Izoe Yukako, Nagao Michinobu, Sato Kayoko, Sakai Akiko, Ando Kiyoe, Kanai Miwa, Yamamoto Astushi, Sakai Shuji, Chida Koichi
Graduate School of Medicine, Health Sciences, Division of Radiological Examination and Technology Tohoku University, Sendai City, Japan.
Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Int J Cardiol Heart Vasc. 2022 Aug 12;42:101098. doi: 10.1016/j.ijcha.2022.101098. eCollection 2022 Oct.
In this study, we implemented dynamic coronary CT angiography (CCTA) in order to estimate the coronary flow rate in morphologically normal coronary arteries as well as to identify factors affecting the coronary flow rate.
We retrospectively enrolled 95 consecutively presenting patients without stenosis or plaque in their major coronary arteries on CCTA conducted with a 320-detector scanner (mean age, 57 years; 43 % men). Time-attenuation curves of the distal sites of the major coronary arteries and the aortic root were extracted from dynamic CCTA data. Coronary flow rate, an indicator of coronary blood flow, was calculated via a convolution-integration method integrating the two curves. Patients with dyslipidemia were divided according to the presence or absence of familial hypercholesterolemia (FH) as well as according to the receipt of statin therapy.
We found that the coronary flow rate was statistically significantly lower in statin-naïve patients with dyslipidemia (n = 27, 0.56 ± 0.10) than in patients without dyslipidemia (n = 32, 0.64 ± 0.10, p = 0.0013). In FH (n = 26), the coronary flow rate was statistically significantly lower in statin-naïve patients (n = 7, 0.65 ± 0.08) than in those taking statins (n = 19, 0.72 ± 0.10, p = 0.0221). Coronary flow rate likewise exhibited a statistically significant negative correlation with hemoglobin A1c (Pearson r, -0.437; p = 0.0003), but no correlation with other coronary risk factors. The coronary flow rate was statistically significantly lower in patients with diabetes (n = 14, 0.55 ± 0.10) than in those without diabetes (n = 81, 0.61 ± 0.11, p = 0.0461).
We found a reduction in coronary flow rate in patients with statin-naive dyslipidemia and diabetes, even within morphologically normal coronary arteries.
在本研究中，我们采用动态冠状动脉CT血管造影（CCTA）来评估形态正常的冠状动脉的血流速度，并确定影响冠状动脉血流速度的因素。
我们回顾性纳入了95例连续就诊的患者，这些患者在使用320排探测器扫描仪进行的CCTA检查中，主要冠状动脉无狭窄或斑块（平均年龄57岁；43%为男性）。从动态CCTA数据中提取主要冠状动脉远端部位和主动脉根部的时间-衰减曲线。通过对这两条曲线进行卷积积分的方法计算冠状动脉血流速度，这是冠状动脉血流量的一个指标。血脂异常患者根据是否存在家族性高胆固醇血症（FH）以及是否接受他汀类药物治疗进行分组。
我们发现，未服用他汀类药物的血脂异常患者（n = 27，0.56±0.10）的冠状动脉血流速度在统计学上显著低于无血脂异常的患者（n = 32，0.64±0.10，p = 0.0013）。在FH患者（n = 26）中，未服用他汀类药物的患者（n = 7，0.65±0.08）的冠状动脉血流速度在统计学上显著低于服用他汀类药物的患者（n = 19，0.72±0.10，p = 0.0221）。冠状动脉血流速度与糖化血红蛋白同样呈现出统计学上显著的负相关（Pearson相关系数r为-0.437；p = 0.0003），但与其他冠状动脉危险因素无相关性。糖尿病患者（n = 14，0.55±0.10）的冠状动脉血流速度在统计学上显著低于无糖尿病患者（n = 81，0.61±0.11，p = 0.0461）。
我们发现，即使在形态正常的冠状动脉内，未服用他汀类药物的血脂异常患者和糖尿病患者的冠状动脉血流速度也会降低。
