Benetos Georgios, Benz Dominik C, Rampidis Georgios P, Giannopoulos Andreas A, von Felten Elia, Bakula Adam, Sustar Aleksandra, Fuchs Tobias A, Pazhenkottil Aju P, Gebhard Catherine, Kaufmann Philipp A, Gräni Christoph, Buechel Ronny R
Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur Radiol. 2021 Jul;31(7):5116-5126. doi: 10.1007/s00330-020-07586-y. Epub 2021 Jan 16.
Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), has been proposed as an indicator of diffuse atherosclerosis. We investigated the association of CAVi with quantitative flow parameters and its ability to predict ischemia as derived from N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI).
Sixty patients who underwent hybrid CCTA/PET-MPI due to suspected CAD were retrospectively included. CAVi was defined as total coronary artery lumen volume over myocardial mass, both derived from CCTA. From PET-MPI, quantitative stress and rest myocardial blood flow (MBF) and myocardial flow reserve (MFR) were obtained and correlated with CAVi, and semi-quantitative perfusion images were analyzed for the presence of ischemia. Harrell's c-statistic and net reclassification improvement (NRI) analysis were performed to evaluate the incremental value of CAVi over the CCTA model (i.e., stenosis > 50% and > 70%).
CAVi correlated moderately with stress MBF and MFR (R = 0.50, p < 0.001, and R = 0.39, p = 0.002). Mean stress MBF and MFR were lower in patients with low (i.e., ≤ 20.2 mm/g, n = 24) versus high (i.e., > 20.2 mm/g, n = 36) CAVi (p < 0.001 for both comparisons). CAVi was independently associated with abnormal stress MBF (OR 0.90, 95% CI 0.82-0.998, p = 0.045). CAVi increased the predictive ability of the CCTA model for abnormal stress MBF and ischemia (c-statistic 0.763 versus 0.596, p < 0.05 and 0.770 versus 0.645, p < 0.05, NRI 0.84, p = 0.001 and 0.96, p < 0.001, respectively).
CAVi exhibits incremental value to predict both abnormal stress MBF and ischemia over CCTA alone.
• Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), is correlated with myocardial blood flow indices derived from N-ammonia positron emission tomography myocardial perfusion imaging. • CAVi is independently associated with abnormal stress myocardial blood flow. • CAVi provides incremental diagnostic value over CCTA for both abnormal stress MBF and ischemia.
基于冠状动脉计算机断层扫描血管造影（CCTA）得出的冠状动脉容积指数与左心室心肌质量（CAVi），已被提议作为弥漫性动脉粥样硬化的一个指标。我们研究了CAVi与定量血流参数之间的关联，以及其预测由N-氨正电子发射断层扫描心肌灌注成像（PET-MPI）得出的心肌缺血的能力。
回顾性纳入60例因疑似冠心病接受CCTA/PET-MPI联合检查的患者。CAVi定义为基于CCTA得出的冠状动脉总管腔容积与心肌质量之比。从PET-MPI中获取定量负荷和静息心肌血流量（MBF）以及心肌血流储备（MFR），并将其与CAVi进行关联分析，同时分析半定量灌注图像以确定是否存在心肌缺血。采用Harrell's c统计量和净重新分类改善（NRI）分析来评估CAVi相对于CCTA模型（即狭窄>50%和>70%）的增加值。
CAVi与负荷MBF和MFR呈中度相关（R = 0.50，p < 0.001，以及R = 0.39，p = 0.002）。低CAVi（即≤20.2 mm/g，n = 24）患者的平均负荷MBF和MFR低于高CAVi（即>20.2 mm/g，n = 36）患者（两组比较p均<0.001）。CAVi与异常负荷MBF独立相关（OR 0.90，95%CI 0.82 - 0.998，p = 0.045）。CAVi提高了CCTA模型对异常负荷MBF和心肌缺血的预测能力（c统计量分别为0.763对0.596，p < 0.05；以及0.770对0.645，p < 0.05；NRI分别为0.84，p = 0.001和0.96，p < 0.001）。
与单独的CCTA相比，CAVi在预测异常负荷MBF和心肌缺血方面具有增加值。
• 基于冠状动脉计算机断层扫描血管造影（CCTA）得出的冠状动脉容积指数与左心室心肌质量（CAVi），与由N-氨正电子发射断层扫描心肌灌注成像得出的心肌血流指数相关。• CAVi与异常负荷心肌血流量独立相关。• 对于异常负荷MBF和心肌缺血，CAVi比CCTA具有更高的诊断价值。
