CT衍生的血流储备分数和血管周围脂肪衰减指数的系列变化的长期预后价值。
Long-term prognostic value of the serial changes of CT-derived fractional flow reserve and perivascular fat attenuation index.
作者信息
Dai Xu, Hou Yang, Tang Chunxiang, Lu Zhigang, Shen Chengxing, Zhang Longjiang, Zhang Jiayin
机构信息
Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
出版信息
Quant Imaging Med Surg. 2022 Jan;12(1):752-765. doi: 10.21037/qims-21-424.
BACKGROUND
To investigate the serial changes of computed tomography (CT) fractional flow reserve (CT-FFR) and fat attenuation index (FAI), and explore their relationships with long-term clinical outcomes.
METHODS
Consecutive symptomatic patients with an intermediate pretest probability of coronary artery disease 1-4 were prospectively enrolled if coronary CT angiography (CCTA) revealed at least 1 lesion with 30-70% stenosis on major epicardial arteries. Follow-up CCTA was performed at 1 to 1.5-year intervals. All patients were further followed up after the second CCTA until September 2019. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) grade, high-risk plaque features, lesion-specific CT-FFR, and FAI were measured for prognosis analysis.
RESULTS
A total of 263 patients were included in the analysis, and 38 major adverse cardiac events (MACEs) occurred. In the MACE group, the lesion-specific CT-FFR decreased significantly at the follow-up CCTA [0.80 (0.74-0.90) versus 0.85 (0.76-0.93); P=0.01], whereas the FAI did not notably increase (-70.4±8.9 versus -71.3±7.1 HU; P=0.436). In the non-MACE group, lesion-specific CT-FFR increased markedly [0.91 (0.84-0.95) versus 0.90 (0.82-0.94); P<0.001], while the FAI decreased substantially (-74.0±10.8 versus -72.4±11.5 HU; P=0.004). Decreased CT-FFR (adjusted overall hazard ratio =2.455; P=0.023) and increased FAI (adjusted hazard ratio =2.956; P=0.002) were the strongest independent predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value (Concordance statistic =0.716; P=0.003; over conventional clinical and imaging parameters (Concordance statistic =0.762; P=0.004).
CONCLUSIONS
Decreased CT-FFR and increased FAI at follow-up CCTA were the 2 strongest predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value over conventional clinical and imaging parameters for risk stratification. In addition, decreased CT-FFR provided incremental predictive value for MACEs from 15 months after second CCTA, while increased FAI added prognostic value from the second CCTA onwards.
背景
研究计算机断层扫描（CT）血流储备分数（CT-FFR）和脂肪衰减指数（FAI）的系列变化，并探讨它们与长期临床结局的关系。
方法
如果冠状动脉CT血管造影（CCTA）显示主要心外膜动脉至少有1个狭窄30%-70%的病变，则前瞻性纳入连续的有症状且冠状动脉疾病预测试验概率为中等的患者。每隔1至1.5年进行一次随访CCTA。在第二次CCTA后对所有患者进一步随访至2019年9月。测量冠状动脉疾病报告和数据系统（CAD-RADS）分级、高危斑块特征、病变特异性CT-FFR和FAI以进行预后分析。
结果
共263例患者纳入分析，发生38例主要不良心脏事件（MACE）。在MACE组中，随访CCTA时病变特异性CT-FFR显著降低[0.80（0.74-0.90）对0.85（0.76-0.93）；P=0.01]，而FAI没有明显增加（-70.4±8.9对-71.3±7.1 HU；P=0.436）。在非MACE组中，病变特异性CT-FFR显著增加[0.91（0.84-0.95）对0.90（0.82-0.94）；P<0.001]，而FAI显著降低（-74.0±10.8对-72.4±11.5 HU；P=0.004）。CT-FFR降低（调整后的总体风险比=2.455；P=0.023）和FAI增加（调整后的风险比=2.956；P=0.002）是MACE最强的独立预测因素。CT-FFR和FAI的系列变化提供了额外的预后价值（一致性统计量=0.716；P=0.003；超过传统临床和影像学参数（一致性统计量=0.762；P=0.004）。
结论
随访CCTA时CT-FFR降低和FAI增加是MACE的两个最强预测因素。CT-FFR和FAI的系列变化在风险分层方面比传统临床和影像学参数提供了额外的预后价值。此外，CT-FFR降低从第二次CCTA后15个月起为MACE提供了额外的预测价值，而FAI增加从第二次CCTA起增加了预后价值。
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