Hu Xiyang, Zhang Wei, Zhao Nairui, Zhao Rongcheng, Li Shuofeng
Department of Radiology, Cangzhou Central Hospital, Hebei, 061000, Cangzhou, China.
Department of Radiology, Cangzhou Hospital of Integrated Traditional and Western Medicine, Hebei, 061000, Cangzhou, China.
Oncotarget. 2017 Dec 21;9(7):7727-7738. doi: 10.18632/oncotarget.23558. eCollection 2018 Jan 26.
Coronary computed tomography angiography (CCTA) is a noninvasive test for detection and analysis of coronary plaques morphology and classification. The low- to high-density lipoprotein cholesterol (L/H) ratio is associated with plaques vulnerability. The study aims to investigate the diagnostic accuracy of CCTA and L/H ratio for plaques classification. We enrolled 212 patients with coronary artery single-vessel disease who performed preoperative CCTA and Intravascular ultrasound (IVUS)-guided invasive coronary angiography. Patients were assigned to the acute coronary syndrome (ACS) group ( 129) and stable angina pectoris (SAP) group ( 83). CCTA showed that patients with ACS had more soft plaque and less calcific plaque than those with SAP. The plaque volume and remodeling index measured by CCTA showed good correlation with those measured by IVUS. IVUS identified 91 soft, 58 mixed and 63 calcific plaques in this cohort. For diagnosis of noncalcified plaque (soft and mixed), CCTA had the sensitivity and specificity of 87.9% and 90.4%, respectively. While refer to the further diagnosis of mixed plaque from noncalcified plaque, the sensitivity and specificity was 88.4% and 88.8%, respectively. The L/H ratio was gradually decreased from soft plaque to calcific plaque. If the patients had both the two characteristics (L/H ≥ 2.55 and CCTA), the sensitivity, and specificity were improved in diagnosing noncalcified plaque or mixed plaque. In conclusion, a combined application of CCTA and L/H ratio improves the diagnostic accuracy for coronary noncalcified plaque or mixed plaque as compared to CCTA along.
冠状动脉计算机断层扫描血管造影（CCTA）是一种用于检测和分析冠状动脉斑块形态及分类的无创检查。低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值（L/H）与斑块易损性相关。本研究旨在探讨CCTA及L/H比值对斑块分类的诊断准确性。我们纳入了212例冠状动脉单支血管病变患者，这些患者均接受了术前CCTA及血管内超声（IVUS）引导下的有创冠状动脉造影。患者被分为急性冠状动脉综合征（ACS）组（129例）和稳定型心绞痛（SAP）组（83例）。CCTA显示，ACS患者的软斑块多于SAP患者，钙化斑块少于SAP患者。CCTA测量的斑块体积和重构指数与IVUS测量的结果具有良好的相关性。在该队列中，IVUS识别出91个软斑块、58个混合斑块和63个钙化斑块。对于非钙化斑块（软斑块和混合斑块）的诊断，CCTA的敏感性和特异性分别为87.9%和90.4%。而对于从非钙化斑块中进一步诊断混合斑块，敏感性和特异性分别为88.4%和88.8%。L/H比值从软斑块到钙化斑块逐渐降低。如果患者同时具备这两个特征（L/H≥2.55和CCTA），则在诊断非钙化斑块或混合斑块时，敏感性和特异性会提高。总之，与单独使用CCTA相比，联合应用CCTA和L/H比值可提高冠状动脉非钙化斑块或混合斑块的诊断准确性。
