非阻塞性高危斑块但冠脉 CTA 未见钙化，以及 G 评分预测缺血。
Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia.
机构信息
Dept. Radiology, Innsbruck Medical University, Austria.
Dept. Internal Medicine III, Cardiology, Innsbruck Medical University, Austria.
出版信息
J Cardiovasc Comput Tomogr. 2019 Nov-Dec;13(6):305-314. doi: 10.1016/j.jcct.2019.01.010. Epub 2019 Jan 4.
BACKGROUND
The association of plaque morphology with ischemia in non-obstructive lesions has not been fully eludicated: Calcium density and high-risk plaque features have not been explored.
OBJECTIVES
to assess whether high-risk plaque or calcified, and global mixed including non-calcified plaque burden (G-score) by coronary CTA predict ischemia in non-obstructive lesions using non-invasive fractional flow reserve (FFR).
METHODS
In 106 patients with low-to-intermediate pre-test probability referred to coronary 128-slice dual source CTA, lesion-based and distal FFR were computated. The 4 high-risk-plaque criteria: Low-attenuation-plaque, Napkin Ring Sign, positive remodelling and spotty calcification were recorded. Plaque density (HU) and stenosis (MLA,MLD,%area,%diameter stenosis) were quantified. Plaque composition was classified as type 1-4:1 = calcified, 2 = mixed (calcified > non-calcified), 3 = mixed (non-calcified > calcified), 4 = non-calcified, and expressed by the G-score: Z = Sum of type 1-4 per segment. The total plaque segment involvement score (SIS) and the Coronary Calcium Score (Agatston) were calculated.
RESULTS
89 non-obstructive lesions were included. Both lesion-based and distal FFR were lower in high-risk-plaque as compared to calcified (0.85 vs 0.93, p < 0.001 and 0.79 vs 0.86, p = 0.002). The prevalence of lesion-based ischemia (FFR<0.8) was higher in high-risk-plaque as compared to calcified (25% vs. 2.5%, p = 0.007). Similarly, the rate of distal ischemia (40% vs 17.5%) was higher, respectively. Lower plaque density (HU) indicating higher lipid plaque component (p = 0.024) predicted lesion based FFR in low attenuation plaque. For all lesions (n = 89) including calcified (p = 0.003), the correlation enhanced. Positive remodelling and an increasing non-calcified plaque burden (G-score) in relation to calcified were associated with lower FFR distal (p = 0.042), but not the SIS and calcium score.
CONCLUSION
High-risk-plaque but not calcified, an increasing lipid-necrotic-core component and non-calcified mixed plaque burden (G-score) predict ischemia in non-obstructive lesions (INOCA), while an increasing calcium compactness acts contrary.
背景
非阻塞性病变中斑块形态与缺血之间的关系尚未完全阐明：尚未探讨钙密度和高危斑块特征。
目的
使用非侵入性的血流储备分数（FFR）评估冠状动脉 CT 血管造影（CTA）中高风险斑块或钙化以及整体混合（包括非钙化斑块负担）（G 评分）是否可预测非阻塞性病变中的缺血。
方法
在低至中度的 106 名患者中，进行了冠状动脉 128 层双源 CTA 检查，基于病变和远端的 FFR 计算。记录了 4 种高危斑块标准：低衰减斑块，Napkin Ring Sign，正性重构和点状钙化。量化斑块密度（HU）和狭窄（MLA、MLD、%面积、%直径狭窄）。斑块成分分为 1-4 型：1=钙化，2=混合（钙化＞非钙化），3=混合（非钙化＞钙化），4=非钙化，并用 G 评分表示：Z=每个节段的 1-4 型总和。总斑块节段受累评分（SIS）和冠状动脉钙评分（Agatston）也进行了计算。
结果
共纳入 89 处非阻塞性病变。与钙化斑块相比，高危斑块的病变基础和远端 FFR 更低（0.85 比 0.93，p<0.001 和 0.79 比 0.86，p=0.002）。与钙化斑块相比，高危斑块的病变基础缺血（FFR<0.8）的发生率更高（25%比 2.5%，p=0.007）。同样，远端缺血的发生率也更高（40%比 17.5%）。较低的斑块密度（HU）表明脂质斑块成分较高（p=0.024），这与低衰减斑块的病变基础 FFR 相关。对于所有病变（n=89），包括钙化病变（p=0.003），相关性增强。正性重构和非钙化斑块负担（G 评分）相对于钙化的增加与远端 FFR 降低相关（p=0.042），但与 SIS 和钙评分无关。
结论
与钙化斑块相比，高危斑块（但不是钙化斑块）、脂质坏死核心成分的增加和非钙化混合斑块负担（G 评分）可预测非阻塞性病变中的缺血（INOCA），而钙密度的增加则相反。
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