冠状动脉斑块病变血流动力学及无创评估方法的研究现状
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摘要
冠状动脉CT血管造影(CCTA)已被广泛用于检测或排除显著的冠心病,且CCTA已成为评价冠状动脉解剖结构最主要的无创检查方法;但常规CCTA图像仅提供冠状动脉解剖学的评估,其改善临床预后效果不明显。为了克服常规CCTA的缺点,冠状动脉功能学的CT无创评估技术逐渐成熟,以CCTA图像为基础的冠状动脉血流动力学研究已成为热点。现主要对局部流体力学与冠状动脉粥样硬化的形成及进展的关系进行综述,并对CT心肌灌注及CT无创计算冠状动脉血流储备分数(FFR)进行阐述,为CT功能学无创评估方法对心肌缺血及冠状动脉粥样硬化性心脏病预后检测提供参考依据。
引文
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[5]WONG D T L,KO B S,CAMERON J D,et al.Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion+computed tomography angiography with transluminal attenuation gradient+computed tomography angiography against invasive fractional flow reserve[J].Journal of the American College of Cardiology,2014,63(18):1904-1912.
[6]SOMMER K,BERNAT D,SCHMIDT R,et al.Resting myocardial blood flow quantification using contrast-enhanced magnetic resonance imaging in the presence of stenosis:a computational fluid dynamics study[J].Medphys,2015,42(7):4375-4384.
[7]WARBOYS C M,AMINI N,DE LUCA A,et al.The role of blood flow in determining the sites of atherosclerotic plaques[J].F1000Med Rep,2011(3):5.
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[9]ASAKURA T,KARINO T.Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries[J].Circ Res,1990(66):1045-1066.
[10]WOO K V,QU X,BABAEV V R,et al.Tie1attenuation reduces murine atherosclerosis in a dose-dependent and shear stress-specific manner[J].Journal of Clinical Investigation,2011,121(4):1624-1635.
[11]RAVENSBERGEN J,RAVENSBERGEN J W,KRIJGER J K,et al.Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries[J].Arterioscler Thromb Vasc Biol,1998(18):708-716.
[12]YL?-HERTTUALA S.Stabilisation of atherosclerotic plaques:an update[J].Eur Heart J,2013(34):3251-3258.
[13]ZAKKAROFF C,MOORE S,DOWDING S,et al.T 3Dtime-varying simulations of dynamics in arterial coupled cells:a massively parallel implementation[J].Numer Method Biomed Eng,2016,6(7):723-733.
[14]MICHEL FéLéTOU,RALF K?HLER,VANHOUTTE P M.Nitric oxide:orchestrator of endothelium-dependent responses[J].Annals of Medicine,2012,44(7):23.
[15]ZARBOCK A,LEY K.Mechanisms and consequences of neutrophil interaction with the endothelium[J].American Journal of Pathology,2008,172(1):1-7.
[16]OHURA N,YAMAMOTO K,ICHIOKA S,et al.Global analysis of shear stress-responsive genes in vascular endothelial cells[J].Journal of Atherosclerosis and Thrombosis,2003,10(5):304-313.
[17]姜盛强,庄明华.动脉粥样硬化血流动力学的研究进展[J].中国现代医生,2010,48(36):11-12;36.
[18]CARO C G,FITZ-GERALD J M,SCHROTER R C.Arterial wall shear and distribution of early atheroma in man[J].Nature,1999,12(233):1159-1161.
[19]THAEHER T N,GAMBILLARA V,RICHE F,et al.Regulation of arginase pathway in response to wall shear stress[J].Atheresclerosis,2010,210(1):63-70.
[20]TSAO P S,WANG B,BUITRAGO R,et al.Nitric oxide regulates monocyte chemotactic protein[J].Circulation,1997,96(3):934-940.
[21]CIEHA I,BERONOV K,RAMIREZ E L,et al.Shear stress preconditioning modulates endothelial susceptibility to circulating TNF-alpha and monocytic celI recruitment in a simplified model of arterial bifurcations[J].Atherosclerosis,2009,207(1):93-102.
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[23]WEI D H,WANG G X,TANG C J,et al.Stromal derived factor-1expression is up-regulated in atherosclerosis lesions induced by low density lipoprotein concentration polarization[J].Ann Biomed Eng,2012,40(5):1018-1027.
[24]FENNING R S,WILENSKY R L.New insights into the vulnerable plaque from imaging studies[J].Current Atherosclerosis Reports,2014,16(3):397.
[25]KRAMS R,CHENG C,HELDERMAN F,et al.Shear stress is associated with markers of plaque vulnerability and MMP-9activity[J].Eurointervention Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,2006,2(2):250.
