冠状动脉CT血管造影定量分析预测冠心病患者心血管事件风险的价值
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摘要
目的探究冠状动脉CT血管造影(CTA)定量指标对冠心病患者主要心血管不良事件(MACE)的预测价值。方法选取宁波市李惠利东部医院2016年9月—2017年11月诊断及治疗的冠心病患者251例并进行1年随访,根据是否发生MACE分为观察组与对照组,比较2组诊断时冠状动脉CTA指标,包括:斑块总体积(TPV)、钙化/非钙化斑块体积(CPV/NCPV)、病变长度、斑块负荷及餐巾环标志,应用Cox回归分析MACE的独立危险因素,应用ROC曲线评估CTA定量指标对MACE的预测效能。结果本研究中共有47例(19.67%)患者发生MACE;2组TPV、CPV、NCPV、病变长度、斑块负荷及餐巾环标志差异均有统计学意义(均P<0.05);TPV及斑块负荷是MACE发生的独立危险因素(OR=1.137,P<0.001;OR=1.075,P=0.002);单独应用TPV及斑块负荷预测MACE发生的AUC面积为0.764、0.796,两者联合预测的AUC为0.860,显著优于单独预测(Z=3.376,P=0.001;Z=2.707,P=0.007),且两者联合的敏感性显著优于单独预测(均P<0.05)。结论冠状动脉CTA中TPV与斑块负荷对冠心病患者MACE的发生具有较好的预测价值。
Objective To investigate the value of computed tomography(CTA) quantitative indexes in predicting major adverse cardiovascular events(MACE) in patients with coronary heart disease. Methods From September 2016 to November 2017, 251 patients with coronary heart disease diagnosed and treated in our hospital were selected and followed up for 1 years, they were divided into observation group and control group according to whether MACE occurred, Coronary CTA indexes of the two groups were compared, including the total plaque volume(TPV), calcified and non-calcified plaque volume(CPV/NCPV), lesion length, plaque burden and napkin-ring sign. Cox regression was used to analyze the independent risk factors of MACE, and ROC curve was used to evaluate the diagnostic efficacy of CTA quantitative indicators on MACE. Results In this study, 47 patients(19.67%) developed MACE. There were significant differences in TPV, CPV, NCPV, lesion length, plaque burden and napkin-ring sign between the two groups(all P<0.05). TPV and plaque burden were independent risk factors for MACE(OR=1.137,P<0.001;OR=1.075,P=0.002). ROC curve showed the AUC areas single diagnosed of TPV and plaque burden in MACE were 0.764, 0.796, the combined diagnosis was 0.860, diagnostic efficacy and sensitivity were significantly better than single one(all P<0.05). Conclusion TPV and plaque burden in coronary artery CTA have good predictive value for the occurrence of MACE in patients with coronary heart disease.
Objective To investigate the value of computed tomography(CTA) quantitative indexes in predicting major adverse cardiovascular events(MACE) in patients with coronary heart disease. Methods From September 2016 to November 2017, 251 patients with coronary heart disease diagnosed and treated in our hospital were selected and followed up for 1 years, they were divided into observation group and control group according to whether MACE occurred, Coronary CTA indexes of the two groups were compared, including the total plaque volume(TPV), calcified and non-calcified plaque volume(CPV/NCPV), lesion length, plaque burden and napkin-ring sign. Cox regression was used to analyze the independent risk factors of MACE, and ROC curve was used to evaluate the diagnostic efficacy of CTA quantitative indicators on MACE. Results In this study, 47 patients(19.67%) developed MACE. There were significant differences in TPV, CPV, NCPV, lesion length, plaque burden and napkin-ring sign between the two groups(all P<0.05). TPV and plaque burden were independent risk factors for MACE(OR=1.137,P<0.001;OR=1.075,P=0.002). ROC curve showed the AUC areas single diagnosed of TPV and plaque burden in MACE were 0.764, 0.796, the combined diagnosis was 0.860, diagnostic efficacy and sensitivity were significantly better than single one(all P<0.05). Conclusion TPV and plaque burden in coronary artery CTA have good predictive value for the occurrence of MACE in patients with coronary heart disease.
