冠状动脉CTA：斑块特征定量参数与血流储备分数的相关性分析

【摘要】目的：基于冠状动脉CT血管成像（CCTA）探讨斑块特征定量参数值与血流储备分数（FFRCT）测量值的相关性。方法：回顾性分析行CCTA和有创FFR检查的38例患者共50支血管的资料。测量斑块的特征参数（斑块长度、斑块总体积、钙化斑块体积、脂质斑块体积、纤维斑块体积、狭窄程度、最小管腔面积、重塑指数、偏心指数）和FFRCT值,FFRCT≤0.80定义为冠状动脉缺血特异性病变。结合冠状动脉造影和FFR确定的斑块并依据FFRCT值将其分为FFRCT＞0.80组和FFRCT≤0.80组。采用Mann-Whitney非参数检验和两独立样本t检验比较两组中斑块特征参数的差异性。结果：与FFRCT＞0.80组相比,FFRCT≤0.80组中斑块更长［（45.39±14.03） vs （32.51±12.26）mm,P=0.004］,斑块总体积［335.55(209.90,561.74) vs 206.93(147.70,262.84)mm3,P=0.008］、纤维斑块体积［263.13(112.63,436.20) vs 149.71(88.88,177.97)mm3,P=0.013］及脂质斑块体积［23.78(9.84,34.09) vs 3.06(0.89,7.64)mm3,P=0.001］更大。结论：斑块定量特征参数中斑块长度、斑块总体积、脂质斑块体积和纤维斑块体积是影响冠脉血流储备分数的主要因素。     

冠状动脉CT血管成像斑块分析联合心肌影像组学对心肌缺血的诊断价值

目的 探讨基于冠状动脉CT血管造影（CCTA）的斑块、心肌影像组学特征分别构建的模型及二者的联合模型对心肌缺血的诊断价值。资料与方法 回顾性收集2020年1月—2022年3月郑州大学第一附属医院疑似及确诊冠心病并于1周内行CCTA及SPECT-MPI检查的患者154例（心肌缺血80例，非缺血74例）。以入院时间顺序将患者按8∶2分为训练组122例及测试组32例。从CCTA图像中手动标注心肌区域并提取影像组学特征，选出最优特征构建组学模型；采用最大相关最小冗余算法筛选出最终斑块特征并构建斑块模型；将临床特征、斑块特征及筛选后的组学特征经最大相关最小冗余算法选择最佳特征子集后构建诺模图。通过受试者工作特征曲线、决策曲线判断各模型对心肌缺血的诊断性能。结果 在训练组中，与组学和斑块模型相比，联合模型在预测心肌缺血方面诊断性能显著提高[曲线下面积：0.832比0.772,Z=2.899,P=0.050（组学）；0.832比0.680,Z=1.028,P<0.001（斑块）]，在测试组中联合模型也具有较高的诊断性能，曲线下面积为0.773，敏感度为73.68%，特异度为61.54%。决策曲...     

基于CCTA对胸痛病人高危斑块成分及血流动力学特征的研究

目的 基于冠状动脉CT血管成像（CCTA）研究伴高危斑块的胸痛病人其斑块成分特征及血流动力学特征。方法 回顾性纳入行CCTA且于2个月内行有创冠状动脉造影检查的43例冠心病病人,男30例,女13例,平均年龄（60.8±8.7）岁。依据病人是否存在高危斑块及胸痛将病人分为2组,组1同时存在胸痛和至少1个高危斑块特征（23例）,组2仅有胸痛或高危斑块特征任意一项（20例）。测量斑块成分特征参数[斑块总体积、钙化斑块体积、纤维斑块体积、脂质斑块体积占比（脂质斑块%）、脂质斑块面积、最小管腔面积、偏心指数]和血流动力学特征参数[基于CCTA的血流储备分数（FFR_CT）,斑块近、远端FFR_CT差值（△FFR_CT）]。采用Mann-Whitney U检验或独立样本t检验比较2组间参数的差异。利用约登指数计算斑块成分特征及血流动力学特征判断高危斑块合并胸痛的临界值,采用受试者操作特征（ROC）曲线分析计算其临界值的敏感度、特异度以及曲线下面积（AUC）。结果 组1的脂质斑块%、脂质斑块面积均高于组2（均P<0.05）,FFR_CT值低于组2（P<0.05）,2组间其他斑块成分特征参数及△FFR_CT差异均无统计学意义（均P>0.05）。分析脂质斑块%、脂质斑块面积及FFR_CT 特征参数的诊断能力,FFR_CT的临界值为0.82时的敏感度最高（61%）、特异度最低（85%）,AUC最高（0.80）。结论 采用CCTA分析高危斑块中脂质斑块成分特征并进行FFR_CT测量,可作为评估高危斑块合并胸痛病人的有效辅助手段,为临床治疗决策提供依据。     

