Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
JACC Cardiovasc Imaging. 2009 Nov;2(11):1262-70. doi: 10.1016/j.jcmg.2009.07.007.
We sought to describe the progression of coronary atherosclerotic plaque over time by computed tomography (CT) angiography stratified by plaque composition and its association with cardiovascular risk profiles.
Data on the progression of atherosclerosis stratified by plaque composition with the use of noninvasive assessment by CT are limited and hampered by high measurement variability.
This analysis included patients who presented with acute chest pain to the emergency department but initially showed no evidence of acute coronary syndromes. All patients underwent contrast-enhanced 64-slice CT at baseline and after 2 years with the use of a similar protocol. CT datasets were coregistered and assessed for the presence of calcified and noncalcified plaque at 1 mm cross sections of the proximal 40 mm of each major coronary artery. Plaque progression over time and its association with risk factors were determined. Measurement reproducibility and correlation to plaque volume was performed in a subset of patients.
We included 69 patients (mean age 55 +/- 12 years, 59% male patients) and compared 8,311 coregistered cross sections at baseline and follow-up. At baseline, any plaque, calcified plaque, and noncalcified were detected in 12.5%, 10.1%, and 2.4% of cross sections per patient, respectively. There was significant progression in the mean number of cross sections containing any plaque (16.5 +/- 25.3 vs. 18.6 +/- 25.5, p = 0.01) and noncalcified plaque (3.1 +/- 5.8 vs. 4.4 +/- 7.0, p = 0.04) but not calcified plaque (13.3 +/- 23.1 vs. 14.2 +/- 22.0, p = 0.2). In longitudinal regression analysis, the presence of baseline plaque, number of cardiovascular risk factors, and smoking were independently associated with plaque progression after adjustment for age, sex, and follow-up time interval. The semiquantitative score based on cross sections correlated closely with plaque volume progression (r = 0.75, p < 0.0001) and demonstrated an excellent intraobserver and interobserver agreement (kappa = 0.95 and kappa = 0.93, respectively).
Coronary plaque burden of patients with acute chest pain significantly increases during the course of 2 years. Progression over time is dependent on plaque composition and cardiovascular risk profile. Larger studies are needed to confirm these results and to determine the effect of medical treatment on progression.
我们通过计算机断层（CT）血管造影术对斑块成分进行分层，以描述冠状动脉粥样硬化斑块随时间的进展，并探讨其与心血管风险特征的关系。
使用 CT 进行非侵入性评估时，有关动脉粥样硬化进展的斑块成分数据有限，且受高度测量变异性的限制。
该分析纳入了因急性胸痛就诊于急诊科但最初无急性冠状动脉综合征证据的患者。所有患者均在基线和 2 年后接受对比增强 64 层 CT 检查，使用相似的方案。将 CT 数据集配准，并在近端 40mm 每个主要冠状动脉的 1mm 横截面上评估钙化和非钙化斑块的存在情况。确定随时间推移的斑块进展及其与危险因素的关系。在部分患者中评估测量的可重复性和与斑块体积的相关性。
我们纳入了 69 例患者（平均年龄 55±12 岁，59%为男性），比较了基线和随访时的 8311 个配准的横切面。基线时，每位患者的横切面上分别有 12.5%、10.1%和 2.4%存在任何斑块、钙化斑块和非钙化斑块。平均含任何斑块（16.5±25.3 比 18.6±25.5，p=0.01）和非钙化斑块（3.1±5.8 比 4.4±7.0，p=0.04）的横切面数量显著增加，但钙化斑块（13.3±23.1 比 14.2±22.0，p=0.2）无显著增加。在纵向回归分析中，基线时存在斑块、心血管危险因素数量和吸烟与年龄、性别和随访时间间隔调整后的斑块进展独立相关。基于横切面的半定量评分与斑块体积进展密切相关（r=0.75，p<0.0001），并且观察者内和观察者间的一致性均很好（kappa=0.95 和 kappa=0.93）。
急性胸痛患者的冠状动脉斑块负担在 2 年内显著增加。随时间的进展取决于斑块成分和心血管风险特征。需要更大的研究来证实这些结果，并确定药物治疗对进展的影响。
