St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada.
St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada.
J Cardiovasc Comput Tomogr. 2018 May-Jun;12(3):231-237. doi: 10.1016/j.jcct.2018.05.011. Epub 2018 May 19.
The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA).
CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque.
Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components.
The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.
本研究旨在通过连续冠状动脉计算机断层扫描血管造影术（CTA）检查非阻塞性（<50%狭窄）左主干（LM）疾病对冠状动脉疾病自然史的影响。
对 PARADIGM（通过计算机断层扫描血管造影成像确定动脉粥样硬化斑块进展）研究的 CTA 进行分析，该研究是一项前瞻性多国注册研究，对至少两次间隔 2 年以上进行连续 CTA 的患者进行了研究。排除基线扫描无 CAD 证据的患者和阻塞性左主干疾病患者。对冠状动脉血管及其分支进行了以下定量分析：斑块体积和组成；直径狭窄；高危斑块的存在。
在 944 名（62±9 岁，60%为男性）基线时有 CAD 证据的患者中，444 名（47%）患有 LM 疾病。LM 疾病患者的基线斑块体积更大（194.8±221mm3 与 72.9±84.3mm3，p<0.001），高危斑块的患病率更高（17.5%与 13%，p<0.001）。多变量线性模型分析显示，LM 疾病患者总斑块（26.5±31.4mm3/年与 14.9±20.1mm3/年，p<0.001）和钙化斑块体积（17±24mm3/年与 7±11mm3/年，p<0.001）的年进展率更高，但纤维、纤维脂肪或坏死核心斑块成分无差异。
与无 LM 受累的 CAD 相比，非阻塞性 LM 疾病的存在与整个冠状动脉树中斑块进展更快和高危斑块的患病率更高相关。我们的数据表明，非阻塞性 LM 疾病可能是 CAD 侵袭性表型的标志物，可能受益于更强化的治疗策略。