引文
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[19] CHAIKRIANGKRAI K,VELANKAR P,SCHUTT R,et al.Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease[J].Am J Cardiol,2015,115(6):738-744.
[2] LI J,SONG M,JIAN Z,et al.Laboratory aspirin resistance and the risk of major adverse cardiovascular events in patients with coronary heart disease on confirmed aspirin adherence[J].J Atheroscler Thromb,2014,21(3):239-247.
[3] DEY D,ACHENBACH S,SCHUHBAECK A,et al.Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease[J].J Cardiovasc Comput Tomogr,2014,8(5):368-374.
[4] PUCHNER S B,LU M T,MAYRHOFER T,et al.High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease,independent of coronary plaque and stenosis burden:results from the ROMICAT II trial[J].Radiology,2015,274(3):693-701.
[5] MOTOYAMA S,ITO H,SARAI M,et al.Reply:plaque characterization by coronary computed tomography angiography and association with acute coronary syndrome[J].J Am Coll Cardiol,2016,67(4):459-460.
[6] 国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南[J].中国医学前沿杂志(电子版),2016,8(6):19-108.
[7] 祖凌云,葛洪霞,高炜.SYNTAX积分和Gensini评分对急性ST段抬高心肌梗死患者远期心血管事件的预测价值[J].中国介入心脏病学杂志,2014,22(12):755-760.
[8] UTSUNOMIYA D,ODA S,KIDOH M,et al.Partially calcified plaque mimicking the “napkin-ring sign” on coronary CT angiography[J].J Cardiovasc Comput Tomogr,2017,11(3):244.
[9] 李一凡,李昭屏.微血管性心绞痛发病机制的研究进展[J].心血管病学进展,2014,35(3):291-294.
[10] GASSETT A J,SHEPPARD L,MCCLELLAND R L,et al.Risk factors for long-term coronary artery calcium progression in the multi-ethnic study of atherosclerosis[J].J Am Heart Assoc,2015,4(8):e001726.
[11] ZHANG L J,QI L,WANG J,et al.Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp:initial experience[J].Eur Radiol,2014,24(7):1537-1546.
[12] TESCHE C,PLANK F,DE CECCO C N,et al.Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events[J].J Cardiovasc Comput Tomogr,2016,10(6):458-465.
[13] SONG F X,ZHOU J,ZHOU J J,et al.The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography[J].J Thorac Dis,2018,10(4):2365-2376.
[14] FEUCHTNER G,KERBER J,BURGHARD P,et al.The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE:a long-term follow-up study[J].Eur Heart J Cardiovasc Imaging,2017,18(7):772-779.
[15] ZHAI X,CHI J,TANG W,et al.Yellow wine polyphenolic compounds inhibit matrix metalloproteinase-2,-9 expression and improve atherosclerotic plaque in LDL-receptor-knockout mice[J].J Pharmacol Sci,2014,125(2):132-141.
[16] HAO W,FRIEDMAN A.The LDL-HDL profile determines the risk of atherosclerosis:a mathematical model[J].PLoS One,2014,9(3):e90497.
[17] WONGCHAROEN W,SUTTHIWUTTHICHAI S,GUNAPARN S,et al.Is non-HDL-cholesterol a better predictor of long-term outcome in patients after acute myocardial infarction compared to LDL-cholesterol?A retrospective study[J].BMC Cardiovasc Disord,2017,17(1):10.
[18] SHIMIZU T,MINTZ G S,DE BRUYNE B,et al.Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis:results from the PROSPECT study[J].Coron Artery Dis,2018,29(5):397-402.
[19] CHAIKRIANGKRAI K,VELANKAR P,SCHUTT R,et al.Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease[J].Am J Cardiol,2015,115(6):738-744.