[26]MAUROVICH-HORVAT PáI,FERENCIK M,VOROS S,et al.Comprehensive plaque assessment by coronary CT angiography[J].Nature Reviews Cardiology,2014,11(7):390-402.
[27]CHENG C.Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stres[J].Circulation,2006(113):2744-2753.
[28]危当恒,夏敏,贾小英,等.组织蛋白酶L在动脉粥样硬化病变中的表达以及对巨噬细胞脂质蓄积的影响[J].中国动脉硬化杂志,2011,19(12):963-968.
[29]CHATZIZISIS Y S,BAKER A B,SUKHOVA G K,et al.Augmented expression and activity of extracellular matrix-degrading enzymes in regions of low endothelial shear stress colocalize with coronary atheromata with thin fibrous caps in pigs[J].Circulation,2016,123(6):621.
[30]SAMADY H,ESHTEHARDI P,MCDANIEL M C,et al.Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease[J].Circulation,2011,124(7):779-788.
[31]GIJSEN F J H,MASTIK F,SCHAAR J A,et al.High shear stress induces a strain increase in human coronary plaques over a6-month period[J].Eurointervention,2011,7(1):121-127.
[32]PARK J B,CHOI G,CHUN E J,et al.Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics[J].Heart,2016,102(20):1655.
[33]LOVETT J K,ROTHWELL P M.Site of carotid plaque ulceration in relation to direction of blood flow:an angiographic and pathological study[J].Cerebrovasc Dis,2003,10(16):369-375.
[34]DIRKSEN M T,VAN DER WAL A C,VAN DEN BERG F M,et al.Distribution of inflammatory cells in atherosclerotic plaques relates to the direction of flow[J].Circulation,1998,98(19):2000-2003.
[35]KOSKINAS K C,SUKHOVA G K,BAKER A B,et al.Thincapped atheromata with reduced collagen content in pigs develop in coronary arterial regions exposed to persistently low endothelial shear stress[J].Arteriosclerosis,Thrombosis,and Vascular Biology,2013,33(7):1494-1504.
[36]BJ?RN F,RYNDEL M,KJELLDAHL J,et al.Differences in lesion severity and cellular composition between in vivo assessed upstream and downstream sides of human symptomatic carotid atherosclerotic plaques[J].Journal of Vascular Research,2010,47(3):221-230.
[37]FUKUMOTO Y,HIRO T,FUJII T,et al.Localize delevation of shear stress is related to coronary plaque rupture:a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution[J].J Am Coll Cardiol,2008(51):645-650.
[38]DOLAN J M,KOLEGA J,MENG H.High wall shear stress and spatial gradients in vascular pathology:a review[J].Ann Biomed Eng,2013(41):1411-1427.
[39]CHOI G,LEE J M,KIM H J,et al.Coronary artery axial plaque stress and its relationship with lesion geometry:application of computational fluid dynamics to coronary CT angiography[J].JACC Cardiovasc Imaging,2015,8(10):1156-1166.
[40]STONE P H,COSKUN A U.Conceptualnew biomechanical approaches to identify coronary plaques at risk of disruption[J].JACC Cardiovasc Imaging,2015,8(10):1167-1169.
[41]杨俊杰,杨晓波,荆晶,等.冠状动脉粥样硬化病变流体力学无创评估的初步研究[J].中华心血管病杂志,2017,45(8):716-721.
[42]TAYLOR C A,STEINMAN D A.Image-based modeling of blood flow and vessel wall dynamics:applications,methods and future directions[J].Annals of Biomedical Engineering,2010,38(3):1188-1203.
[43]SAMADY H,ESHTEHARDI P,MCDANIEL M C,et al.Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease[J].Circulation,2011,124(7):779-788.
[44]GIJSEN F J H,WENTZEL J J,THURY A,et al.Strain distribution over plaques in human coronary arteries relates to shear stress[J].American Journal of Physiology Heart&Circulatory Physiology,2008,295(4):H1608.
[45]HUANG D,MURAMATSU T,LI Y,et al.Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography:comparison with invasive coronary angiography[J].International Journal of Cardiovascular Imaging,2017,33(7):1101-1110.
[46]TAKX R A P,BLOMBERG B A,AIDI H E,et al.Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis[J].Circulation:Cardiovascular Imaging,2015,8(1):e002666.
[47]NEWHOUSE J H,MURPHY RX Jr.Tissue distribution of soluble contrast:effect of dose variation and changes with time[J].AJR Am J Roentgenol,1981,136(3):463-467.
