Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Cardiovascular Research Methods Centre (A.H.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Circ Cardiovasc Imaging. 2022 Jan;15(1):e012654. doi: 10.1161/CIRCIMAGING.121.012654. Epub 2022 Jan 18.
Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery.
Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUB, and TRANS, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction.
Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUB was an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUB, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANS, as a continuous variable, was also found to be a predictor of MACE (=0.027).
Our study demonstrates that SUB and TRANS are independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.
计算机断层扫描心肌灌注异常与冠状动脉疾病和主要不良心血管事件（MACE）有关。我们旨在研究冠状动脉计算机断层扫描血管造影术（CCTA）中的心内膜下衰减是否可预测择期非心脏手术后 30 天的 MACE。
使用 17 节段模型，分析 CCTA 图像的心内膜下和透壁衰减以及相应的血池。将最低的心内膜下和透壁衰减节段分别与具有最高的心内膜下和透壁衰减节段进行归一化（分别为 SUB 和 TRANS）。我们评估心肌衰减的独立和增量价值，以预测心血管死亡或非致死性心肌梗死的复合终点。
在总共 995 例 CTA VISION（非心脏手术患者冠状动脉计算机断层扫描血管造影和血管事件评估研究）患者中，735 例有可用于这些分析的图像和完整数据。在这些患者中，有 60 例发生了 MACE。根据修订后的心血管风险指数，257、302、138 和 38 例患者的评分分别为 0、1、2 和≥3。在 CCTA 上，75 例患者有正常冠状动脉，297 例患者有非阻塞性冠状动脉疾病，264 例患者有阻塞性疾病，99 例患者有广泛阻塞性冠状动脉疾病。SUB 是包含修订后的心血管风险指数和冠状动脉疾病严重程度的模型中事件的独立和增量预测因子。与 SUB 最高三分位组的患者相比，第二和第一三分位组的患者发生事件的危险比增加（2.23 [95%CI，1.091-4.551]和 2.36 [95%CI，1.16-4.81]）。作为连续变量的 TRANS 也被发现是 MACE 的预测因子（=0.027）。
我们的研究表明，SUB 和 TRANS 是择期非心脏手术后 30 天发生 MACE 的独立和增量预测因子。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01635309。
