Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd, Shanghai, China.
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd, Shanghai, China.
Eur Radiol. 2020 Feb;30(2):673-681. doi: 10.1007/s00330-019-06400-8. Epub 2019 Aug 23.
This study aimed to investigate the association between perivascular fat attenuation index (FAI) and hemodynamic significance of coronary lesions.
Patients with stable angina who underwent coronary computed tomography (CT) angiography and invasive fractional flow reserve (FFR) measurement within 2 weeks were retrospectively included. Lesion-based perivascular FAI, high-risk plaque features, total plaque volume (TPV), machine learning-based FFR, and other parameters were recorded. Lesions with invasive FFR ≤ 0.8 were considered functionally significant.
This study included 167 patients with 219 lesions. Diameter stenosis (DS), lesion length, TPV, and perivascular FAI were significantly larger or longer in the group of hemodynamically significant lesions (FFR ≤ 0.8). In addition, smaller FFR value was associated with functionally significant lesions (0.720 ± 0.11 vs 0.846 ± 0.10, p < 0.001). No significant difference was found between the hemodynamically significant and insignificant subgroups with respect to CT-derived high-risk plaque features. According to multivariate analysis, DS, TPV, and perivascular FAI were significant predictors of lesion-specific ischemia. When integrating DS, TPV, and perivascular FAI, the area under the curve (AUC) of this combined method was 0.821, which was similar to that of FFR (AUC, 0.821 vs 0.850; p = 0.426). The diagnostic accuracy of FFR was higher than that of the combined approach, but the difference was statistically insignificant (79.0% vs 74.0%, p = 0.093).
Perivascular FAI was significantly higher for flow-limiting lesions than for non-flow-limiting lesions. The combined use of FAI, TPV, and DS could predict ischemic coronary stenosis with high diagnostic accuracy.
• Perivascular FAI was significantly higher for flow-limiting lesions than for non-flow-limiting lesions. • Combined use of FAI, plaque volume, and DS provided diagnostic performance comparable to that of machine learning-based FFR for predicting ischemic coronary stenosis. • No significant difference was found between the hemodynamically significant and insignificant subgroups with respect to CT-derived high-risk plaque features.
本研究旨在探讨血管周围脂肪衰减指数（FAI）与冠状动脉病变血流动力学意义之间的关系。
回顾性纳入在 2 周内接受冠状动脉计算机断层扫描（CT）血管造影和有创血流储备分数（FFR）测量的稳定性心绞痛患者。记录基于病变的血管周围 FAI、高危斑块特征、总斑块体积（TPV）、基于机器学习的 FFR 和其他参数。将有创 FFR≤0.8 的病变定义为功能显著病变。
本研究共纳入 167 例患者的 219 处病变。在血流动力学显著病变（FFR≤0.8）组，直径狭窄（DS）、病变长度、TPV 和血管周围 FAI 明显更大或更长。此外，更小的 FFR 值与功能显著病变相关（0.720±0.11 比 0.846±0.10，p<0.001）。在血流动力学显著和不显著亚组之间，基于 CT 的高危斑块特征无显著差异。多变量分析显示，DS、TPV 和血管周围 FAI 是病变特异性缺血的显著预测因子。当整合 DS、TPV 和血管周围 FAI 时，该联合方法的曲线下面积（AUC）为 0.821，与 FFR 的 AUC（0.821 比 0.850；p=0.426）相似。FFR 的诊断准确性高于联合方法，但差异无统计学意义（79.0%比 74.0%，p=0.093）。
血管周围 FAI 在限制血流的病变中显著高于非限制血流的病变。FAI、TPV 和 DS 的联合使用可以以较高的诊断准确性预测缺血性冠状动脉狭窄。
血管周围 FAI 在限制血流的病变中显著高于非限制血流的病变。
FAI、斑块体积和 DS 的联合使用提供了与基于机器学习的 FFR 相当的诊断性能，可用于预测缺血性冠状动脉狭窄。
在基于 CT 的高危斑块特征方面，血流动力学显著和不显著亚组之间无显著差异。
