Henein Michael Y, Bengrid Tarek, Nicoll Rachel, Zhao Ying, Johansson Bengt, Schmermund Axel
Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden.
Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Int J Cardiol Heart Vasc. 2016 Dec 28;14:41-45. doi: 10.1016/j.ijcha.2016.12.001. eCollection 2017 Mar.
The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients.
Retrospective analysis of 120 patients (age 65.1 ± 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography. Patients were divided into those with high-grade (HG) stenosis (n = 67, age 65.1 ± 9.4 years) and those with no-HG stenosis (n = 53, age 65.1 ± 8.6 years).
There were more males with HG stenosis (82.1% vs. 62.3%, = 0.015), in whom the percentage and number of abnormal perfusion segments were higher at rest (37.3% vs. 17%, = 0.014) but not different with stress ( = 0.83) from those with no-HG stenosis. Thirty-four patients had myocardial perfusion abnormalities at rest and 26 patients developed perfusion defects with stress. Stress-induced myocardial perfusion defects were 22.4% sensitive and 79.2% specific for detecting HG stenosis. The CAC score was lower in patients with no-HG stenosis compared to those with HG stenosis ( < 0.0001). On the ROC curve, a CAC score of 293 had a sensitivity of 71.6% and specificity of 83% in predicting HG stenosis [(AUC 0.80 ( < 0.0001)]. A CAC score of 293 or the presence of at least 1 segment myocardial perfusion abnormality was 74.6% sensitive and 71.7% specific in detecting HG stenosis, the respective values for the 2 abnormalities combined being 19.4% and 90.6%. The severity of CAC correlated with the extent of myocardial perfusion in the patient group as a whole with stress ( = 0.22, = 0.015), particularly in those with no-HG stenosis ( = 0.31, = 0.022). A CAC score of 293 was 31.6% sensitive and 87.3% specific in detecting myocardial perfusion abnormalities.
In a group of patients with exertional angina, coronary calcification is more accurate in detecting high-grade luminal stenosis than myocardial perfusion defects. In addition, in patients with no stenosis, the incremental relationship between coronary calcium score and the extent of myocardial perfusion suggests coronary wall hardening as an additional mechanism for stress-induced angina other than luminal narrowing. These preliminary findings might have a clinical impact on management strategies of these patients other than conventional therapy.
本研究旨在评估一组有症状患者中，通过多排螺旋计算机断层扫描（MDCT）评估的冠状动脉钙化（CAC）与通过心脏磁共振成像（CMR）评估的心肌灌注之间的关系。
回顾性分析2007年至2010年间在德国法兰克福贝塔尼恩医院因非典型胸痛就诊的120例患者（年龄65.1±8.9岁，男性88例），这些患者接受了MDCT、CMR和传统冠状动脉造影的CAC评分。患者分为重度（HG）狭窄组（n = 67，年龄65.1±9.4岁）和无HG狭窄组（n = 53，年龄65.1±8.6岁）。
HG狭窄组男性更多（82.1%对62.3%，P = 0.015），其中静息时异常灌注节段的百分比和数量更高（37.3%对17%，P = 0.014），但与无HG狭窄组相比，负荷时无差异（P = 0.83）。34例患者静息时存在心肌灌注异常，26例患者负荷时出现灌注缺损。负荷诱导的心肌灌注缺损检测HG狭窄的敏感性为22.4%，特异性为79.2%。无HG狭窄组的CAC评分低于HG狭窄组（P < 0.0001）。在ROC曲线上，CAC评分为293时预测HG狭窄的敏感性为71.6%，特异性为83%[曲线下面积0.80（P < 0.0001）]。CAC评分为293或至少存在1个节段心肌灌注异常检测HG狭窄的敏感性为74.6%，特异性为71.7%，两种异常联合的相应值分别为19.4%和90.6%。在整个患者组中，负荷时CAC的严重程度与心肌灌注范围相关（r = 0.22，P = 0.015），特别是在无HG狭窄的患者中（r = 0.31，P = 0.022）。CAC评分为293时检测心肌灌注异常的敏感性为31.6%，特异性为87.3%。
在一组劳力性心绞痛患者中，冠状动脉钙化检测重度管腔狭窄比心肌灌注缺损更准确。此外，在无狭窄的患者中，冠状动脉钙化评分与心肌灌注范围之间的增量关系表明，除管腔狭窄外，冠状动脉壁硬化是负荷诱导心绞痛的另一种机制。这些初步发现可能对这些患者的管理策略产生临床影响，而不仅仅是传统治疗。
