Diaz-Zamudio Mariana, Fuchs Tobias A, Slomka Piotr, Otaki Yuka, Arsanjani Reza, Gransar Heidi, Germano Guido, Berman Daniel S, Kaufmann Philipp A, Dey Damini
Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
Eur Heart J Cardiovasc Imaging. 2017 May 1;18(5):499-507. doi: 10.1093/ehjci/jew274.
We aimed to investigate whether quantitative plaque features measured from coronary CT angiography (CCTA) predict ischemia by myocardial perfusion SPECT imaging (MPI).
Hundred and eighty-four consecutive patients (63% males) with suspected-coronary artery disease, undergoing hybrid CCTA, and attenuation corrected solid state 99mTc stress/rest MPI and single vessel ischemia were considered. Quantitative analysis of CCTA derived non-calcified plaque (NCP), low-density NCP [< 30 Hounsfield Units (HU)] (LDNCP), calcified and total plaque burdens (%, normalized to vessel volume), maximum diameter stenosis and contrast density difference (CD, maximum difference in HU/lumen area within lesion). Normal thresholds for plaque features were defined as 95th percentile thresholds, from 40% of vessels with non-ischemic MPI regions. These vessels were excluded from further analysis. Regional ischemia (≥ 2%) was quantified from MPI. All plaque features were higher in arteries corresponding to ischemia (P < 0.003 for all). In multi-variable analysis, abnormal NCP burden [odds ratio (OR) 2.6], LDNCP burden (OR 3.9), and CD (OR 2.7) were significantly associated with ischemia, whereas stenosis ≥ 50% was not (P = 0.14). In a subset of vessels with ≥ 50% stenosis, LDNCP burden (OR 4.3, P = 0.008) and CD (OR 3.7, P = 0.029) were associated with ischemia. In subsets of vessels with stenosis 30-69% and ≥ 70%, abnormal LDNCP burden (OR 6.4, P = 0.006) and CD (OR 7.3, P = 0.02) were associated with ischemia.
Quantitative plaque features obtained from CCTA, LDNCP, and CD, are associated with ischemia by MPI independent of stenosis. LDNCP burden and CD are associated with ischemia in stenosis 30-69% and ≥ 70%, respectively.
我们旨在研究从冠状动脉CT血管造影（CCTA）测量的定量斑块特征是否能通过心肌灌注SPECT成像（MPI）预测心肌缺血。
连续纳入184例疑似冠心病患者（63%为男性），这些患者接受了混合CCTA检查，并进行了衰减校正的固态99mTc负荷/静息MPI检查，且存在单支血管缺血。对CCTA得出的非钙化斑块（NCP）、低密度NCP[<30亨氏单位（HU）]（LDNCP）、钙化和总斑块负荷（%，以血管体积标准化）、最大直径狭窄以及对比剂密度差异（CD，病变内HU/管腔面积的最大差异）进行定量分析。斑块特征的正常阈值定义为第95百分位数阈值，来自具有非缺血性MPI区域的40%的血管。这些血管被排除在进一步分析之外。从MPI定量分析区域缺血（≥2%）情况。所有斑块特征在对应缺血的动脉中均更高（所有P<0.003）。在多变量分析中，异常NCP负荷[比值比（OR）2.6]、LDNCP负荷（OR 3.9）和CD（OR 2.7）与缺血显著相关，而狭窄≥50%则不然（P=0.14）。在狭窄≥50%的血管亚组中，LDNCP负荷（OR 4.3，P=0.008）和CD（OR 3.7，P=0.029）与缺血相关。在狭窄30 - 69%和≥70%的血管亚组中，异常LDNCP负荷（OR 6.4，P=0.006）和CD（OR 7.3，P=0.02）与缺血相关。
从CCTA获得的定量斑块特征，即LDNCP和CD，与MPI显示的缺血相关，且独立于狭窄情况。LDNCP负荷和CD分别与狭窄30 - 69%和≥70%时的缺血相关。
