Division of Cardiology, Department of Medicine, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Copenhagen, Denmark.
Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Eur Heart J Cardiovasc Imaging. 2018 Aug 1;19(8):850-858. doi: 10.1093/ehjci/jey012.
To clarify the potential role of coronary computed tomographic angiography (CCTA) in assessing the remodelling impact of statin therapy on plaque burden and compositions.
A systematic literature review and meta-analysis were conducted to examine the effect of statin therapy on different plaque volumes assessed by serial CCTA. Twelve studies were included with a mean (±standard deviation) follow-up period of 14.5 ± 9.5 months. Data on plaque volume were pooled using weighted mean difference method. Available data on a total of 199 intensive statin therapy receivers, 404 moderate statin therapy receivers and 189 controls (mean age = 62 ± 5 years, male gender = 78%) were meta-analysed. Intensive statin therapy reduced total plaque volume (TPV) by -20.87 [95% confidence interval (CI) -31.17, -10.56; P < 0.001] mm3, while moderate statin therapy reduced it by -1.67 (95% CI -9.99, 6.65; P = 0.69) mm3. In contrast TPV increased significantly in controls by 14.96 (95% CI 5.28, 24.64; P = 0.002) mm3. Percents of mean volume regression were -3.6% and -0.7% in intensive and moderate statin receivers, respectively, vs. +5.8% progression in controls. Statin therapy decreased non-calcified plaque volume by -7.62 (95% CI -17.38, 2.13; P = 0.124) mm3 and low attenuation plaque volume by -5.84 (95% CI -8.02, -3.66; P < 0.001) mm3. In statin therapy receivers, calcified plaque volume increased by 11.83 (95% CI 3.37, 20.29; P = 0.006) mm3 and calcium signal intensity increased by 21.99 (95% CI 9.2, 34.8; P < 0.001) Hounsfield units.
Initial studies demonstrated CCTA's possible role in evaluating the effect of statin therapy on plaque volume and composition. Further studies are warranted to delineate the mechanisms behind plaque changes.
阐明冠状动脉计算机断层血管造影术（CCTA）在评估他汀类药物治疗对斑块负荷和组成的重塑作用中的潜在作用。
系统地进行了文献复习和荟萃分析，以检查他汀类药物治疗对通过连续 CCTA 评估的不同斑块体积的影响。共纳入 12 项研究，平均（±标准差）随访时间为 14.5±9.5 个月。使用加权均数差法对斑块体积数据进行汇总。对总共 199 名强化他汀治疗接受者、404 名中等他汀治疗接受者和 189 名对照者（平均年龄=62±5 岁，男性=78%）的总共有数据进行了荟萃分析。强化他汀治疗使总斑块体积（TPV）减少了 20.87 [95%置信区间（CI）-31.17，-10.56；P<0.001]mm3，而中等他汀治疗则减少了 1.67（95%CI-9.99，6.65；P=0.69）mm3。相比之下，对照组的 TPV 显著增加了 14.96（95%CI 5.28，24.64；P=0.002）mm3。强化和中等他汀治疗接受者的平均体积回归百分比分别为-3.6%和-0.7%，而对照组则增加了 5.8%。他汀类药物治疗使非钙化斑块体积减少了-7.62 [95%CI-17.38，2.13；P=0.124]mm3，使低衰减斑块体积减少了-5.84 [95%CI-8.02，-3.66；P<0.001]mm3。在他汀类药物治疗接受者中，钙化斑块体积增加了 11.83 [95%CI 3.37，20.29；P=0.006]mm3，钙信号强度增加了 21.99 [95%CI 9.2，34.8；P<0.001]HU。
初步研究表明 CCTA 可能在评估他汀类药物治疗对斑块体积和组成的影响方面发挥作用。需要进一步的研究来阐明斑块变化背后的机制。
