冠脉CT血管成像斑块定量参数预测冠心病患者心肌缺血事件的临床价值

罗江; 祝唯; 苗涵

doi:10.12122/j.issn.1674-4500.2023.02.30

冠脉CT血管成像斑块定量参数预测冠心病患者心肌缺血事件的临床价值

doi: 10.12122/j.issn.1674-4500.2023.02.30

德阳市第二人民医院放射科，四川德阳 618000

基金项目:

德阳市重点科技计划项目 DYCC20160053

详细信息

作者简介:
罗江，副主任医师，E-mail: luojiang821217@126.com

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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-08
- 网络出版日期: 2023-04-28
- 刊出日期: 2023-03-20

Clinical value of coronary CT angiography plaque quantitative parameters on predicting myocardial ischemic events in patients with coronary heart disease

Department of Radiology, Deyang Second People's Hospital, Deyang 618000, China

摘要

摘要: 目的分析冠脉CT血管成像（CTA）斑块定量参数预测冠心病患者心肌缺血事件的临床价值。方法纳入2020年1月~2022年6月256例初诊冠心病患者作为研究对象，均行冠脉CTA检查，检测斑块定量参数，根据血流储备分数检测结果将患者分为心肌缺血组和非心肌缺血组，比较两组冠脉CTA斑块定量参数，采用多元线性回归分析斑块定量参数与心肌缺血性损伤的关系，采用ROC曲线评估斑块定量参数对心肌缺血性损伤的预测价值。结果心肌缺血组总斑块体积、非钙化斑块体积、低密度非钙化斑块（LDNCP）体积、斑块长度、直径狭窄度均大于非心肌缺血组（P < 0.05），钙化斑块（CP）体积及血流储备分数小于非心肌缺血组（P < 0.05）；多元线性回归分析显示，总斑块体积、LDNCP体积为冠心病患者心肌缺血的独立影响因素（P < 0.05）；ROC曲线显示，总斑块体积、LDNCP体积联合预测心肌缺血性损伤的敏感度、特异性、曲线下面积分别为94.30%、77.80%、0.948。结论冠脉CTA斑块定量参数变化与冠心病患者心肌缺血性损伤有关，其中总斑块体积、LDNCP体积可作为心肌缺血事件的预测指标。
- 冠脉CT血管成像 /
- 冠心病 /
- 心肌缺血 /
- 预测价值
Abstract: Objective To analyze the clinical value of coronary CT angiography (CTA) plaque quantitative parameters on predicting myocardial ischemia events in patients with coronary heart disease. Methods A total of 256 patients with newly diagnosed coronary heart disease during the period from January 2020 and June 2022 were included as the research subjects. All patients underwent coronary CTA examination. The plaque quantitative parameters were detected. According to fractional flow reverse, the patients were divided into myocardial ischemia group and non-myocardial ischemia group. The coronary CTA plaque quantitative parameters were compared between the two groups. Multivariate linear regression analysis was used to analyze the relationship between plaque quantitative parameters and myocardial ischemic injury. ROC curve was drawn to evaluate the predictive value of plaque quantitative parameters on myocardial ischemic injury. Results The total plaque volume, non-calcified plaque volume, volume of low-density non-calcified plaque (LDNCP), plaque length and diameter stenosis in myocardial ischemia group were larger or higher than those in non-myocardial ischemia group (P < 0.05) while the calcified plaque volume and fractional flow reverse were smaller than that in non-myocardial ischemia group (P < 0.05). Multivariate linear regression analysis showed that total plaque volume and LDNCP volume were the independent influencing factors of myocardial ischemia in patients with coronary heart disease (P < 0.05). ROC curve showed that the sensitivity, specificity and area under curve of total plaque volume and LDNCP volume in combination on predicting myocardial ischemic injury were 94.30%, 77.80% and 0.948, respectively. Conclusion The changes in coronary CTA plaque quantitative parameters are related to myocardial ischemic injury in patients with coronary heart disease. Total plaque volume and LDNCP volume can be used as predictors of myocardial ischemic events.
- coronary CT angiography /
- coronary heart disease /
- myocardial ischemia /
- predictive value

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图 1 斑块定量参数预测冠心病患者心肌缺血性损伤的ROC曲线

Figure 1. ROC curve of quantitative plaque parameters predicting myocardial ischemic injury in patients with coronary heart disease.

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图 2 冠心病患者冠脉CTA扫描图像

Figure 2. Coronary CTA scanning images of patients with coronary heart disease.

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表 1 两组一般资料比较

Table 1. Comparison of general data between the two groups [n(%)]

资料	心肌缺血组（n=175）	非心肌缺血组（n=81）	t/χ²	P
性别			0.160	0.690
男	121（69.14）	58（71.60）
女	54（30.86）	23（28.40）
年龄（岁, Mean±SD）	59.73±10.12	58.65±7.41	0.859	0.391
BMI（kg/m², Mean±SD）	24.07±3.62	24.02±2.14	0.115	0.908
高血压	93（53.14）	39（48.15）	0.553	9.457
糖尿病	82（46.86）	34（41.98）	0.533	0.466
高血脂	54（30.86）	23（28.40）	0.160	0.690
吸烟	59（33.71）	27（33.33）	0.004	0.952
饮酒	92（52.57）	37（45.68）	1.052	0.305
心血管家族史	33（18.86）	16（19.75）	0.029	0.865

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表 2 两组冠脉CTA斑块定量参数及FFR比较

Table 2. Comparison of coronary CTA plaque quantitative parameters and FFR between the two groups (Mean±SD)

指标	心肌缺血组（n=175）	非心肌缺血组（n=81）	t	P
斑块体积（mm³）
总斑块体积	99.89±11.93	72.47±6.11	19.520	< 0.001
CP体积	7.25±1.72	9.09±1.26	8.614	< 0.001
NCP体积	92.64±11.69	63.38±5.89	21.295	< 0.001
LDNCP体积	14.62±3.83	8.54±1.79	13.605	< 0.001
斑块长度（mm）	4.97±1.64	3.42±1.13	7.698	< 0.001
直径狭窄度（%）	19.06±4.85	13.27±3.88	9.434	< 0.001
FFR	0.70±0.11	0.83±0.04	10.316	< 0.001
CP: 钙化斑块; NCP: 非钙化斑块; LDNCP: 低密度非钙化斑块; FFR: 血流储备分数.

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表 3 斑块定量参数与冠心病患者心肌缺血性损伤的关系分析

Table 3. Analysis of the relationship between quantitative plaque parameters and myocardial ischemic injury in patients with coronary heart disease

指标	β	SE	Waldχ²	P	OR	95% CI
总斑块体积	0.9712	0.219	10.570	0.001	2.038	1.327~3.131
CP体积	0.645	0.442	2.129	0.145	1.906	0.801~4.533
NCP体积	0.682	0.374	3.325	0.069	1.978	0.950~4.117
LDNCP体积	0.614	0.167	13.518	< 0.001	1.848	1.332~2.563
斑块长度	0.498	0.372	1.792	0.181	1.645	0.794~3.411
直径狭窄度	0.507	0.398	1.623	0.203	1.660	0.761~3.622

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表 4 斑块定量参数对冠心病患者心肌缺血性损的预测效能

Table 4. Predictive efficacy of quantitative plaque parameters on myocardial ischemic damage in patients with coronary heart disease

指标	最佳截断值	曲线下面积	敏感度（%）	特异性（%）
总斑块体积	82.300	0.872	92.00	84.00
LDNCP体积	10.845	0.832	81.70	79.00
联合	-	0.948	94.30	77.80

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