From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Radiology. 2015 Jul;276(1):73-81. doi: 10.1148/radiol.15141110. Epub 2015 Feb 26.
To determine the risk-stratification ability of plaque volume and composition assessment with cardiac computed tomographic (CT) angiography and high-sensitivity troponin T (hsTnT) in patients at intermediate risk for coronary artery disease (CAD).
The study complied with the Declaration of Helsinki and was approved by the local ethics committee. All patients gave written informed consent. Five hundred twenty-one consecutive patients (mean age ± standard deviation, 62 years ± 10; 256 men and 265 women) were included in this prospective, observational, longitudinal, single-center study. Quantitative cardiac CT angiography analysis was performed in all patients (for 7690 coronary segments), whereas biomarkers (hsTnT and high-sensitivity C-reactive protein) were available in 408 patients (78%). To evaluate the incremental value of cardiac CT angiography and hsTnT for the prediction of cardiovascular events, multivariate Cox regression and integrated discrimination improvement analysis were applied.
In 521 patients, 13 hard cardiac events occurred during a mean follow-up period of 2.3 years ± 1.1 (median, 2.4 years; range, 0.5-4.5 years), while 23 patients underwent late coronary revascularization. The Duke clinical score was 51% ± 30, indicating intermediate risk. The presence of no plaques or purely calcified versus noncalcified plaques, plaque volume according to tertiles, and increased hsTnT (≥14 pg/mL) was independently associated with hard cardiac events (hazard ratio [HR] = 26.08, 95% confidence interval [CI]: 2.78, 244.99; HR = 12.14, 95% CI: 1.87, 78.74; and HR = 10.31, 95% CI: 2.72, 39.0, respectively; P < .01 for all). Patients with increased hsTnT and plaque burden (n = 53) showed the highest incidence for hard cardiac events (annual rate, 12.7%), followed by those with either increased hsTnT or plaque burden (n = 145; annual rate = 0.44%, P < .03), while those with lower hsTnT and plaque burden exhibited excellent outcomes and no hard event during the follow-up duration (n = 210; annual rate = 0%, P < .001).
Use of hsTnT as a marker of myocardial microinjury and cardiac CT angiography as a marker of the total atherosclerotic burden improves the prediction of cardiac outcome in patients with presumably stable CAD and may aid in personalized risk stratification in patients at intermediate risk.
确定心脏 CT 血管造影和高敏肌钙蛋白 T（hsTnT）检测斑块体积和成分评估在有中度冠状动脉疾病（CAD）风险患者中的风险分层能力。
该研究符合赫尔辛基宣言，并得到了当地伦理委员会的批准。所有患者均签署了书面知情同意书。本前瞻性、观察性、纵向、单中心研究共纳入 521 例连续患者（平均年龄±标准差，62 岁±10；男 256 例，女 265 例）。所有患者均进行定量心脏 CT 血管造影分析（共 7690 个冠状动脉节段），而生物标志物（hsTnT 和高敏 C 反应蛋白）则可在 408 例患者（78%）中获得。为了评估心脏 CT 血管造影和 hsTnT 对心血管事件预测的增量价值，应用多变量 Cox 回归和综合鉴别改善分析。
在 521 例患者中，平均随访 2.3 年±1.1 期间（中位数 2.4 年；范围 0.5-4.5 年）发生 13 例硬终点心脏事件，23 例患者接受了晚期冠状动脉血运重建。杜克临床评分 51%±30%，提示为中度风险。无斑块或纯钙化与非钙化斑块、按三分位的斑块体积以及 hsTnT 升高（≥14 pg/ml）与硬终点心脏事件独立相关（风险比[HR]分别为 26.08，95%置信区间[CI]：2.78，244.99；HR = 12.14，95% CI：1.87，78.74；和 HR = 10.31，95% CI：2.72，39.0；P<.01）。hsTnT 升高且斑块负担增加（n=53）的患者发生硬终点心脏事件的发生率最高（年发生率 12.7%），其次是 hsTnT 或斑块负担增加的患者（n=145；年发生率=0.44%，P<.03），而 hsTnT 和斑块负担较低的患者在随访期间表现出极好的结果，无硬终点心脏事件（n=210；年发生率=0%，P<.001）。
将 hsTnT 作为心肌微损伤标志物和心脏 CT 血管造影作为总动脉粥样硬化负担标志物的应用提高了对有疑似稳定型 CAD 患者心脏结局的预测能力，并可能有助于对中度风险患者进行个体化风险分层。
