斑块体积百分比：用冠状动脉 CTA 报告全心脏动脉粥样硬化斑块负担的最佳变量，PARADIGM 研究。
Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study.
机构信息
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
出版信息
J Cardiovasc Comput Tomogr. 2020 Sep-Oct;14(5):400-406. doi: 10.1016/j.jcct.2020.01.012. Epub 2020 Jan 30.
BACKGROUND AND AIMS
Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.
METHODS
The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAV) in mm [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAV were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed.
RESULTS
The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAV, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAV) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAV (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex.
CONCLUSIONS
PAV was less affected by patient's body surface area then PV and TAV and may be the preferred method to report coronary atherosclerotic burden.
背景与目的
在冠状动脉 CT 血管造影 (CCTA) 中，已经使用了不同的方法来报告全心脏动脉粥样硬化斑块。我们研究了在体表面积 (BSA) 和性别差异的情况下，哪三种常用的斑块负担定义受影响最小。
方法
PARADIGM 研究纳入了疑似患有冠状动脉粥样硬化的症状性患者，他们在 2 年以上的时间内进行了连续的 CCTA。通过核心实验室，以 0.5 毫米的横截面从冠状动脉树定量量化冠状动脉腔、血管和斑块，并对每位患者进行总结。使用了三种定量的斑块负担方法：(1) 毫米的总斑块体积 (PV)，(2) 粥样斑块体积百分比 (PAV)，以 %表示[等于：PV/血管体积 * 100%]，和 (3) 标准化总粥样斑块体积 (TAV)，以毫米表示[等于：PV/血管长度 * 人群平均血管长度]。仅使用基线 CCTA 的数据。比较了 BSA 最高四分位数患者与其余患者之间，以及男女之间的 PV、PAV 和 TAV。评估了血管体积、BSA 与三种斑块负担方法之间的关系。
结果
研究人群包括 1479 名患者（年龄 60.7 ± 9.3 岁，58.4%为男性），他们接受了 CCTA。总共评估了 17649 个冠状动脉节段，每个患者中位数为 12 个（IQR 11-13）节段（来自 16 节段的冠状动脉树）。与其余患者相比，BSA 较大（最高四分位数）的患者具有更大的 PV 和 TAV，但 PAV 相似。较大的 BSA 与较大的绝对斑块体积（PV 和 TAV）之间的关系是由冠状动脉血管体积介导的。独立于动脉粥样硬化性心血管疾病风险 (ASCVD) 评分，血管体积与 PV (P < 0.001) 和 TAV (P = 0.003) 相关，但与 PAV 不相关 (P = 0.201)。三种斑块负担方法都受到性别因素的同等影响。
结论
与 PV 和 TAV 相比，PAV 受患者体表面积的影响较小，可能是报告冠状动脉粥样硬化负担的首选方法。
Zotero 插件