Ge Chenjin, Mao Dinbiao, Ni Jiong
Department of Medical Imaging, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China No. 230, Baoding Road, Shanghai 200082, China; Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China No. 389, Xincun Road, Shanghai 200065, China.
Department of Medical Imaging, Huadong Hospital, Fudan University, Shanghai, China No. 221, Yanan east Road, Shanghai 200000, China.
Int J Cardiol. 2021 Feb 15;325:161-167. doi: 10.1016/j.ijcard.2020.10.019. Epub 2020 Oct 14.
Although the adverse events of pathologic Vieussens' arterial ring (VAR) have been reported, it is difficult to determine optimal clinical management. Thus, we hypothesized that the luminal diameter ratio of VAR obtained from coronary computed tomography angiography (CCTA) could be used as a clinical tool to inform appropriate patient management.
A total of 29 patients with pathologic VAR were retrospectively recruited for this study. The VAR luminal diameter ratio was defined as a quotient of VAR fistula divided by the orifice of RCA or LAD, based on which, patients were divided into small fistula group and large fistula group. The AUC, sensitivity, specificity, positive and negative predictive values were obtained from ROC curve. The cutoff value of the VAR luminal diameter ratio was calculated and assessed during the follow-up.
The VAR luminal diameter ratio of fistula/RCA orifice was 0.505 ± 0.098 in small fistula group and 1.020 ± 0.150 in large fistula group. The VAR luminal diameter ratio of fistula/LAD orifice was 0.507 ± 0.123 in small fistula group and 1.039 ± 0.151 in large group. The value was correlated with the choice of the treatment (r = 0.643 p < 0.01, r = 0.627 p < 0.01). The AUC, sensitivity, specificity, positive and negative predictive values were 0.803, 54.5%, 100%, 100% and 78.3% of the fistula/RCA orifice ratio and 0.833, 63.64%, 94.44%, 87.5% and 81.0% of the fistula/LAD orifice ratio, respectively. The cutoff values of both fistula/RCA orifice and fistula/LAD orifice ratios were 0.676.
The VAR luminal diameter ratio may be a valuable index to determine appropriate treatment for patients with pathologic VAR.
尽管病理性 Vieussens 动脉环（VAR）的不良事件已有报道，但难以确定最佳临床管理方案。因此，我们推测，从冠状动脉计算机断层扫描血管造影（CCTA）获得的 VAR 管腔直径比可作为指导患者合理管理的临床工具。
本研究回顾性纳入了 29 例病理性 VAR 患者。VAR 管腔直径比定义为 VAR 瘘口除以右冠状动脉（RCA）或左前降支（LAD）开口的商，据此将患者分为小瘘口组和大瘘口组。从 ROC 曲线获得曲线下面积（AUC）、敏感性、特异性、阳性和阴性预测值。计算并评估随访期间 VAR 管腔直径比的截断值。
小瘘口组瘘口/RCA 开口的 VAR 管腔直径比为 0.505±0.098，大瘘口组为 1.020±0.150。小瘘口组瘘口/LAD 开口的 VAR 管腔直径比为 0.507±0.123，大瘘口组为 1.039±0.151。该值与治疗选择相关（r = 0.643，p < 0.01；r = 0.627，p < 0.01）。瘘口/RCA 开口比的 AUC、敏感性、特异性、阳性和阴性预测值分别为 0.803、54.5%、100%、100%和 78.3%，瘘口/LAD 开口比分别为 0.833、63.64%、94.44%、87.5%和 81.0%。瘘口/RCA 开口比和瘘口/LAD 开口比的截断值均为 0.676。
VAR 管腔直径比可能是确定病理性 VAR 患者合适治疗方案的有价值指标。
