Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Royal Papworth Hospital, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge.
JACC Cardiovasc Imaging. 2021 Jan;14(1):233-242. doi: 10.1016/j.jcmg.2020.08.036. Epub 2020 Nov 18.
The aim of the current study was to explore the impact of plaque calcification in terms of absolute calcified plaque volume (CPV) and in the context of its percentage of the total plaque volume at a lesion and patient level on the progression of coronary artery disease.
Coronary artery calcification is an established marker of risk of future cardiovascular events. Despite this, plaque calcification is also considered a marker of plaque stability, and it increases in response to medical therapy.
This analysis included 925 patients with 2,568 lesions from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry, in which patients underwent clinically indicated serial coronary computed tomography angiography. Plaque calcification was examined by using CPV and percent CPV (PCPV), calculated as (CPV/plaque volume) × 100 at a per-plaque and per-patient level (summation of all individual plaques).
CPV was strongly correlated with plaque volume (r = 0.780; p < 0.001) at baseline and with plaque progression (r = 0.297; p < 0.001); however, this association was reversed after accounting for plaque volume at baseline (r = -0.146; p < 0.001). In contrast, PCPV was an independent predictor of a reduction in plaque volume (r = -0.11; p < 0.001) in univariable and multivariable linear regression analyses. Patient-level analysis showed that high CPV was associated with incident major adverse cardiac events (hazard ratio: 3.01: 95% confidence interval: 1.58 to 5.72), whereas high PCPV was inversely associated with major adverse cardiac events (hazard ratio: 0.529; 95% confidence interval: 0.229 to 0.968) in multivariable analysis.
Calcified plaque is a marker for risk of adverse events and disease progression due to its strong association with the total plaque burden. When considered as a percentage of the total plaque volume, increasing PCPV is a marker of plaque stability and reduced risk at both a lesion and patient level. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
本研究旨在探讨斑块钙化（以绝对钙化斑块体积[CPV]表示）及其在病变和患者水平上占总斑块体积的百分比对冠状动脉疾病进展的影响。
冠状动脉钙化是未来心血管事件风险的既定标志物。尽管如此，斑块钙化也被认为是斑块稳定性的标志物，并且它会随着医学治疗而增加。
该分析纳入了来自 PARADIGM（通过计算机断层血管造影成像确定动脉粥样硬化斑块进展）注册研究的 925 名患者的 2568 处病变，这些患者接受了临床指征明确的连续冠状动脉计算机断层血管造影检查。通过 CPV 和百分比 CPV（PCPV）来检查斑块钙化，PCPV 计算为（CPV/斑块体积）×100，按病变和患者水平计算（所有个体斑块的总和）。
CPV 与基线时的斑块体积（r=0.780；p<0.001）和斑块进展（r=0.297；p<0.001）呈强相关；然而，在考虑到基线时的斑块体积后，这种相关性发生了逆转（r=-0.146；p<0.001）。相比之下，PCPV 是斑块体积减少的独立预测因子（r=-0.11；p<0.001），在单变量和多变量线性回归分析中也是如此。患者水平分析显示，高 CPV 与主要不良心脏事件的发生相关（风险比：3.01：95%置信区间：1.58 至 5.72），而高 PCPV 与主要不良心脏事件呈负相关（风险比：0.529；95%置信区间：0.229 至 0.968），在多变量分析中也是如此。
由于钙化斑块与总斑块负荷密切相关，因此钙化斑块是不良事件和疾病进展风险的标志物。当考虑为总斑块体积的百分比时，PCPV 的增加是斑块稳定性和病变及患者水平降低风险的标志物。（通过计算机断层血管造影成像确定动脉粥样硬化斑块进展[PARADIGM]；NCT02803411）。
