCTA的FAI和斑块进展参数在非阻塞性冠心病患者中可预测发生MACE的高风险人群,具有较好风险分层价值。Objective To explore the value of coronary artery plaque progression parameters based on coronary CT angiography(CCTA)in predicting the occurrence of major adverse cardiovascular events(MACE)in patients with non-obstructive coronary artery disease.Methods The study included clinical,imaging,and prognosis(MACE)parameters of non-obstructive coronary artery disease patients who underwent CCTA at the First Affiliated Hospital of Nanjing Medical University from September 2010 to December 2022.Patients were grouped based on the occurrence of MACE,and differences in clinical data,plaque baseline,and progression parameters between the two groups were compared.Univariate and multivariate Cox regression analyses were employed to identify factors that could effectively predict the occurrence of MACE in patients.Models were constructed using plaque baseline parameters,plaque progression parameters,and a combination of both.The concordance index-time curve,net reclassification improvement and integrated discrimination improvement were used to evaluate the risk stratification ability of the models.Results A total of 258 patients were included,of whom 62 cases experienced MACE during the follow-up period.In comparison to the MACE(-)group,patients in the MACE(+)group exhibited longer lesion length,greater degree of stenosis,larger plaque total volume,calcified plaque volume,non-calcified plaque volume,fibrous plaque volume,total plaque burden,lipid-rich plaque burden,higher peri-coronary adipose tissue attenuation index(FAI),and annual change of diameter stenosis(ΔDS/y).There were also more cases of coronary artery disease reporting and data system upgrades and non-obstructive progression to obstructive status(P<0.05).Multivariate Cox analysis revealed that FAI,ΔDS/y,and non-obstructive progression to obstructive status were independent predictors of MACE occurrence.Concordance index-time curve results indicated that the combined model had a better predictive efficacy for MACE in patients with non-obstructive coronary artery d

关 键 词：冠心病 冠状动脉CT血管成像 斑块进展 主要不良心血管事件 

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