Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Nucl Med Mol Imaging. 2013 Aug;40(8):1171-80. doi: 10.1007/s00259-013-2437-4. Epub 2013 May 29.
Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT).
Included in the study were 40 patients (mean age 58.2 ± 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS ≥2) on gated myocardial perfusion SPECT.
Myocardial ischaemia was seen in 25 patients (62.5%) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95% CI 2.41-24.7, p < 0.001, and OR 1.07, 95% CI 1.00-1.45, p = 0.032, respectively) after correcting for clinical variables and visually assessed significant stenosis. The addition of quantitatively assessed significant stenosis (χ(2) = 20.7) and lesion length (χ(2) = 26.0) to the clinical variables and the visual assessment (χ(2) = 5.9) had incremental value in the association with myocardial ischaemia.
Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have incremental value over baseline variables and visually assessed significant stenosis. Potentially, QCT can refine assessment of CAD, which may be of potential use for identification of patients with myocardial ischaemia.
自动化软件工具使冠状动脉 CT 血管造影（CTA）数据的狭窄程度、斑块负荷和斑块位置的更全面、更强大和更具可重复性的定量分析成为可能。这些定量 CTA（QCT）参数与心肌缺血之间的关联尚未得到探索。本研究旨在评估冠状动脉病变的 QCT 参数与门控心肌灌注单光子发射 CT（SPECT）上存在心肌缺血之间的关联。
本研究纳入了 40 名（平均年龄 58.2 ± 10.9 岁，27 名男性）患有已知或疑似冠状动脉疾病（CAD）的患者，这些患者在 6 个月内接受了多排 CT 血管造影和门控心肌灌注 SPECT。从 CTA 数据集进行基于血管和基于病变的视觉分析。随后，进行基于病变的 QCT 以评估斑块长度、斑块负荷、管腔面积狭窄百分比和重构指数。随后，使用门控心肌灌注 SPECT 的总和差值评分（SDS≥2）评估心肌缺血的存在。
37 个血管区域中有 25 名（62.5%）患者存在心肌缺血。定量评估的显著狭窄和定量评估的病变长度与心肌缺血独立相关（OR 7.72，95%CI 2.41-24.7，p<0.001，和 OR 1.07，95%CI 1.00-1.45，p=0.032），校正临床变量和视觉评估的显著狭窄后。定量评估的显著狭窄（χ²=20.7）和病变长度（χ²=26.0）与临床变量和视觉评估（χ²=5.9）的联合增加了与心肌缺血的关联。
冠状动脉病变长度和定量评估的显著狭窄与心肌缺血独立相关。这两个定量参数在与心肌缺血的关联中具有超过基线变量和视觉评估的显著狭窄的增量价值。定量 CTA 可能可以改善 CAD 的评估，这可能对识别存在心肌缺血的患者具有潜在的应用价值。
