CT 血管造影、CT 心肌灌注、有创性冠状动脉造影和 SPECT 中的缺血但无明显狭窄（INOCA）：CORE320 研究。
Ischemia and No Obstructive Stenosis (INOCA) at CT Angiography, CT Myocardial Perfusion, Invasive Coronary Angiography, and SPECT: The CORE320 Study.
机构信息
From the Global RDC, Canon Medical Systems Europe, Zoetermeer, the Netherlands (J.D.S.); Department of Epidemiology, Johns Hopkins University, Baltimore, Md (M.B.M., C.C.); Departments of Medicine and Radiology, Johns Hopkins School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (M.R.O., A.A., J.A.C.L.); Department of Cardiology and Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.H.A.S.); Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.D.); Canon Medical Systems, Otawara, Japan (C.S.); InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Radiology, Iwate Medical University, Morioka, Japan (K.Y.); and Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.).
出版信息
Radiology. 2020 Jan;294(1):61-73. doi: 10.1148/radiol.2019190978. Epub 2019 Nov 19.
Background CT allows evaluation of atherosclerosis, coronary stenosis, and myocardial ischemia. Data on the characterization of ischemia and no obstructive stenosis (INOCA) at CT remain limited. Purpose This was an observational study to describe the prevalence of INOCA defined at coronary CT angiography with CT perfusion imaging and associated clinical and atherosclerotic characteristics. The analysis was also performed for the combination of invasive coronary angiography (ICA) and SPECT as a secondary aim. Materials and Methods The prospective CORE320 study (: NCT00934037) enrolled participants between November 2009 and July 2011 who were symptomatic and referred for clinically indicated ICA. Participants underwent CT angiography, rest-adenosine stress CT perfusion, and rest-stress SPECT prior to ICA. For this ancillary study, the following three phenotypes were considered, using either CT angiography/CT perfusion or ICA/SPECT data: participants with obstructive (≥50%) stenosis, participants with no obstructive stenosis but ischemia (ie, INOCA) on the basis of abnormal perfusion imaging results, and participants with no obstructive stenosis and normal perfusion imaging results. Clinical characteristics and CT angiography atherosclerotic plaque measures were compared by using the Pearson χ or Wilcoxon rank-sum test. Results A total of 381 participants (mean age, 62 years [interquartile range, 56-68 years]; 129 [34%] women) were evaluated. A total of 31 (27%) of 115 participants without obstructive (≥50%) stenosis at CT angiography had abnormal CT perfusion findings. The corresponding value for ICA/SPECT was 45 (30%) of 151. The prevalence of INOCA was 31 (8%) of 381 (95% confidence interval [CI]: 5%, 11%) with CT angiography/CT perfusion and 45 (12%) of 381 (95% CI: 9%, 15%) with ICA/SPECT. Participants with CT-defined INOCA had greater total atheroma volume (118 vs 60 mm, = .008), more positive remodeling (13% vs 1%, = .006), and greater low-attenuation atheroma volume (20 vs 10 mm, = .007) than participants with no obstructive stenosis and no ischemia. Comparisons for ICA/SPECT showed similar trends. Conclusion In CORE320, ischemia and no obstructive stenosis (INOCA) prevalence was 8% and 12% at CT angiography/CT perfusion and invasive coronary angiography/SPECT, respectively. Participants with INOCA had greater atherosclerotic burden and more adverse plaque features at CT compared with those with no obstructive stenosis and no ischemia. © RSNA, 2019 See also the editorial by François in this issue.
背景 CT 可用于评估动脉粥样硬化、冠状动脉狭窄和心肌缺血。关于 CT 对无阻塞性狭窄（INOCA）的缺血特征的描述数据仍然有限。
目的 本研究旨在描述以 CT 灌注成像为基础的冠状动脉 CT 血管造影术（CTA）诊断的 INOCA 的患病率，并分析其与临床和动脉粥样硬化特征的关系。本分析还结合了侵入性冠状动脉造影（ICA）和单光子发射计算机断层扫描（SPECT），作为次要目标。
材料与方法 前瞻性 CORE320 研究（: NCT00934037）纳入了 2009 年 11 月至 2011 年 7 月期间因症状性且经临床指征推荐进行 ICA 的患者。所有患者均接受 CTA、静息腺苷负荷 CT 灌注成像和静息-应激 SPECT 检查。在这项辅助研究中，使用 CTA/CT 灌注或 ICA/SPECT 数据，考虑了以下三种表型：1）存在阻塞性（≥50%）狭窄的患者；2）存在非阻塞性狭窄但灌注成像结果异常的患者（即INOCA）；3）存在非阻塞性狭窄且灌注成像结果正常的患者。采用 Pearson χ 检验或 Wilcoxon 秩和检验比较临床特征和 CTA 粥样硬化斑块指标。
结果 共纳入 381 例患者（平均年龄 62 岁[四分位间距：56-68 岁]；129[34%]为女性）。在 CTA 无阻塞性（≥50%）狭窄的 115 例患者中，有 31 例（27%）存在 CT 灌注异常。ICA/SPECT 的相应值为 151 例中有 45 例（30%）。CT 血管造影/CT 灌注成像显示 INOCA 的患病率为 31（8%）例，占 381 例（95%置信区间：5%，11%）；ICA/SPECT 的相应值为 45（12%）例，占 381 例（95%置信区间：9%，15%）。与无阻塞性狭窄且无缺血的患者相比，CT 诊断为 INOCA 的患者总粥样斑块体积更大（118 比 60mm， =.008），正性重构比例更高（13%比 1%， =.006），低衰减斑块体积更大（20 比 10mm， =.007）。ICA/SPECT 的比较结果显示出类似的趋势。
结论 在 CORE320 研究中，CT 血管造影/CT 灌注成像和 ICA/SPECT 诊断的缺血和无阻塞性狭窄（INOCA）的患病率分别为 8%和 12%。与无阻塞性狭窄且无缺血的患者相比，INOCA 患者的动脉粥样硬化负担更大，斑块特征更差。
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