[48]SO A,LEE T Y.Quantitative myocardial CT perfusion:apictorial review and the current state of technology development[J].JCardiovasc Comput Tomogr,2011,5(6):467-481.
[49]霍福涛,苏续清,张维新.CT灌注成像的原理、技术及其临床应用[J].中国CT和MRI杂志,2004,2(2):49-54.
[50]HUBER A M,LEBER V,GRAMER B M,et al.Myocardium:dynamic versus single-shot CT perfusion imaging[J].Radiology,2013,269(2):378-386.
[51]ARNOLDI E,LEE Y S,RUZSICS B,et al.CT detection of myocardial blood volume deficits:dual-energy CT compared with singleenergy CT spectra[J].J Cardiovasc Comput Tomogr,2011,5(6):421-429.
[52]BAMBERG F,MARCUS R P,Becker A,et al.Dynamic myocardial CT perfusion imaging for evaluation of myocardial ischemia as determined by MR imaging[J].JACC Cardiovasc Imaging,2014,7(3):267-277.
[53]冠状动脉血流储备分数临床应用专家共识专家组.冠状动脉血流储备分数临床应用专家共识[J].中华心血管病杂志,2016,44(4):292-297.
[54]KIM Y H,Park S J.Ischemia-guided percutaneous coronary intervention for patients with stable coronary artery disease[J].Circ J,2013,77(8):1967-1974.
[55]DE BRUYNE B,PIJLS N H,KALESAN B,et al.Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease[J].New England Journal of Medicine,2012,367(11):991-1001.
[56]KIM H J,VIGNON-CLEMENTEL I E,COOGAN J S,et al.Patient-specific modeling of blood flow and pressure in human coronary arteries[J].Ann Biomed Eng,2010,38(10):3195-3209.
[57]SHARMA P,ITU L,ZHENG X,et al.A framework for personalization of coronary flow computations during rest and hyperemia[C].Engineering in Medicine&Biology Society,Conf Proc IEEE Eng Med Biol Soc,2012:1.
[58]COENEN A,LUBBERS M M,KURATA A,et al.Fractional flow reserve computed from noninvasive CT angiography data:diagnostic performance of an on-site clinician operated computational fluid dynamics algorithm[J].Radiology,2015,274(3):674-683.
[2]NIELSEN L H,ORTNER N,NCRGAARD B L,et al.The diagnostic accuracy and outcomes after coronary computed tomography angiography vs.Conventional functional testing in patients with stable angina pectoris:a systematic review and meta analysis[J].Eur Heart J Cardiovasc Imaging,2014,15(9):961-971.
[3]FEARON W F,SHILANE D,PIJLS N H,et al.Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve[J].Circulation,2013,128(12):1335-1340.
[4]DOUGLAS P S,HOFFMANN U,PATEL M R,et al.Outcomes of anatomical versus functional testing for coronary artery disease[J].N Engl J Med,2015,372(14):1291-1300.
[5]WONG D T L,KO B S,CAMERON J D,et al.Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion+computed tomography angiography with transluminal attenuation gradient+computed tomography angiography against invasive fractional flow reserve[J].Journal of the American College of Cardiology,2014,63(18):1904-1912.
[6]SOMMER K,BERNAT D,SCHMIDT R,et al.Resting myocardial blood flow quantification using contrast-enhanced magnetic resonance imaging in the presence of stenosis:a computational fluid dynamics study[J].Medphys,2015,42(7):4375-4384.
[7]WARBOYS C M,AMINI N,DE LUCA A,et al.The role of blood flow in determining the sites of atherosclerotic plaques[J].F1000Med Rep,2011(3):5.
[8]RAVENSBERGEN J,RAVENSBERGEN J W,KRIJGER J K,et al.Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries[J].Arterioscler Thromb Vasc Biol,1998,18(5):708-716.
[9]ASAKURA T,KARINO T.Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries[J].Circ Res,1990(66):1045-1066.
[10]WOO K V,QU X,BABAEV V R,et al.Tie1attenuation reduces murine atherosclerosis in a dose-dependent and shear stress-specific manner[J].Journal of Clinical Investigation,2011,121(4):1624-1635.
[11]RAVENSBERGEN J,RAVENSBERGEN J W,KRIJGER J K,et al.Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries[J].Arterioscler Thromb Vasc Biol,1998(18):708-716.
[12]YL?-HERTTUALA S.Stabilisation of atherosclerotic plaques:an update[J].Eur Heart J,2013(34):3251-3258.
[13]ZAKKAROFF C,MOORE S,DOWDING S,et al.T 3Dtime-varying simulations of dynamics in arterial coupled cells:a massively parallel implementation[J].Numer Method Biomed Eng,2016,6(7):723-733.