冠状动脉CT血管成像斑块主要成分定量分析对斑块类型的鉴别价值

【摘要】目的：探讨冠状动脉CT血管成像（CCTA）斑块定量分析技术在不稳定性心绞痛（UAP）和稳定性心绞痛（SAP）患者的易损性斑块、稳定性斑块主要成分定量中的价值。方法：回顾性连续搜集并分析41例心绞痛患者（UAP18例、SAP23例）的320排CT冠状动脉成像（CTA）和冠状动脉造影（CAG）检查结果，并将斑块分为UAP易损性斑块（Ⅰ组）、UAP稳定性斑块（Ⅱ组）和SAP稳定性斑块（Ⅲ）。三组斑块节段内脂质、纤维、钙化的体积及体积百分比差异的比较采用单因素方差分析，之后的两两比较采用LSD检验。采用受试者操作特征（ROC）曲线分析诊断易损性斑块与所有稳定性斑块较好指标的诊断阈值，并计算其对应的敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。结果：共45个斑块进行定量分析研究，Ⅰ组、Ⅱ组、Ⅲ组分别为10个、9个、26个斑块。易损性斑块与两组稳定性斑块在脂质（49.3%±4.1% vs 31.8%±6.3%、33.4%±6.9%）和钙化（2.9%±2.7% vs 13.0%±11.8%、17.2%±10.8%）百分比差异均具有统计学意义（P＜0.05），脂质百分比易损性斑块高于稳定性斑块，钙化百分比易损性斑块低于稳定性斑块。易损性斑块与UAP稳定性斑块在纤维体积（47.5±14.4 vs 74.7±37.5）差异具有统计学意义（P＜0.05）。两组稳定性斑块在脂质（31.8%±6.3% vs 33.4%±6.9%）和钙化（13.0%±11.8% vs 17.2%±10.8%）百分比上差异均无统计学意义（P＞0.05）。诊断易损性斑块各项指标中，脂质百分比的ROC曲线下面积（AUC）较高，为0.994，其对应的脂质体积AUC为0.811，基于脂质百分比ROC曲线判断易损性斑块与稳定性斑块的分界点为44.1%，其对应的敏感度、特异度、PPV和NPV分别为100%、88.5%、71.4%、100%。此外，纤维体积和纤维百分比、钙化体积和钙化百分比仅有低或无诊断价值。结论：CCTA斑块定量分析技术可测量冠状动脉斑块主要成分，为临床提供鉴别斑块类型的依据。     

