Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Klinik für Kardiologie, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
PLoS One. 2020 Jan 31;15(1):e0228292. doi: 10.1371/journal.pone.0228292. eCollection 2020.
There is limited knowledge about morphological molecular-imaging-derived parameters to further characterize hemodynamically relevant coronary lesions.
The aim of this study was to describe and differentiate specific parameters between hemodynamically significant and non-significant coronary lesions using various invasive and non-invasive measures.
This clinical study analyzed patients with symptoms suggestive of coronary artery disease (CAD) who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-angiography). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability, respectively.
Overall 29 coronary segments from 14 patients were examined. Segments containing lesions with a QFR <0.8 (n = 9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a lesions without significant stenosis (lesion-QFR>0.8; n = 19) (5.32 (4.47-7.02) vs. 2.42 (1.04-5.11); p = 0.042). No differences in signal enhancement were seen on native T1-weighted CMR (2.2 (0.68-6.75) vs. 2.09 (0.91-6.57), p = 0.412). 66.7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions.
The findings of this pilot study suggest that signal enhancement on albumin-binding probe-enhanced CMR but not on T1-weighted CMR is associated with hemodynamically relevant coronary lesions.
目前对于形态学分子影像学衍生参数的了解有限，无法进一步对血流动力学相关的冠状动脉病变进行特征描述。
本研究旨在使用各种有创和无创方法，描述和区分血流动力学意义明确与不明确的冠状动脉病变之间的特定参数。
本临床研究纳入了有冠状动脉疾病（CAD）症状的患者，这些患者接受了 native T1-weighted CMR 和钆塞酸二钠增强 CMR 检查以及有创冠状动脉造影。部分患者还进行了血管内光学相干断层成像（OCT）以确定斑块类型。使用定量血流储备分数（QFR-angiography）检查所有病变的功能相关性。血流动力学意义明确的病变定义为 QFR＜0.8 的病变。native T1-weighted CMR 和钆塞酸二钠增强 CMR 的信号强度（对比噪声比；CNRs）分别定义为斑块内出血和内皮通透性的指标。
共检查了 14 名患者的 29 个冠状动脉节段。包含 QFR＜0.8 的病变的节段（n=9）与包含无明显狭窄病变的节段（病变-QFR＞0.8；n=19）相比，在钆塞酸二钠增强 CMR 上的信号增强明显更高（5.32（4.47-7.02）比 2.42（1.04-5.11）；p=0.042）。在 native T1-weighted CMR 上未见信号增强差异（2.2（0.68-6.75）比 2.09（0.91-6.57）；p=0.412）。OCT 评估的所有易损斑块中有 66.7%（4/6）和所有非易损斑块（纤维粥样斑块）中有 33.3%（2/6）为血流动力学意义明确的病变。
本研究初步结果表明，白蛋白结合探针增强 CMR 上的信号增强与血流动力学相关的冠状动脉病变相关，而 T1-weighted CMR 上的信号增强则不然。
