CCTA定量斑块特征及血管周围脂肪在急性冠脉综合征中的临床价值

目的:使用冠状动脉CT血管成像(CCTA)定量急性冠脉综合征(ACS)患者斑块特征与冠状动脉周围脂肪组织(PCAT),探讨相关参数评价ACS的临床应用价值。方法:回顾性分析2019年2月-2020年6月本院胸痛中心收治的35例ACS患者为研究对象,同期选取35例稳定性心绞痛(SAP)患者作为临床对照,搜集所有患者CCTA影像及一般临床资料。采用半自动计算机软件定量斑块特征,包括总斑块(TP)、钙化斑块(CP)、非钙化斑块(NCP)以及低、中、高不同衰减程度的NCP负荷、正性重构等指标。另外测量罪犯血管的PCAT比值,以及三支大血管周围的EAT厚度与CT值。结果:ACS组TP、NCP、低衰减NCP、中衰减NCP负荷、重建指数及PCAT比值均显著高于SAP组(P<0.05),而两组在CP负荷、狭窄程度、平均EAT厚度及密度比较上差异无统计学意义(P>0.05);ROC曲线分析结果显示,PCAT比值、TP、NCP、低衰减NCP、中衰减NCP曲线下面积(AUC)分别为0.762、0.786、0.825、0.888、0.683,其中低衰减NCP的AUC值最大,95%CI为0.811~0.966,敏感度及特异度均为82.9%。结论:CCTA在显示ACS与SAP患者斑块特征、PCAT比值的差异性上有重要的作用,且低衰减NCP负荷对于ACS的诊断效能最佳,值得临床合理应用。

Clinical value of CCTA quantitative plaque characteristics and perivascular fat in acute coronary syndrome

Objective:Coronary CT angiography(CCTA)was used to quantify the plaque characteristics of patients with acute coronary syndrome(ACS)and to discuss the related parameters of pericoronary adipose tissue(PCAT),to evaluate the clinical value of ACS.Methods:A retrospective analysis was made on 35 ACS patients treated in chest pain center of our hospital from February 2019 to June 2020,and 35(SAP)patients with stable angina pectoris were selected as clinical control group in the same period.CCTA images and general clinical data of all patients were collected.Semi-automatic computer software was used to quantify plaque characteristics,including total plaque(TP),calcified plaque(CP),non-calcified(NCP),low,medium and high attenuation of non-calcified plaque load,and positive remodeling.In addition,the PCAT ratio of criminal vessels,the thickness and CT value of EAT around the three major vessels were measured.Results:TP,NCP,low attenuation NCP,moderate attenuation NCP load,remodeling index and PCAT ratio in ACS group were significantly higher than those in SAP group,but there was no significant difference for CP load,stenosis degree,average EAT thickness and density between the two groups.The results of ROC curve analysis showed that the area under PCAT ratio,TP,NCP,low attenuation NCP and medium attenuation NCP curve were 0.762、0.786、0.825、0.888 and 0.683,respectively.The AUC value of low attenuation NCP was the highest,while 95%CI was 0.811 to 0.966,and sensitivity and specificity were both 0.829.Conclusion:CCTA plays an important role in showing the plaque characteristics and the difference of PCAT between ACS and SAP.And the low attenuation NCP load is the best diagnostic index of ACS and worthy for clinical application.