Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia.
Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia.
Int J Cardiol. 2018 Nov 1;270:343-348. doi: 10.1016/j.ijcard.2018.06.022. Epub 2018 Jun 8.
Visual assessment of diameter-stenosis on Computed Tomography Coronary Angiography (CTCA) lacks specificity to determine functional significance of coronary artery stenosis. Percent-aggregate plaque volume (%APV) and ASLA score, which incorporates Area of Stenosis, Lesion length, and area of myocardium subtended estimated by APPROACH score (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) have been described to predict lesion specific ischaemia in focal lesions with intermediate stenosis.
Included were 81 patients (mean age 64.7 ± 9 years, 62% male; 94 vessels) who underwent 320- detector-row CTCA, invasive coronary angiography and fractional-flow-reserve (FFR). We examined vessels with wide range of diameter stenosis (mid to severe) and with multiple lesions. Invasive FFR of ≤0.8 was considered functionally significant. The first 54 patients (62 vessels) formed the derivation cohort. ASLA score was the best predictor of FFR ≤ 0.8 (AUC 0.83, p < 0.001) compared to %APV (0.72), CT >50% (0.76), APPROACH score (0.79), area-stenosis (0.73), diameter-stenosis (0.74), minimum-luminal-diameter (0.74), minimal-luminal-area (0.72), and lesion-length (0.67). ASLA score and not %APV, provided incremental predictive value when added to CT > 50 [(NRI 0.71, p = 0.005) vs. (NRI 0.01, p = 0.96)]. In the validation cohort of 27 patients (32 vessels), the ASLA score (AUC 0.85) was again a better predictor of FFR ≤ 0.8 compared to %APV (0.71), CT > 50% (0.66) and other CT indices. The AUC of ASLA score was superior to CTCA>50% (p = 0.001).
ASLA score is a novel predictor of functional significance of coronary stenosis and adds incremental predictive value to CT > 50 but %APV did not.
计算机断层扫描冠状动脉造影（CTCA）上直径狭窄的视觉评估缺乏特异性，无法确定冠状动脉狭窄的功能意义。已经描述了 %APV 和 ASLA 评分，它综合了 Area of stenosis（狭窄面积）、Lesion length（病变长度）和 APPROACH 评分（Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease）估计的心肌覆盖面积，以预测具有中度狭窄的局灶性病变中的特定病变的缺血。
共纳入 81 例患者（平均年龄 64.7±9 岁，62%为男性；94 支血管），接受了 320 排 CTCA、血管造影和血流储备分数（FFR）检查。我们检查了直径狭窄范围较宽（中度至重度）和多支病变的血管。FFR 小于或等于 0.8 被认为具有功能意义。前 54 例患者（62 支血管）组成了推导队列。与 %APV（0.72）、CT >50%（0.76）、APPROACH 评分（0.79）、面积狭窄（0.73）、直径狭窄（0.74）、最小管腔直径（0.74）、最小管腔面积（0.72）和病变长度（0.67）相比，ASLA 评分是 FFR≤0.8 的最佳预测指标（AUC 0.83，p<0.001）。当将 ASLA 评分添加到 CT>50 时，与 %APV 相比，ASLA 评分提供了额外的预测价值[NRI 0.71，p=0.005，与 NRI 0.01，p=0.96]。在 27 例患者（32 支血管）的验证队列中，ASLA 评分（AUC 0.85）再次优于 %APV（0.71）、CT>50%（0.66）和其他 CT 指数。ASLA 评分的 AUC 优于 CT>50%（p=0.001）。
ASLA 评分是冠状动脉狭窄功能意义的一种新的预测指标，与 CT>50%相比，它提供了额外的预测价值，但 %APV 没有。
