PARADIGM 注册研究中主动脉瓣钙化进展与冠状动脉粥样硬化斑块体积进展的相关性。

Association between Aortic Valve Calcification Progression and Coronary Atherosclerotic Plaque Volume Progression in the PARADIGM Registry.

机构信息

From the Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea (S.E.L.); Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (S.E.L., J.M.S., H.J.C.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea (J.M.S., S.S., H.J.C.); Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., E.C., G.P.); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex (M.H.A.); Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, Calif (M.J.B.); Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy (F.C.); Department of Cardiology, William Beaumont Hospital, Royal Oak, Mich (K.C.); Pusan University Hospital, Busan, South Korea (J.H.C.); Seoul National University Bundang Hospital, Seongnam, South Korea (E.J.C.); Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany (M.H.); Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (Y.J.K.); Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.K.L.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.); Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.); UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal (H.M., P.d.A.G.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass (P.H.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (H.S.); Department of Pathology, CVPath Institute, Gaithersburg, Md (R.V.); Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY (L.J.S., F.Y.L., J.K.M.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.).

出版信息

Radiology. 2021 Jul;300(1):79-86. doi: 10.1148/radiol.2021202630. Epub 2021 May 11.

DOI:10.1148/radiol.2021202630

PMID:33973837

Abstract

Background Aortic valve calcification (AVC) is a key feature of aortic stenosis, and patients with aortic stenosis often have coronary -artery disease. Therefore, proving the association between the progression of AVC and coronary atherosclerosis could improve follow-up and treatment strategies. Purpose To explore the association between the progression of AVC and the progression of total and plaque volume composition from a large multicenter registry of serial coronary CT angiographic examinations. Materials and Methods A prospective multinational registry (PARADIGM) of consecutive participants who underwent serial coronary CT angiography at intervals of every 2 years or more was performed (January 2003-December 2015). AVC and the total and plaque volume composition at baseline and follow-up angiography were quantitatively analyzed. Plaque volumes were normalized by using the mean total analyzed vessel length of the study population. Multivariable linear mixed-effects models were constructed. Results Overall, 594 participants (mean age ± standard deviation, 62 years ± 10; 330 men) were included (mean interval between baseline and follow-up angiography, 3.9 years ± 1.5). At baseline, the AVC score was 31 Agatston units ± 117, and the normalized total plaque volume at baseline was 122 mm ± 219. After adjustment for age, sex, clinical risk factors, and medication use, AVC was independently associated with total plaque volume (standardized β = 0.24; 95% CI: 0.16, 0.32; < .001) and both calcified (β = 0.26; 95% CI: 0.18, 0.34; < .001) and noncalcified (β = 0.17; 95% CI: 0.08, 0.25; < .001) plaque volumes at baseline. The progression of AVC was associated with the progression of total plaque volume (β = 0.13; 95% CI: 0.03, 0.22; = .01), driven solely by calcified plaque volume (β = 0.24; 95% CI: 0.14, 0.34; < .001) but not noncalcified plaque volumes (β = -0.06; 95% CI: -0.14, 0.03; = .17). Conclusion The overall burden of coronary atherosclerosis was associated with aortic valve calcification at baseline. However, the progression of aortic valve calcification was associated with only the progression of calcified plaque volume but not with the -progression of noncalcified plaque volume. Clinical trial registration no. NCT02803411 © RSNA, 2021 See also the editorial by Sinitsyn in this issue.

摘要

背景主动脉瓣钙化（AVC）是主动脉瓣狭窄的一个关键特征，而主动脉瓣狭窄患者常伴有冠状动脉疾病。因此，证明 AVC 进展与冠状动脉粥样硬化进展之间的相关性，可以改善随访和治疗策略。目的从大型多中心连续冠状动脉 CT 血管造影检查队列中，探讨 AVC 进展与总斑块体积成分和斑块体积成分进展之间的相关性。材料与方法进行了一项连续接受冠状动脉 CT 血管造影检查的连续参与者前瞻性多国注册研究（PARADIGM）（2003 年 1 月至 2015 年 12 月）。对基线和随访血管造影时的 AVC 和总斑块体积成分进行定量分析。通过研究人群的平均总分析血管长度对斑块体积进行归一化。构建多变量线性混合效应模型。结果共纳入 594 名参与者（平均年龄±标准差，62 岁±10；330 名男性）（基线与随访血管造影之间的平均间隔时间为 3.9 年±1.5）。基线时，AVC 评分为 31 个 Agatston 单位±117，基线时标准化的总斑块体积为 122mm±219。调整年龄、性别、临床危险因素和药物使用后，AVC 与总斑块体积独立相关（标准化β=0.24；95%CI：0.16，0.32；<.001）和钙化（β=0.26；95%CI：0.18，0.34；<.001）以及非钙化（β=0.17；95%CI：0.08，0.25；<.001）斑块体积在基线时。AVC 的进展与总斑块体积的进展相关（β=0.13；95%CI：0.03，0.22；=0.01），这仅由钙化斑块体积驱动（β=0.24；95%CI：0.14，0.34；<.001），而非钙化斑块体积无进展（β=-0.06；95%CI：-0.14，0.03；=0.17）。结论冠状动脉粥样硬化的总体负担与基线时的主动脉瓣钙化有关。然而，主动脉瓣钙化的进展仅与钙化斑块体积的进展相关，而与非钙化斑块体积的进展无关。临床试验注册号 NCT02803411 © RSNA，2021 也可参见本期 Sinitsyn 编辑的评论。