基于冠状动脉CT血管成像的斑块定量分析及其与心肌缺血损伤的相关性研究

目的使用第三代双源冠状动脉CT血管成像(CCTA)及斑块定量技术分析冠状动脉斑块成分特征,探讨其与心肌缺血的相关性,并评价各项定量特征在评估心肌缺血中的价值。方法回顾性分析2018年6月至2019年9月于山东省立医院行CCTA和冠状动脉造影(ICA)检查的742例初诊冠心病患者,纳入ICA证实存在单支病变局限性狭窄的患者109例。将患者根据心肌酶升高伴心脏室壁运动不良和心肌酶及心脏室壁运动正常分为心肌缺血性损伤组(n=75)和心肌无缺血损伤组(n=34)。测量斑块的特征参数,包括斑块长度、斑块总体积、钙化斑块体积、脂质斑块体积、纤维斑块体积、斑块负荷、最小管腔面积、最大面积狭窄率(MAS%)、重塑指数、偏心指数、"餐巾纸环"征、斑点状钙化。采用卡方检验、Mann-Whitney U非参数检验、两独立样本t检验、多因素logistic回归及DeLong检验进行统计学分析。结果在冠状动脉管腔狭窄定量指标方面,心肌缺血损伤组的MAS%为85.00%(80.00%,92.00%),心肌无缺血损伤组的MAS%为63.00%(60.00%,65.00%),两组间差异具有统计学意义(Z=-4.32,P=0.001)。在斑块成分定量指标方面,心肌缺血损伤组的斑块总体积(TPV)、斑块负荷(TPB)、纤维成分斑块体积(FPV)、脂质成分斑块体积(LPV)、脂质成分斑块占比(LPR)分别为150.13(104.44,202.20)mm^3、75.67%±9.90%、95.73(66.57,134.23)mm^3、32.18(18.93,54.55)mm^3、25.13%±13.71%,心肌无缺血损伤组的相应指标分别为109.94(79.39,121.67)mm^3、65.37%±6.94%、67.35(57.67,90.11)mm^3、16.64(13.26,24.73)mm^3、18.44%±7.09%,两组间差异具有统计学意义(Z=-2.59,P=0.010;t=3.11,P=0.003;Z=-2.16,P=0.031;Z=-2.18,P=0.029;t=2.19,P=0.037)。Logistic回归分析显示,MAS%(OR=1.55,P=0.021)是心肌缺血性损伤的独立预测因子。MAS%、LPV、LPR、TPV、TPB、FPV的ROC曲线下面积分别为0.84、0.82、0.77、0.72、0.74、0.67,差异均具有统计学意义(P<0.05)。结论在CCTA斑块定量分析中,MAS%、TPV、TPB、FPV、LPV、LPR是影响心肌缺血性损伤的主要因素;MAS%是心肌缺血性损伤的独立预测因子;且MAS%及LPV诊断心肌缺血的准确性更高。

Correlation study of coronary plaque quantitative analysis and myocardial ischemic injury based on coronary CT angiography

Objective To analyze the quantitative features of coronary plaque and evaluate its diagnostic performance for myocardial ischemic injury in patient with coronary artery disease.Methods Retrospectively enrolled 109 patients with suspected coronary artery disease,who successively underwent coronary CT angiography(CCTA)and coronary angiography in Shandong Provincial Hospital from June 2018 to September 2019.Elevated myocardial enzyme with segmental wall motion abnormalities(SWMA)in ultrasound was defined as myocardial ischemic injury,with which the subjects were divided into two groups,with and without myocardial ischemic injury(n=75,34)respectively.CCTA images of each target vessel were quantitatively analyzed by automated plaque analysis software to obtain the following indexes:minimal lumen area(MLA),plaque length(PL),total plaque volume(TPV),total plaque burden(TPB),calcified plaque volume(CPV),calcified plaque ratio(CPR),fibrous plaque volume(FPV),fibrous plaque ratio(FPR),lipid plaque volume(LPV),lipid plaque ratio(LPR),napkin-ring sign(NRS),spotty calcification(SC),remodeling index(RI)and eccentric index(EI).Chi-square,Mann-Whitney U tests,logistic regression and area under the receiver operating characteristics were determined.Results For the degree of coronary artery stenosis,MAS% was 85.00%(80.00%,92.00%)and 63.00%(60.00%,65.00%)in myocardial ischemic group and without myocardial ischemic injury group,which was statistically significant(Z=-4.32,P=0.001).For the quantitative plaque features,TPV 150.13(104.44,202.20)mm^3,TPB(75.67%±9.90%),FPV 95.73(66.57,134.23)mm^3,LPV 32.18(18.93,54.55)mm^3,LPR(25.13%±13.71%)in the group with myocardial ischemic injury were larger than those in group without myocardial ischemic injury 109.94(79.39,121.67)mm^3,65.37%±6.94%,67.35(57.67,90.11)mm^3,16.64(13.26,24.73)mm^3,18.44%±7.09% respectively with statistically significant(Z=-2.59,P=0.010;t=3.11,P=0.003;Z=-2.16,P=0.031;Z=-2.18,P=0.029;t=2.19,P=0.037).In logistic regression analysis,MAS%(OR=1.55,P=0.021)was independent significant predictors of myocardial ischemic injury.The AUC of MAS%,LPV,LPR,TPV,TPB,FPV were 0.84,0.82,0.77,0.72,0.74,0.67,respectively,which were all statistically significant(P<0.05).Conclusions In quantitative plaque analysis by coronary CT angiography,MAS%,TPV,TPB,FPV,LPV,LPR were affecting factors of myocardial ischemic injury,in which MAS%was independent predictors.MAS%and LPV have higher diagnostic accuracy in myocardial ischemic injury.