From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.).
Radiology. 2022 Dec;305(3):578-587. doi: 10.1148/radiol.213271. Epub 2022 Aug 16.
Background Plaque assessments with coronary CT angiography (CCTA) and coronary flow indexes have prognostic implications. Purpose To investigate the association and additive prognostic value of plaque burden and characteristics at CCTA with coronary pressure and flow. Materials and Methods Data of patients with coronary artery disease who underwent CCTA within 90 days before physiologic assessments at tertiary cardiovascular centers between January 2011 and December 2018 were retrospectively analyzed, which included fractional flow reserve (FFR), resting distal coronary artery pressure (Pd)-to-aortic pressure (Pa) ratio (hereafter, Pd/Pa), coronary flow reserve (CFR), hyperemic flow (1/hyperemic mean transit time [Tmn]), resting flow (1/resting Tmn), and index of microcirculatory resistance (IMR). Four high-risk plaque (HRP) attributes at CCTA defined high disease burden (plaque burden, ≥70%; minimum lumen area, <4 mm) and adverse plaque (low-attenuation plaque, positive remodeling). Their lesion-specific relationships with coronary hemodynamic parameters and major adverse cardiovascular events (MACE) were investigated using a generalized estimating equation and marginal Cox model. Results Among 406 lesions from 335 patients (mean age, 67 years ± 10 [SD]; 259 men), high disease burden is predicted by FFR (odds ratio [OR], 0.55; < .001), resting Pd/Pa (OR, 0.47; < .001), CFR (OR, 0.85; = .004), and hyperemic flow (OR, 0.91; = .03), and adverse plaque by FFR (OR, 0.67; < .001), resting Pd/Pa (OR, 0.69; = .001), hyperemic flow (OR, 0.76; = .006), resting flow (OR, 0.54; = .001), and IMR (OR, 1.27; = .008). High disease burden (hazard ratio [HR], 4.0; = .004) and adverse plaque (HR, 2.7; = .02) were associated with a higher risk of MACE ( = 27) over median 2.9-year follow-up. In six lesion subsets with normal flow or pressure, at least three HRP attributes predicted a higher MACE rate (HR range, 2.6-6.3). Conclusion High-risk plaque features and plaque burden at coronary CT angiography were associated with cardiovascular events independent of coronary hemodynamic parameters. Clinical trial registration no. NCT04037163 © RSNA, 2022 See also the editorial by Leipsic and Tzimas in this issue.
背景 冠状动脉 CT 血管造影（CCTA）和冠状动脉血流指数评估斑块与预后有关。
目的 旨在研究 CCTA 斑块负荷和特征与冠状动脉压力和血流之间的相关性及其附加预后价值。
材料与方法 回顾性分析了 2011 年 1 月至 2018 年 12 月在三级心血管中心行 CCTA 检查后 90 天内进行生理评估的冠心病患者的数据，包括血流储备分数（FFR）、静息远端冠状动脉压力（Pd）与主动脉压力（Pa）比值（Pd/Pa）、冠状动脉血流储备（CFR）、充血性血流（1/充血性平均通过时间[Tmn]）、静息血流（1/静息 Tmn）和微血管阻力指数（IMR）。采用广义估计方程和边际 Cox 模型，探讨 CCTA 中定义为高疾病负担（斑块负荷≥70%；最小管腔面积<4mm）和不良斑块（低衰减斑块、正性重构）的 4 种高危斑块（HRP）特征与冠状动脉血流动力学参数和主要不良心血管事件（MACE）的病变特异性关系。
结果 在 335 例患者的 406 个病变中（平均年龄 67 岁±10[标准差]；259 例男性），高疾病负担与 FFR（比值比[OR]，0.55；<.001）、静息 Pd/Pa（OR，0.47；<.001）、CFR（OR，0.85；=.004）和充血性血流（OR，0.91；=.03）相关，不良斑块与 FFR（OR，0.67；<.001）、静息 Pd/Pa（OR，0.69；=.001）、充血性血流（OR，0.76；=.006）、静息血流（OR，0.54；=.001）和 IMR（OR，1.27；=.008）相关。在中位 2.9 年随访期间，高疾病负担（HR，4.0；=.004）和不良斑块（HR，2.7；=.02）与更高的 MACE（ = 27）风险相关。在静息血流或压力正常的 6 个病变亚组中，至少有 3 种 HRP 特征预测 MACE 发生率较高（HR 范围，2.6-6.3）。
结论 冠状动脉 CT 血管造影中的高危斑块特征和斑块负荷与独立于冠状动脉血流动力学参数的心血管事件相关。
临床试验注册号 NCT04037163 ©RSNA，2022 本期亦见 Leipsic 和 Tzimas 的述评。