多层螺旋CT对心外膜脂肪组织体积与冠状动脉粥样硬化相关性的研究

目的 探讨CT测量心外膜脂肪组织(epicardial adipose tissue,EAT)体积与冠状动脉粥样硬化的关系.资料与方法 605例临床怀疑冠心病(579例)及冠状动脉支架术后患者(26例)行双源CT冠状动脉造影检查,其中男333例,女272例,年龄22～87岁,平均(60.1±12.5)岁.利用工作站软件测量每例心脏EAT体积,同时观察冠状动脉是否发生病变、病变程度(包括冠状动脉病变支数、钙化积分程度、冠状动脉狭窄程度)、斑块性质(分为无斑、软斑、钙斑、混斑)、有无壁冠状动脉,记录体重指数(body mass index,BMI)及有先相关疾病(如高血压、高血脂、高血糖等),分析EAT体积与BMI及冠状动脉病变的相关性.结果 EAT体积与BMI呈正相关(r,=0.504,P＜0.001).所有病例总体分析,有、无粥样硬化两组EAT体积差异有统计学意义,无病变组低于有病变组(Z=-4.839,P＜0.001).患相关疾病者中有、无粥样硬化两组EAT体积的差异有统计学意义,无冠状动脉病变组低于有冠状动脉病变组(Z=-2.885,P=0.004).分别对BMI＜ 24、≥24及＜30的病例按有、无粥样硬化分组比较EAT体积差异,均显示EAT体积无病变组低于有病变组(Z=-3.714,P＜0.001;Z=-3.53,P＜0.001;Z=-4.871,P.＜0.001);但BMI ≥30的28例中,冠状动脉有、无病变组EAT体积差异却无统计学意义(Z=-0.024,P=1).进一步对BMI＜ 30的病例行冠状动脉患病风险评估计算得出,EAT体积＞147.13 mm3则患病风险高;EAT体积与冠状动脉病变严重程度的相关性分析显示,EAT体积与右冠状动脉、左主干、左前降及左旋支的狭窄程度均无相关.EAT体积与钙化积分程度呈正相关(r,=0.146,P＜0.001).EAT体积与冠状动脉粥样硬化支数呈正相关(r,=0.209,P＜0.001).不同性质斑块心外膜脂肪量不同(x2=21.288,P＜0.001);进一步两两比较,无斑块组低于软斑组(P =0.002);无斑块组低于混斑组(P＜0.001);其他无差别.分别对有、无粥样硬化病例按是否出现壁冠状动脉分组,分析两组间EAT体积差异,结果显示无论有无粥样硬化,有、无壁冠状动脉两组心外膜脂肪量差异均无统计学意义(Z=-1.022,P=0.307;Z=-0.267,P=0.79).结论 CT测量EAT体积与BMI呈正相关;对于非肥胖者,EAT体积是冠状动脉粥样硬化发病危险性的独立预测指标,EAT体积＞147.13 mm3者,出现冠状动脉粥样硬化可能性大;EAT体积与冠状动脉病变支数及钙化积分呈正相关,与冠状动脉狭窄程度无相关;带有软斑(包括软斑及混斑)患者EAT体积较大;EAT体积与是否出现壁冠状动脉无关.     

冠状动脉CTA多参数AI特征对急性冠脉综合征的诊断价值

目的:基于冠状动脉CTA(CCTA)探讨通过人工智能技术获取罪犯斑块多参数特征对急性冠脉综合征(ACS)的诊断价值。方法:本研究共纳入65名ACS患者,根据侵入性冠脉造影(ICA)结果将斑块分为罪犯斑块组(n=65)和非罪犯斑块组(n=67),利用CCTA对冠脉血管进行分析,通过人工智能软件获得冠脉周围脂肪衰减指数(FAI)、基于CCTA血流储备分数(FFRct)及斑块定量参数,比较罪犯斑块与非罪犯斑块的差异性及罪犯斑块的影响因素。同时根据罪犯斑块组中的FFRct值进行分组,分为FFRct>0.8组(n=28),FFRct≤0.8组(n=37),比较其FFRct与斑块定量参数的相关性。结果:罪犯斑块与非罪犯斑块在FAI、FFRct、最狭窄处管腔面积(MLA)、重构指数(RI)及钙化斑块负荷存在差异性(P均<0.05)。FAI、FFRct、RI、MLA是罪犯斑块的主要影响因素(P值分别为0.002、0.002、0.004、0.025),FAI、FFRct、MLA、RI及4个指标联合诊断模型诊断罪犯斑块的ROC曲线显示,联合诊断模型的曲线下面积最大(AUC=0.792),提示其...     

64排CT冠状动脉成像评估糖尿病患者斑块量化特征

目的 :探讨糖尿病和无糖尿病冠心病患者64排CT冠状动脉成像(CCTA)斑块量化特征的区别。方法:拟诊冠心病行64排CCTA检查且证实有斑块者315例,比较糖尿病组103例和非糖尿病组212例的冠状动脉粥样硬化斑块的最大横截面积、体积、斑块负荷、重构指数和厚度长度比及CT值。结果:糖尿病组体质量指数高于非糖尿病组(P0.05)。2组年龄、性别、吸烟情况、血压、血脂情况均无明显差异。糖尿病组斑块的最大横截面积(平均6.22 mm2)、体积(平均25.34 mm3)、斑块负荷(平均48.55%)、重构指数(平均1.37)、厚度长度比(平均0.37)、钙化斑块比例(38.57%)、混合斑块比例(34.29%)均显著高于非糖尿病组(分别为4.81 mm2、12.60 mm3、32.43%、1.11、0.23、28.34%、23.53%),非钙化斑块比例(27.14%)低于非糖尿病组(48.13%)(均P0.05)。结论:64排CT能够有效测量斑块,糖尿病患者的斑块体积、面积、斑块负荷、重构指数、厚度长度比均显著大于非糖尿病患者。与非糖尿病者相比,糖尿病组钙化斑块及混合性斑块比例更高,非钙化斑块比例较低。     

