2024 年第 11 期 第 19 卷

冠状动脉CT血管造影血管和斑块特征评估冠心病心肌缺血的效能

The efficacy of vascular and plaque characteristics of coronary CT angiography in evaluating myocardial ischemia in coronary atherosclerotic heart disease

作者：史彪阮维圣马晓璇

英文作者：Shi Biao Ruan Weisheng Ma Xiaoxuan

单位：河北省张家口市第一医院CT室，张家口075000

英文单位：CT Room Zhangjiakou First Hospital Hebei Province Zhangjiakou 075000 China

关键词：冠状动脉疾病；CT血管成像；狭窄率；斑块特征；心肌缺血

英文关键词：

• 摘要：

• 目的 分析冠状动脉CT血管造影（CCTA）血管和斑块特征评估冠心病（冠状动脉粥样硬化性心脏病）心肌缺血的效能。方法 回顾性分析2021年11月至2023年10月河北省张家口市第一医院收治的70例疑似或者确认为冠心病并行侵入性冠状动脉造影（ICA）的患者的临床资料，所有患者依次进行了CCTA、ICA以及血流储备分数（FFR）检查。以ICA引导下经压力导丝测量的心肌FFR为金标准，将所有病变血管分为缺血组（FFR≤0.8）和非缺血组（FFR＞0.8）2组，其中缺血组32例（37支病变血管），非缺血组38例（44支病变血管）。比较2组病变血管的斑块特征（斑块负荷、非钙化斑块体积百分比、钙化体积百分比、病变长度、斑块高危征象）以及左主干、前降支、右冠状动脉等部位动脉狭窄程度，应用Logistic回归分析CCTA狭窄率及斑块特征与心肌缺血病变的关系，采用受试者工作特征曲线评估不同指标对心肌缺血病变的诊断效能。结果 缺血组CT高危斑块、餐巾环征发生率均高于非缺血组，而低密度斑块、正性重构发生率均低于非缺血组（均P＜0.05）。2组患者动脉狭窄程度比较差异有统计学意义（Z=9.275，P＜0.001）。多因素Logistic回归分析结果显示，导致心肌缺血的危险因素包括CCTA狭窄率、病变长度和CT高危斑块（比值比=3.796、1.029、2.463，均P＜0.05）。CCTA（≥50%狭窄）与CT高危斑块、病变长度联合诊断的效能高于CCTA（≥50%狭窄）和ICA（≥50%狭窄）单独诊断（曲线下面积：0.715比0.626、0.665，均P＜0.05）。结论 冠心病心肌缺血的预测因素包括CCTA狭窄率、病变长度和CT高危斑块，三者联合应用可以较大程度地提升对心肌缺血病变的诊断效能。

• Objective To analyze the efficacy of vascular and plaque characteristics of coronary computed tomography angiography (CCTA) in evaluating myocardial ischemia in patients with coronary atherosclerotic heart disease (CHD). Methods The clinical data of 70 patients with suspected or confirmed CHD who underwent invasive coronary angiography (ICA) in Zhangjiakou First Hospital, Hebei Province from November 2021 to October 2023 were retrospectively analyzed. All patients underwent CCTA, ICA and fractional flow reserve (FFR) examination in turn. Myocardial FFR measured by pressure guidewire under ICA guidance was used as the gold standard, and all diseased vessels were divided into the ischemia group (FFR≤0.8) and the non-ischemia group (FFR>0.8), including 32 patients (37 diseased vessels) in the ischemia group and 38 patients (44 diseased vessels) in the non-ischemia group. The plaque characteristics (plaque burden, non-calcified plaque volume percentage, calcified plaque volume percentage, lesion length, high-risk signs of plaque) and the degree of arterial stenosis in left main coronary artery, anterior descending artery, right coronary artery were compared between the two groups. Logistic regression analysis was used to analyze the relationship between CCTA stenosis rate, plaque characteristics and myocardial ischemic lesions. The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of different indicators for myocardial ischemic lesions. Results The incidences of CT high-risk plaque and napkin ring sign in the ischemia group were higher than those in the non-ischemia group, while the incidences of low-density plaque and positive remodeling were lower than those in the non-ischemia group (all P＜ 0.05). There was a significant difference in the degree of arterial stenosis between the two groups (Z=9.275, P＜0.001). Multivariate Logistic regression analysis showed that the risk factors of myocardial ischemia included CCTA stenosis rate, lesion length and CT high-risk plaque (odds ratio=3.796, 1.029, 2.463, respectively; all P＜0.05). The diagnostic efficacy of CCTA (≥50% stenosis) combined with CT high-risk plaque and lesion length was higher than that of CCTA (≥50% stenosis) or ICA (≥50% stenosis) alone (area under the curve: 0.715 vs 0.626, 0.665, both P＜0.05). Conclusion The predictive factors of myocardial ischemia in CHD include CCTA stenosis rate, lesion length and CT high-risk plaque. The combined application of the three can greatly improve the diagnostic efficiency of myocardial ischemia.