1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece.
RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.
Eur J Prev Cardiol. 2022 Mar 30;29(4):608-624. doi: 10.1093/eurjpc/zwab067.
Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features' extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.
目前，利用临床风险评分系统或血浆生物标志物进行心血管风险分层效果较好，但仍不能完全满足识别冠心病残余风险患者的需求。最近的临床证据进一步强调了冠状动脉计算机断层扫描血管造影（CCTA）在稳定型缺血性心脏病患者管理中的作用。现有的 CT 技术可定量评估斑块负荷、识别高危斑块，或对冠状动脉病变进行功能评估以检测缺血和治疗难治性心绞痛症状。目前 CT 技术还可通过血管周围脂肪衰减指数（FAI）进一步增强，FAI 是冠状动脉炎症的一种非侵入性指标，可首次直接定量评估残余血管炎症负担。机器学习和放射组学特征提取以及光谱 CT 组织特征分析也有望最大限度地提高 CCTA 的诊断和预后效能。CCTA 可提供冠状动脉循环的解剖学、功能学和生物学信息，为患者风险分层和有针对性的强化预防策略患者选择提供了独特的工具。本文综述了该领域的最新研究进展，并讨论了如何将 CCTA 的全部功能整合到临床治疗路径中，为冠状动脉疾病的个体化治疗提供新的机会。