应用冠状动脉CTA影像迭代重建算法提高脂质核心斑块的检出率——与组织学对比研究

摘要目的与组织学对比,评估迭代重建算法是否能提高冠状动脉CT血管成像(CCTA)检出脂质核心斑块(LCP)的准确性。材料与方法从3个体外心脏中获得CCTA和组     

冠状动脉周围脂肪密度指数与代谢综合征组分及斑块参数关系分析

目的 探讨冠状动脉斑块周围脂肪密度指数(FAI)与代谢综合征(MS)相关组分及斑块参数间的关系。方法 回顾性搜集2020年1月至12月连云港市第一人民医院147例因胸痛或胸部不适行冠状动脉CT造影(CCTA)患者的资料，其中男100例，女47例，年龄27～88岁，平均(62.08±10.78)岁，所有患者均接受CCTA及一个月内的冠状动脉数字减影血管造影(DSA)检查。定量资料测量包括斑块周围FAI、钙化积分、心外膜脂肪组织(ECAT)密度及体积，定性资料测量包括斑块类型、血管分布、狭窄程度等。根据MS诊断指南搜集患者相关临床指标(如血糖、血脂、身高、体重等)。以斑块周围FAI值是否≥-70 HU,将患者和斑块分为FAI阳性组(52例)与FAI阴性组(95例),分析比较两组间年龄、性别、斑块性质、血管分布、狭窄程度、MS相关组分等指标之间的关系。结果 FAI阴性组在MS组分个数之间无统计学差异(F值=1.354,P值=0.256),FAI阳性组在MS组分个数间有统计学差异(F值=5.049,P值=0.002)。FAI阳性组及FAI阴性组在斑块类型有统计学差异(χ²...     

CT-心肌灌注成像联合多层螺旋CT冠状动脉成像对冠状动脉粥样硬化性心脏病患者心肌缺血的诊断价值

多层螺旋CT冠状动脉成像(CCTA)属于临床常用冠状动脉粥样硬化性心脏病(冠心病)早期诊断方式,能够对患者冠状动脉狭窄情况进行有效评估,而且诊断准确率较高,但是单纯CCTA技术在心肌缺血预测及评价方面存在一定的局限性[1]。冠心病患者合并冠状动脉狭窄会加大血流动力学紊乱风险并表现出血管重构等表现,因此,了解冠心病患者斑块性质、冠状动脉狭窄状况以及冠状动脉病变对心肌血流灌注情况造成的影响有助于提高诊断准确率并可为临床对患者实际病情以及预后进行准确评估提供依据[2]。此次研究以冠心病心肌缺血患者85例为研究对象,纳入患者自2018年6月至2019年5月接受诊疗,探讨为患者实施CT-心肌灌注成像(CT-MPI)与CCTA联合检测的价值,报告如下。     

