冠状动脉异常起源于对侧主动脉窦的CT-FFR风险评估及预后评价  

Assessment of CT-FFR risk and prognosis of coronary artery anomalies originating from the contralateral aortic sinus

作　　者：冯月 魏榕辰 张晓洁 李月戈 孙春晶 何亚清 程汉琪 武柏林[1] FENG Yue;WEI Rong-chen;ZHANG Xiao-jie(Department of Medical Imaging,the Second Hospital of Hebei Medical University,Shijiazhuang 050061,China)

机构地区：[1]河北医科大学第二医院放射科,石家庄050061

出　　处：《放射学实践》2025年第3期349-355,共7页Radiologic Practice

基　　金：河北省卫生和健康委员会医学科学研究课题计划(20221053)。

摘　　要：目的:分析冠状动脉异常起源于对侧主动脉窦(ACAOS)的CT血管造影血流储备分数(CT-FFR)及解剖特征,评估其在ACAOS初诊患者预后评估中的价值,帮助筛选高危患者。方法:回顾性分析2020年2月-2023年2月所有于本中心接受冠状动脉CTA检查的患者,从中连续性纳入ACAOS初诊患者,测算CT-FFR值并分析开口角度等解剖特征,根据CT-FFR值是否>0.80将患者分为正常值组和异常值组,并于此后的3年内对患者进行重大心血管不良事件的临床追踪。将终点事件定义为因心血管事件导致的再入院。对于两组间分类变量资料采用卡方检验进行组间比较。采用Kaplan-Meier法及Log-rank检验比较不同CT-FFR值ACAOS患者再入院的累计危险概率。采用多因素Cox比例回归模型对ACAOS患者再入院风险进行分析,评估CT-FFR及有意义解剖因素与ACAOS预后的关联。结果:最终共纳入ACAOS患者92例,占总筛查人数的0.39%。年龄为22~82岁,平均55.8±11.9岁,CT-FFR正常组63例和异常组29例(31.52%)。CT-FFR正常组和异常组终点事件发生率分别为11.1%、55.2%。Logistic回归分析结果提示左冠状动脉起自右冠窦、起始段狭窄≥50%、大动脉间走行等解剖特征使得病变血管的CT-FFR≤0.80的风险显著增加。Kaplan-Meier曲线显示两组生存曲线有显著性差异,Cox比例回归模型在临床特征和解剖特征中仅筛选出CT-FFR≤0.80可预示较高的重点事件发生率,为心血管事件再入院的独立危险因素。结论:左冠状动脉起自右冠窦、起始段狭窄≥50%、走行与大动脉间的ACAOS患者更容易发生血流动力学异常。ACAOS伴有CT-FFR值≤0.80是患者3年内因心血管事件再次入院的独立危险因素。应对相应高危患者给予更积极的临床随诊和干预。Objective:To analyze the CT fractional flow reserve(CT-FFR)and anatomical characteristics of coronary artery anomalies originating from the contralateral aortic sinus(ACAOS),and further to assess their value in the prognostic assessment of patients with primary diagnosis of ACAOS,and aim to help screen high-risk patients.Methods:A retrospective search was performed for all patients who underwent coronary CTA at our center from February 2020 to February 2023.Consecutive patients with a primary diagnosis of ACAOS were enrolled.CT-FFR values were measured and anatomical features such as opening angle were analyzed.Patients were classified into normal-value and abnormal-value groups according to whether the CT-FFR value was greater than 0.8,and were clinically followed up in the following 3 years for major cardiovascular Adverse events.The endpoint event was defined as readmission due to a cardiovascular event.For comparisons of categorical variable data between two groups the chi-square test was used.The Kaplan-Meier method and Log-rank test were used to compare the cumulative hazard probability of readmission in ACAOS patients with different CT-FFR values.The risk of readmission in ACAOS patients was analyzed using Cox multivariate analysis to assess the association of CT-FFR and meaningful anatomical factors with the prognosis of ACAOS.Results:A total of 92 patients from 22~82 years with a mean of 55.8±11.9 years with ACAOS were finally included,representing 0.39%of the total screening population.There were 63 cases in the normal CT-FFR group and 29 cases in the abnormal group(31.52%).The incidence of endpoint events in the normal CT-FFR group and the abnormal group were 11.1%and 55.2%,respectively.The results of logistic regression analysis suggested that the left coronary artery originated from the right coronary sinus,the stenosis of the origin segment was≥50%,and the intercortical travel between the large arteries made the risk of CT-FFR≤0.8 in diseased vessels significantly higher.Kaplan-Meier curves sho

关 键 词：冠状动脉异常起源 体层摄影术 X-线计算机 血流储备分数 预后 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.3[医药卫生—放射医学]