[14]MICHEL FéLéTOU,RALF K?HLER,VANHOUTTE P M.Nitric oxide:orchestrator of endothelium-dependent responses[J].Annals of Medicine,2012,44(7):23.
[15]ZARBOCK A,LEY K.Mechanisms and consequences of neutrophil interaction with the endothelium[J].American Journal of Pathology,2008,172(1):1-7.
[16]OHURA N,YAMAMOTO K,ICHIOKA S,et al.Global analysis of shear stress-responsive genes in vascular endothelial cells[J].Journal of Atherosclerosis and Thrombosis,2003,10(5):304-313.
[17]姜盛强,庄明华.动脉粥样硬化血流动力学的研究进展[J].中国现代医生,2010,48(36):11-12;36.
[18]CARO C G,FITZ-GERALD J M,SCHROTER R C.Arterial wall shear and distribution of early atheroma in man[J].Nature,1999,12(233):1159-1161.
[19]THAEHER T N,GAMBILLARA V,RICHE F,et al.Regulation of arginase pathway in response to wall shear stress[J].Atheresclerosis,2010,210(1):63-70.
[20]TSAO P S,WANG B,BUITRAGO R,et al.Nitric oxide regulates monocyte chemotactic protein[J].Circulation,1997,96(3):934-940.
[21]CIEHA I,BERONOV K,RAMIREZ E L,et al.Shear stress preconditioning modulates endothelial susceptibility to circulating TNF-alpha and monocytic celI recruitment in a simplified model of arterial bifurcations[J].Atherosclerosis,2009,207(1):93-102.
[22]危当恒,王贵学.血流剪切应力与动脉粥样硬化[J].中南医学科学杂志,2012,40(3):217-222.
[23]WEI D H,WANG G X,TANG C J,et al.Stromal derived factor-1expression is up-regulated in atherosclerosis lesions induced by low density lipoprotein concentration polarization[J].Ann Biomed Eng,2012,40(5):1018-1027.
[24]FENNING R S,WILENSKY R L.New insights into the vulnerable plaque from imaging studies[J].Current Atherosclerosis Reports,2014,16(3):397.
[25]KRAMS R,CHENG C,HELDERMAN F,et al.Shear stress is associated with markers of plaque vulnerability and MMP-9activity[J].Eurointervention Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,2006,2(2):250.
[26]MAUROVICH-HORVAT PáI,FERENCIK M,VOROS S,et al.Comprehensive plaque assessment by coronary CT angiography[J].Nature Reviews Cardiology,2014,11(7):390-402.
[27]CHENG C.Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stres[J].Circulation,2006(113):2744-2753.
[28]危当恒,夏敏,贾小英,等.组织蛋白酶L在动脉粥样硬化病变中的表达以及对巨噬细胞脂质蓄积的影响[J].中国动脉硬化杂志,2011,19(12):963-968.
[29]CHATZIZISIS Y S,BAKER A B,SUKHOVA G K,et al.Augmented expression and activity of extracellular matrix-degrading enzymes in regions of low endothelial shear stress colocalize with coronary atheromata with thin fibrous caps in pigs[J].Circulation,2016,123(6):621.
[30]SAMADY H,ESHTEHARDI P,MCDANIEL M C,et al.Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease[J].Circulation,2011,124(7):779-788.
[31]GIJSEN F J H,MASTIK F,SCHAAR J A,et al.High shear stress induces a strain increase in human coronary plaques over a6-month period[J].Eurointervention,2011,7(1):121-127.
[32]PARK J B,CHOI G,CHUN E J,et al.Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics[J].Heart,2016,102(20):1655.
[33]LOVETT J K,ROTHWELL P M.Site of carotid plaque ulceration in relation to direction of blood flow:an angiographic and pathological study[J].Cerebrovasc Dis,2003,10(16):369-375.
[34]DIRKSEN M T,VAN DER WAL A C,VAN DEN BERG F M,et al.Distribution of inflammatory cells in atherosclerotic plaques relates to the direction of flow[J].Circulation,1998,98(19):2000-2003.
[35]KOSKINAS K C,SUKHOVA G K,BAKER A B,et al.Thincapped atheromata with reduced collagen content in pigs develop in coronary arterial regions exposed to persistently low endothelial shear stress[J].Arteriosclerosis,Thrombosis,and Vascular Biology,2013,33(7):1494-1504.