双源CT锐利卷积核重建诊断钙化性冠状动脉狭窄的价值

目的 探讨双源CT上锐利卷积核重建图像对于钙化性冠状动脉狭窄的诊断价值.方法 收集42例临床怀疑冠心病的患者分别行双源CT冠状动脉CT血管成像(CCTA)及冠状动脉造影(CAG)检查.将CCTA图像分别行锐利卷积核(I46f)重建和平滑卷积核(I26f)重建,比较2组图像的噪声、信噪比(SNR)及对比噪声比(CNR),并对钙化斑块显影情况评分;以上述患者的56处因钙化造成的血管狭窄作为研究对象,以CAG结果为金标准,描画2组重建图像在中度狭窄(≥50%)和重度狭窄(≥75%)时的受试者工作特征(ROC)曲线,分别得出相应的敏感性、特异性和最佳阈值.结果 I46f组图像噪声高[I46f:(45.43±9.00) HU;I26f:(31.43±5.55) HU;t=-8.58,P=0.000]、SNR低[I46f:(10.26±2.09) HU;I26f:(14.86±3.53) HU;t=7.28,P=0.000]、CNR低[I46f:(14.04±4.51) HU;I26f:(20.80±7.18) HU;t=5.17,P=0.000],但其钙化斑块显影评分高[I46f:(2.33±0.75)分;I26f:(1.64±0.70)分,Z=-4.61,P=0.000].中度狭窄(≥50%)时,I46f组曲线下面积(0.946)优于I26f组(0.935);此时以I46f重建图像来诊断,最佳阈值为55%,特异性为95.0%,敏感性为88.9%;以I26f来诊断,最佳阈值为65%,特异性为90%,敏感性为88.9%.重度狭窄(≥75%)时,I46f组的曲线下面积(0.927)优于I26f组(0.924);此时以I46f重建图像来诊断,最佳阈值为77.5%,特异性为79.1%,敏感性为92.3%;以I26f来诊断,最佳阈值为85%,特异性为74.4%,敏感性为100%.结论 双源CT上I46f重建图像较常规I26f重建图像在诊断钙化性冠状动脉狭窄时有一定优势,是诊断的更佳方法.     

CCTA技术对冠状动脉狭窄及其钙化斑块的评估

冠状动脉CT血管成像（CCTA）是一种可无创检测冠状动脉粥样硬化性疾病的成像手段,已成为临床筛查及诊断冠心病的首要检查方法。但对于钙化严重的冠状动脉节段,CCTA的特异性及阳性预测值偏低,可导致病人过度治疗,因此限制了CCTA的临床应用。综述钙化斑块伪影对CCTA的影响,并就CCTA对冠状动脉狭窄准确评估的相关技术进展进行分析,以利于临床诊断中提高CCTA对冠状动脉狭窄率的评估。     

Image quality and artifacts in coronary CT angiography with dual-source CT: Initial clinical experience

Introduction

We aimed to characterize artifacts observed in a routine clinical coronary CT angiography (CCTA) performed by a dual-source CT (DSCT) scanner (Definition; Siemens Medical Solutions).

Methods

Studies of 167 consecutive patients referred for CCTA, performed after β-blockade (if not contraindicated), were prospectively analyzed for artifacts with a predefined visual approach. American Heart Association coronary segments (n = 2589) were assessed in 40%-80% R-R interval phases by 2 experts for stenosis, plaque presence or composition, and presence or type of artifacts. Each segment was considered evaluable when image quality was diagnostic in at least one cardiac phase. Artifacts included motion (cardiac, respiratory, patient), phase misregistration because of varying heart beats, calcified plaque blooming or beam hardening, metal beam hardening, large patient size, and contrast timing error.

Results

Maximum HR (HR) during CCTA ranged from 45 to 120 beats/min (66.4 ± 14.8 beats/min). Artifacts of some type were observed in 69 (41.3%) of 167 studies. Calcified plaque was the most common source of artifacts (14.4%), followed by misregistration (13.8%). Only 25 (1%) of 2589 coronary segments, in 6 (4%) of 167 patients were unevaluable, primarily because of calcified plaque blooming (coronary calcium score [CCS], 1112 ± 1255]. Artifacts were associated with CCS (P = 0.002), change in HR (P = 0.01), age (P = 0.03), and body mass index (P = 0.048). The optimal phase for evaluation of all coronary arteries was 70% (mid-diastole), with a shift toward the systolic phases for HR > 70 beats/min.

Conclusion

CCTA artifacts with DSCT were related primarily to calcified plaque and cardiac phase misregistration. When correctly recognized, the artifacts did not have a serious effect on the final interpretation.     

The evolving role of coronary computed tomography in understanding sex differences in coronary atherosclerosis

Our understanding of sex differences in subclinical atherosclerosis and plaque composition and characteristics have greatly improved with the use of coronary computed tomography (CCTA) over the past years. CCTA has emerged as an important frontline diagnostic test for women, especially as we continue to understand the impact of non-obstructive atherosclerosis as well as diffuse, high risk plaque as precursors of acute cardiac events in women.Based on its ability to identify complex plaque morphology such as low attenuation plaque, high risk non calcified plaque, positive remodeling, fibrous cap, CCTA can be used to assess plaque characteristics. CCTA can avoid false positive of other imaging studies, if included earlier in assessment of ischemic symptoms. In the contemporary clinical setting, CCTA will prove useful in further understanding and managing cardiovascular disease in women and those without traditional obstructive coronary disease.     

Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events

BackgroundThe current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE).MethodsThe multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted.ResultsThe study population comprised 1166 patients (age 60.5 ?± ?9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P ?< ?0.001.ConclusionsWhole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.     

Improvement in LDL is associated with decrease in non-calcified plaque volume on coronary CTA as measured by automated quantitative software

BackgroundComputed tomography coronary angiography (CTA) can be used for assessment of plaque characteristics; however, quantitative assessment of changes in plaque composition in response to LDL lowering has not been performed with CTA. We sought to assess the association between LDL reduction and changes in plaque composition with quantitative CTA.MethodsQuantification of total, calcified, non-calcified and low-density non-calcified plaque volumes (TPV, CPV, NCPV and LD-NCPV) was performed using semi-automated software in 234 vessels from 116 consecutive patients (89 men, 60 ± 10 years) with baseline LDL>70 mg/dl. Significant reduction in LDL was defined as a decrease by >10% of baseline LDL. Changes (Δ) in plaque volumes between the second and baseline study were compared between patients with LDL reduction (n = 63) and those with no decrease in LDL (n = 53).ResultsMedian LDL at baseline was 98 mg/dl [interquartile range (IQR) 83–119 mg/dl] and median ΔLDL was −14 mg/dl (IQR -38 to 3 mg/dl). Mean interval between sequential CTA was 3.5 ± 1.6 years. TPV, NCPV, and LD-NCPV decreased in patients with a reduction in LDL compared to baseline; whereas, patients without reduction in LDL experienced an increase in TPV, NCPV and LD-NCPV. After adjusting for age, statin use, diabetes, baseline LDL and baseline TPV, reduction in LDL was associated with a decrease in TPV (P = 0.005), NCPV (P = 0.002) and LD-NCPV (P = 0.011) compared to patients without a reduction in LDL.ConclusionReduction in LDL was associated with beneficial changes in the amount and composition of noncalcified plaque as measured using semi-automated quantitative software by CTA.     

Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

Objectives

To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE).

Methods

We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined.

Results

The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05).

Conclusions

Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE.

Key Points

? Repeat CCTA can provide information regarding the progression of coronary atherosclerosis. ? Coronary atherosclerosis progression at CCTA is independently associated with MACE. ? CCTA findings could serve as incremental predictors of MACE.

     

Incremental Prognostic Value of Different Components of Coronary Atherosclerotic Plaque at Cardiac CT Angiography beyond Coronary Calcification in Patients with Acute Chest Pain

Purpose: To systematically evaluate the incremental predictive value of cardiac computed tomographic (CT) angiography beyond the assessment of coronary artery calcium (CAC) in patients who present with acute chest pain but without evidence of acute coronary syndrome (ACS). Materials and Methods: The human research committee approved this study and waived the need for individual written informed consent. The study was HIPAA compliant. A total of 458 patients (36% male; mean age, 55 years ± 11) with acute chest pain at low to intermediate risk for coronary artery disease underwent coronary calcification assessment with cardiac CT angiography. All patients who did not experience ACS at index hospitalization were followed for instances of a major adverse cardiac event (MACE), such as a myocardial infarct, revascularization, cardiac death, or angina requiring hospitalization. CAC score and cardiac CT angiography were used to derive the presence and extent of atherosclerotic plaque (calcified, noncalcified, or mixed), and obstructive lesions (>50% luminal narrowing) were related to outcomes by using univariate and adjusted Cox proportional hazards models. Results: Of the 458 patients, 70 (15%) experienced MACE (median follow-up, 13 months). Patients with no plaque at cardiac CT angiography remained free of events during the follow-up period, while 11 (5%) of 215 patients with no CAC had MACE. The extent of plaque was the strongest predictor of MACE independent of traditional risk factors (hazard ratio [HR], 151.77 for four or more segments containing plaque as compared with those containing no plaque; P < .001). Patients with mixed plaque were more likely to experience MACE (HR, 86.96; P = .002) than those with exclusively noncalcified plaque (HR, 58.06; P = .005) or exclusively calcified plaque (HR, 32.94; P = .02). Conclusion: The strong prognostic value of cardiac CT angiography is incremental to its known diagnostic value in patients with acute chest pain without ACS and is independent of traditional risk factors and CAC. ? RSNA, 2012.