Tada Hayato, Kawashiri Masa-aki, Okada Hirofumi, Teramoto Ryota, Konno Tetsuo, Yoshimuta Tsuyoshi, Sakata Kenji, Nohara Atsushi, Inazu Akihiro, Kobayashi Junji, Mabuchi Hiroshi, Yamagishi Masakazu, Hayashi Kenshi
Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Am J Cardiol. 2015 Mar 15;115(6):724-9. doi: 10.1016/j.amjcard.2014.12.034. Epub 2015 Jan 6.
The aims of this study were (1) to determine whether the accumulation of coronary plaque burden assessed with coronary computed tomography angiography (CCTA) can predict future events and (2) to estimate the onset and progression of coronary atherosclerosis in patients with familial hypercholesterolemia (FH). Consecutive 101 Japanese patients with heterozygous FH (men = 52, mean age 56 ± 16 years, mean low-density lipoprotein cholesterol 264 ± 58 mg/dl) who underwent 64-detector row CCTA without known coronary artery disease were retrospectively evaluated by assigning a score (0 to 5) to each of 17 coronary artery segments according to the Society of Cardiovascular Computed Tomography guidelines. Those scores were summed and subsequently natural log transformed. The periods to major adverse cardiac events (MACE) were estimated using multivariable Cox proportional hazards models. During the follow-up period (median 941 days), 21 MACE had occurred. Receiver operating characteristic curve analyses identified a plaque burden score of 3.35 (raw score 28.5) as the optimal cutoff for predicting a worse prognosis. Multivariate Cox regression analysis identified the presence of a plaque score ≥3.35 as a significant independent predictor of MACE (hazard ratio = 3.65; 95% confidence interval 1.32 to 25.84, p <0.05). The regression equations were Y = 0.68X - 15.6 (r = 0.54, p <0.05) in male and Y = 0.74X - 24.8 (r = 0.69, p <0.05) in female patients with heterozygous FH. In conclusion, coronary plaque burden identified in a noninvasive, quantitative manner was significantly associated with future coronary events in Japanese patients with heterozygous FH and that coronary atherosclerosis may start to develop, on average, at age 23 and 34 years in male and female patients with heterozygous FH, respectively.
（1）确定通过冠状动脉计算机断层扫描血管造影（CCTA）评估的冠状动脉斑块负荷的累积是否能够预测未来事件；（2）评估家族性高胆固醇血症（FH）患者冠状动脉粥样硬化的发病及进展情况。对101例连续接受64排探测器CCTA检查且无已知冠状动脉疾病的日本杂合子FH患者（男性52例，平均年龄56±16岁，平均低密度脂蛋白胆固醇264±58mg/dl）进行回顾性评估，根据心血管计算机断层扫描协会指南，对17个冠状动脉节段分别进行评分（0至5分）。将这些分数相加，随后进行自然对数转换。使用多变量Cox比例风险模型估计发生主要不良心脏事件（MACE）的时间。在随访期（中位时间941天）内，发生了21例MACE。受试者工作特征曲线分析确定斑块负荷评分为3.35（原始分数28.5）是预测预后较差的最佳临界值。多变量Cox回归分析确定斑块评分≥3.35是MACE的显著独立预测因子（风险比=3.65；95%置信区间1.32至25.84，p<0.05）。在杂合子FH男性患者中，回归方程为Y = 0.68X - 15.6（r = 0.54，p<0.05），在杂合子FH女性患者中为Y = 0.74X - 24.8（r = 0.69，p<0.05）。总之，以无创、定量方式确定的冠状动脉斑块负荷与日本杂合子FH患者未来的冠状动脉事件显著相关，并且杂合子FH男性和女性患者的冠状动脉粥样硬化平均分别在23岁和34岁开始发展。