[36]BJ?RN F,RYNDEL M,KJELLDAHL J,et al.Differences in lesion severity and cellular composition between in vivo assessed upstream and downstream sides of human symptomatic carotid atherosclerotic plaques[J].Journal of Vascular Research,2010,47(3):221-230.
[37]FUKUMOTO Y,HIRO T,FUJII T,et al.Localize delevation of shear stress is related to coronary plaque rupture:a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution[J].J Am Coll Cardiol,2008(51):645-650.
[38]DOLAN J M,KOLEGA J,MENG H.High wall shear stress and spatial gradients in vascular pathology:a review[J].Ann Biomed Eng,2013(41):1411-1427.
[39]CHOI G,LEE J M,KIM H J,et al.Coronary artery axial plaque stress and its relationship with lesion geometry:application of computational fluid dynamics to coronary CT angiography[J].JACC Cardiovasc Imaging,2015,8(10):1156-1166.
[40]STONE P H,COSKUN A U.Conceptualnew biomechanical approaches to identify coronary plaques at risk of disruption[J].JACC Cardiovasc Imaging,2015,8(10):1167-1169.
[41]杨俊杰,杨晓波,荆晶,等.冠状动脉粥样硬化病变流体力学无创评估的初步研究[J].中华心血管病杂志,2017,45(8):716-721.
[42]TAYLOR C A,STEINMAN D A.Image-based modeling of blood flow and vessel wall dynamics:applications,methods and future directions[J].Annals of Biomedical Engineering,2010,38(3):1188-1203.
[43]SAMADY H,ESHTEHARDI P,MCDANIEL M C,et al.Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease[J].Circulation,2011,124(7):779-788.
[44]GIJSEN F J H,WENTZEL J J,THURY A,et al.Strain distribution over plaques in human coronary arteries relates to shear stress[J].American Journal of Physiology Heart&Circulatory Physiology,2008,295(4):H1608.
[45]HUANG D,MURAMATSU T,LI Y,et al.Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography:comparison with invasive coronary angiography[J].International Journal of Cardiovascular Imaging,2017,33(7):1101-1110.
[46]TAKX R A P,BLOMBERG B A,AIDI H E,et al.Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis[J].Circulation:Cardiovascular Imaging,2015,8(1):e002666.
[47]NEWHOUSE J H,MURPHY RX Jr.Tissue distribution of soluble contrast:effect of dose variation and changes with time[J].AJR Am J Roentgenol,1981,136(3):463-467.
[48]SO A,LEE T Y.Quantitative myocardial CT perfusion:apictorial review and the current state of technology development[J].JCardiovasc Comput Tomogr,2011,5(6):467-481.
[49]霍福涛,苏续清,张维新.CT灌注成像的原理、技术及其临床应用[J].中国CT和MRI杂志,2004,2(2):49-54.
[50]HUBER A M,LEBER V,GRAMER B M,et al.Myocardium:dynamic versus single-shot CT perfusion imaging[J].Radiology,2013,269(2):378-386.
[51]ARNOLDI E,LEE Y S,RUZSICS B,et al.CT detection of myocardial blood volume deficits:dual-energy CT compared with singleenergy CT spectra[J].J Cardiovasc Comput Tomogr,2011,5(6):421-429.
[52]BAMBERG F,MARCUS R P,Becker A,et al.Dynamic myocardial CT perfusion imaging for evaluation of myocardial ischemia as determined by MR imaging[J].JACC Cardiovasc Imaging,2014,7(3):267-277.
[53]冠状动脉血流储备分数临床应用专家共识专家组.冠状动脉血流储备分数临床应用专家共识[J].中华心血管病杂志,2016,44(4):292-297.
[54]KIM Y H,Park S J.Ischemia-guided percutaneous coronary intervention for patients with stable coronary artery disease[J].Circ J,2013,77(8):1967-1974.
[55]DE BRUYNE B,PIJLS N H,KALESAN B,et al.Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease[J].New England Journal of Medicine,2012,367(11):991-1001.
[56]KIM H J,VIGNON-CLEMENTEL I E,COOGAN J S,et al.Patient-specific modeling of blood flow and pressure in human coronary arteries[J].Ann Biomed Eng,2010,38(10):3195-3209.
[57]SHARMA P,ITU L,ZHENG X,et al.A framework for personalization of coronary flow computations during rest and hyperemia[C].Engineering in Medicine&Biology Society,Conf Proc IEEE Eng Med Biol Soc,2012:1.
[58]COENEN A,LUBBERS M M,KURATA A,et al.Fractional flow reserve computed from noninvasive CT angiography data:diagnostic performance of an on-site clinician operated computational fluid dynamics algorithm[J].Radiology,2015,274(3):674-683.