van Driest F Y, Bijns C M, van der Geest R J, Broersen A, Dijkstra J, Scholte A J H A, Jukema J W
Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur Radiol. 2022 May;32(5):3408-3422. doi: 10.1007/s00330-021-08393-9. Epub 2022 Jan 8.
To present an overview of studies using serial coronary computed tomography angiography (CCTA) as a tool for finding both quantitative (changes) and qualitative plaque characteristics as well as epicardial adipose tissue (EAT) volume changes as predictors of plaque progression and/or major adverse cardiac events (MACE) and outline the challenges and advantages of using a serial non-invasive imaging approach for assessing cardiovascular prognosis.
A literature search was performed in PubMed, Embase, Web of Science, Cochrane Library and Emcare. All observational cohort studies were assessed for quality using the Newcastle-Ottawa Scale (NOS). The NOS score was then converted into Agency for Healthcare Research and Quality (AHRQ) standards: good, fair and poor.
A total of 36 articles were analyzed for this review, 3 of which were meta-analyses and one was a technical paper. Quantitative baseline plaque features seem to be more predictive of MACE and/or plaque progression as compared to qualitative plaque features.
A critical review of the literature focusing on studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. Significant questions regarding the clinical implications of these specific quantitative and qualitative plaque features as well as the challenges of using serial CCTA have yet to be resolved in studies using this imaging technique.
• Use of (serial) CCTA can identify plaque characteristics and plaque changes as well as changes in EAT volume that are predictive of plaque progression and/or major adverse events (MACE) at follow-up. • Studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. • Ultimately, serial CCTA is a promising technique for the evaluation of cardiovascular prognosis, yet technical details remain to be refined.
概述使用冠状动脉计算机断层扫描血管造影（CCTA）序列作为一种工具来发现定量（变化）和定性斑块特征以及心外膜脂肪组织（EAT）体积变化，以预测斑块进展和/或主要不良心脏事件（MACE），并概述使用序列无创成像方法评估心血管预后的挑战和优势。
在PubMed、Embase、Web of Science、Cochrane图书馆和Emcare中进行文献检索。使用纽卡斯尔-渥太华量表（NOS）对所有观察性队列研究进行质量评估。然后将NOS评分转换为医疗保健研究与质量机构（AHRQ）标准：良好、中等和差。
本综述共分析了36篇文章，其中3篇是荟萃分析，1篇是技术论文。与定性斑块特征相比，定量基线斑块特征似乎更能预测MACE和/或斑块进展。
对聚焦于使用CCTA序列的研究的文献进行批判性综述发现，与定性斑块特征相反，主要是定量基线斑块特征和定量斑块变化可预测MACE和/或斑块进展。关于这些特定定量和定性斑块特征的临床意义以及使用CCTA序列的挑战等重大问题，在使用这种成像技术的研究中尚未得到解决。
• 使用（序列）CCTA可以识别斑块特征、斑块变化以及EAT体积变化，这些变化可预测随访时的斑块进展和/或主要不良事件（MACE）。• 利用CCTA序列的研究表明，与定性斑块特征相反，主要是定量基线斑块特征和定量斑块变化可预测MACE和/或斑块进展。• 最终，CCTA序列是评估心血管预后的一种有前景的技术，但技术细节仍有待完善。
