Rizvi Asim, Hartaigh Bríain Ó, Danad Ibrahim, Han Donghee, Lee Ji Hyun, Gransar Heidi, Szymonifka Jackie, Lin Fay Y, Min James K
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Atherosclerosis. 2017 Mar;258:145-151. doi: 10.1016/j.atherosclerosis.2017.01.018. Epub 2017 Jan 16.
Coronary computed tomography angiography (CCTA) permits effective identification of diffuse CAD and atherosclerotic plaque characteristics (APCs). We sought to examine the usefulness of diffuse CAD beyond luminal narrowing and APCs by CCTA to detect vessel-specific ischemia.
407 vessels (n = 252 patients) from the DeFACTO diagnostic accuracy study were retrospectively analyzed for percent plaque diffuseness (PD). Percent plaque diffuseness (PD) was obtained on per-vessel level by summation of all contiguous lesion lengths and divided by total vessel length, and was logarithmically transformed (log percent PD). Additional CCTA measures of stenosis severity including minimal lumen diameter (MLD), and APCs, such as positive remodeling (PR) and low attenuation plaque (LAP), were also included. Vessel-specific ischemia was defined as fractional flow reserve (FFR) ≤0.80. Multivariable regression, discrimination by area under the receiver operating characteristic curve (AUC), and category-free net reclassification improvement (cNRI) were assessed.
Backward stepwise logistic regression revealed that for every unit increase in log percent PD, there was a 58% (95% CI: 1.01-2.48, p = 0.048) rise in the odds of having an abnormal FFR, independent of stenosis severity and APCs. The AUC indicated no further improvement in discriminatory ability after adding log percent PD to the final parsimonious model of MLD, PR, and LAP (AUC difference: 0.003, 95% CI: -0.003-0.010, p = 0.33). Conversely, adding log percent PD to the base model of MLD, PR, and LAP improved cNRI by 0.21 (95% CI: 0.01-0.41, p < 0.001).
Accounting for diffuse CAD may help improve the accuracy of CCTA for detecting vessel-specific ischemia.
冠状动脉计算机断层扫描血管造影（CCTA）能够有效识别弥漫性冠状动脉疾病（CAD）及动脉粥样硬化斑块特征（APC）。我们试图通过CCTA研究弥漫性CAD在管腔狭窄和APC之外对检测血管特异性缺血的作用。
对来自DeFACTO诊断准确性研究的407条血管（n = 252例患者）进行回顾性分析，以获取斑块弥漫程度百分比（PD）。通过将所有连续病变长度相加并除以血管总长度，在每条血管水平上获得斑块弥漫程度百分比（PD），并进行对数转换（log PD%）。还纳入了其他CCTA狭窄严重程度测量指标，如最小管腔直径（MLD），以及APC指标，如阳性重塑（PR）和低密度斑块（LAP）。血管特异性缺血定义为血流储备分数（FFR）≤0.80。评估多变量回归、受试者操作特征曲线下面积（AUC）的辨别能力以及无类别净重新分类改善（cNRI）。
向后逐步逻辑回归显示，log PD%每增加一个单位，FFR异常的几率增加58%（95%CI：1.01 - 2.48，p = 0.048），与狭窄严重程度和APC无关。AUC表明，在将log PD%添加到MLD、PR和LAP的最终简约模型后，辨别能力没有进一步改善（AUC差异：0.003，95%CI： - 0.003 - 0.010，p = 0.33）。相反，将log PD%添加到MLD、PR和LAP的基础模型中，cNRI提高了0.21（95%CI：0.01 - 0.41，p < 0.001）。
考虑弥漫性CAD可能有助于提高CCTA检测血管特异性缺血的准确性。
