Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.
Eur Heart J Cardiovasc Imaging. 2023 May 31;24(6):776-784. doi: 10.1093/ehjci/jeac130.
Coronary atherosclerosis with a large necrotic core has been postulated to reduce the vasodilatory capacity of vascular tissue. In the present analysis, we explored whether total plaque volume and necrotic core volume on coronary computed tomography angiography (CCTA) are independently associated with myocardial ischaemia on positron emission tomography (PET).
From a registry of symptomatic patients with suspected coronary artery disease and clinically indicated CCTA with sequential [15O]H2O PET myocardial perfusion imaging, we quantitatively measured diameter stenosis, total and compositional plaque volumes on CCTA. Primary endpoint was myocardial ischaemia on PET, defined as an absolute stress myocardial blood flow ≤2.4 mL/g/min in ≥1 segment. Multivariable prediction models for myocardial ischaemia were consecutively created using logistic regression analysis (stenosis model: diameter stenosis ≥50%; plaque volume model: +total plaque volume; plaque composition model: +necrotic core volume). A total of 493 patients (mean age 63 ± 8 years, 54% men) underwent sequential CCTA/PET imaging. In 153 (31%) patients, myocardial ischaemia was detected on PET. Diameter stenosis ≥50% (P < 0.001) and necrotic core volume (P = 0.029) were independently associated with myocardial ischaemia, while total plaque volume showed borderline significance (P = 0.052). The plaque composition model (χ2 = 169) provided incremental value for the prediction of ischaemia when compared with the stenosis model (χ2 = 138, P < 0.001) and plaque volume model (χ2 = 164, P = 0.021).
The volume of necrotic core on CCTA independently and incrementally predicts myocardial ischaemia on PET, beyond diameter stenosis alone.
已有研究提出，富含大坏死核心的冠状动脉粥样硬化会降低血管组织的舒张能力。在本分析中，我们探讨了冠状动脉计算机断层扫描血管造影（CCTA）上的总斑块体积和坏死核心体积是否与正电子发射断层扫描（PET）上的心肌缺血独立相关。
从疑似冠心病且临床指征明确的症状性患者的注册登记中，我们对接受连续[15O]H2O PET 心肌灌注成像的 CCTA 进行定量分析，测量 CCTA 上的直径狭窄、总斑块和组成性斑块体积。主要终点是 PET 上的心肌缺血，定义为≥1 个节段的绝对应激心肌血流≤2.4 mL/g/min。使用逻辑回归分析（狭窄模型：直径狭窄≥50%；斑块体积模型：+总斑块体积；斑块组成模型：+坏死核心体积）连续创建心肌缺血的多变量预测模型。共 493 例患者（平均年龄 63±8 岁，54%为男性）接受了连续的 CCTA/PET 成像。在 153 例（31%）患者中，PET 检测到心肌缺血。直径狭窄≥50%（P<0.001）和坏死核心体积（P=0.029）与心肌缺血独立相关，而总斑块体积具有边缘显著性（P=0.052）。与狭窄模型（χ2=138，P<0.001）和斑块体积模型（χ2=164，P=0.021）相比，斑块组成模型（χ2=169）为缺血的预测提供了增量价值。
CCTA 上的坏死核心体积独立且递增地预测了 PET 上的心肌缺血，超出了单纯的直径狭窄。
