Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Atherosclerosis. 2021 Feb;318:22-31. doi: 10.1016/j.atherosclerosis.2020.12.014. Epub 2020 Dec 19.
The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion.
Fifty-three patients (26% female) with de novo single-vessel coronary artery disease underwent [O]HO positron emission tomography/computed tomography at 1 month (baseline), 1 year, and 3 years after complete revascularization with percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH trial.
Baseline CAC score was 0 in 9%, 0.1-99.9 in 40%, 100-399.9 in 36% and ≥400 in 15% of patients, respectively. Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL min·g) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p < 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time was not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years of follow-up.
Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.
连续的冠状动脉钙（CAC）评分预测绝对心肌灌注和心外膜血管舒缩功能变化的价值记录不佳。本研究探讨了 CAC 评分进展与绝对心肌灌注变化之间的关系。
53 例（26%为女性）新发单支冠状动脉疾病患者在经皮冠状动脉介入治疗（PCI）完全血运重建后 1 个月（基线）、1 年和 3 年接受 [O]HO 正电子发射断层扫描/计算机断层扫描（PET/CT），以评估 CAC 评分、充血性心肌血流（hMBF）、冠状动脉血流储备（CFR）和冷加压试验 MBF（CPT-MBF），这些均在 VANISH 试验中进行。
基线 CAC 评分为 0 的患者占 9%，0.1-99.9 的患者占 40%，100-399.9 的患者占 36%，≥400 的患者占 15%。混合模型分析允许在所有时间点平均灌注指数：hMBF（3.74±0.83；3.33±0.79；3.08±0.78 和 2.44±0.74 mL·min·g）和 CFR（3.82±1.12；3.17±0.80；3.19±0.81；2.63±0.92）在较高的基线 CAC 组中较低（p<0.01；p=0.03）。然而，对于所有灌注指数，均未发现基线 CAC 组与 PCI 后时间之间存在显著的相互作用，这表明在 CAC 组之间，灌注指数随时间的演变没有显著差异。此外，在 3 年的随访期间，CAC 进展与 hMBF（r=0.08，p=0.57）、CFR（r=0.09，p=0.53）或 CPT-MBF（r=0.03，p=0.82）的演变均无相关性。
较高的基线 CAC 与较低的 hMBF 和 CFR 相关。然而，基线 CAC 及其进展均与绝对 hMBF、CFR 和 CPT-MBF 的时间演变无关，这表明 CAC 评分和 CAC 的进展是绝对心肌灌注变化的不良指标。
