Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Department of Cardiology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Medicina (Kaunas). 2022 Jul 20;58(7):964. doi: 10.3390/medicina58070964.
: Cardiac computed tomography angiography (CCTA) is an excellent non-invasive imaging tool to evaluate coronary arteries and exclude coronary artery disease (CAD). Managing intermediate coronary artery stenosis with negative or inconclusive functional tests is still a challenge. A regular stenosis evaluation together with high-risk plaque features, using semi-automated programs, are becoming promising tools. This case-control study was designed to evaluate the intermediate lesion features' impact on CAD outcomes, using a semi-automated CCTA atherosclerotic plaque analysis program. : We performed a single-center, prospective cohort study. A total of 133 patients with low to intermediate risk of CAD, older than 18 years with no previous history of CAD and good quality CCTA images were included in the study, and 194 intermediate stenosis (CAD-RADS 3) were analyzed. For more detailed morphological analysis, we used semi-automated CCTA-dedicated software. Enrolled patients were prospectively followed-up for 2 years. : Agatston score was significantly higher in the major adverse cardiovascular events (MACE) group ( = 0.025). Obstruction site analysis showed a significantly lower coronary artery remodeling index (RI) among patients with MACE ( = 0.037); nonetheless RI was negative in both groups. Plaque consistency analysis showed significantly bigger necrotic core area in the MACE group ( = 0.049). In addition, unadjusted multivariate analysis confirmed Agatston score and RI as significant MACE predictors. : The Agatston score showes the total area of calcium deposits and higher values are linked to MACE. Higher plaque content of necrotic component is also associated with MACE. Additionally, negatively remodeled plaques are linked to MACE and could be a sign of advanced CAD. The Agatston score and RI are significant in risk stratification for the development of MACE.
: 心脏计算机断层扫描血管造影术（CCTA）是一种评估冠状动脉和排除冠状动脉疾病（CAD）的极好的无创成像工具。对于功能性检查阴性或不确定的中度冠状动脉狭窄的管理仍然是一个挑战。使用半自动程序对常规狭窄评估和高风险斑块特征进行评估，正在成为有前途的工具。这项病例对照研究旨在使用半自动 CCTA 动脉粥样硬化斑块分析程序评估中间病变特征对 CAD 结果的影响。 : 我们进行了一项单中心前瞻性队列研究。共纳入 133 例低至中度 CAD 风险、年龄大于 18 岁、无 CAD 既往史和高质量 CCTA 图像的患者，并分析了 194 例中度狭窄（CAD-RADS 3）。为了更详细的形态学分析，我们使用了半自动 CCTA 专用软件。纳入的患者前瞻性随访 2 年。 : 在主要不良心血管事件（MACE）组中，Agatston 评分明显更高（ = 0.025）。阻塞部位分析显示 MACE 患者的冠状动脉重构指数（RI）明显较低（ = 0.037）；然而，两组的 RI 均为负值。斑块一致性分析显示 MACE 组的坏死核心面积明显较大（ = 0.049）。此外，未经调整的多变量分析证实，Agatston 评分和 RI 是 MACE 的显著预测因子。 : Agatston 评分显示钙沉积的总区域，较高的值与 MACE 相关。坏死成分的斑块含量较高也与 MACE 相关。此外，负性重构的斑块与 MACE 相关，可能是 CAD 进展的标志。Agatston 评分和 RI 在预测 MACE 发生的风险分层中具有重要意义。
