Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China (N.D., Z.C., Y.Z., J.Q., J.G.).
National Clinical Research Center for Interventional Medicine, Shanghai, China (N.D., Z.C., Y.Z., J.Q., J.G.).
Circ Cardiovasc Imaging. 2022 Dec;15(12):e014611. doi: 10.1161/CIRCIMAGING.122.014611. Epub 2022 Dec 12.
Lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular events. This study evaluated the relationship between Lp(a) and high-risk attributes by coronary computed tomography angiography as well as their prognostic value.
Lp(a) and coronary computed tomography angiography from 377 consecutive patients at Zhongshan Hospital (Shanghai, China) were evaluated. High-risk attributes were defined as high-risk morphological attributes (low attenuation plaque, positive remodeling, napkin-ring sign, spotty calcification, minimum lumen area <4 mm, or plaque burden [ratio between cross-sectional plaque area at the site of maximum stenosis and cross-sectional vessel area] ≥70%); inflammatory attribute represented by fat attenuation index; high-risk physiological attributes [lesion-specific ischemia defined by fractional flow reserve by coronary computed tomography angiography ≤0.8, physiologic diffuseness defined by fractional flow reserve by coronary computed tomography angiography pullback pressure gradient]. Total plaque volume in mm was also quantified. Quintiles or binary classification of Lp(a) levels were used to evaluate its relationships with plaque features and clinical outcomes with ANOVA, Cox models, and log-rank tests, as appropriate. The major adverse cardiovascular event included cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization.
Lp(a) was significantly associated with total plaque volume (=0.004), fat attenuation index (=0.031), and fractional flow reserve by coronary computed tomography angiography pullback pressure gradient (=0.038). Patients with a high Lp(a) level had a higher total plaque volume (393.3 mm versus 293.9 mm, <0.001), lower pullback pressure gradient (0.62 versus 0.69, =0.023), higher fat attenuation index (-70.5HU versus -73.9HU, =0.004), and higher incidence of major adverse cardiovascular event (14.5% versus 6.3%, adjusted hazard ratio: 2.52, 95% CI: 1.12-5.63, =0.025). In a 4-group classification according to Lp(a) and high-risk attributes, patients with high Lp(a) and ≥3 high-risk attributes had the highest risk of major adverse cardiovascular event (25.9%; overall <0.001). Causal mediation analysis revealed that around 40% of the prognostic effect of Lp(a) was mediated by high-risk attributes.
Lp(a) level is associated with coronary computed tomography angiography high-risk characteristics, including morphologic, physiologic, and inflammatory attributes as well as major adverse cardiovascular event. This effect is partly mediated by inflammation and vulnerable plaque.
URL: https://www.
gov; Unique identifier: NCT05323227.
脂蛋白（a）[Lp(a)]是心血管事件的危险因素。本研究通过冠状动脉计算机断层血管造影评估了 Lp(a)与高风险特征之间的关系及其预后价值。
评估了来自中国上海中山医院的 377 例连续患者的 Lp(a)和冠状动脉计算机断层血管造影数据。高风险特征定义为高风险形态特征（低衰减斑块、正性重构、餐巾环征、点状钙化、最小管腔面积<4mm 或斑块负担[最大狭窄部位斑块面积与血管面积的比值]≥70%）；代表脂肪衰减指数的炎症属性；高风险生理特征[由冠状动脉计算机断层血管造影测量的血流储备分数≤0.8 定义的病变特异性缺血，由冠状动脉计算机断层血管造影测量的血流储备分数拉回压力梯度定义的生理弥散度]。还定量了总斑块体积（mm）。使用 Lp(a)水平的五分位数或二分位数来评估其与斑块特征的关系，并使用 ANOVA、Cox 模型和对数秩检验（视情况而定）评估其与临床结局的关系。主要不良心血管事件包括心血管死亡、非致死性心肌梗死和靶血管血运重建。
Lp(a)与总斑块体积（=0.004）、脂肪衰减指数（=0.031）和冠状动脉计算机断层血管造影测量的血流储备分数拉回压力梯度（=0.038）显著相关。高 Lp(a)水平患者的总斑块体积更大（393.3mm 与 293.9mm，<0.001），拉回压力梯度更低（0.62 与 0.69，=0.023），脂肪衰减指数更高（-70.5HU 与-73.9HU，=0.004），主要不良心血管事件发生率更高（14.5%与 6.3%，调整后的危险比：2.52，95%CI：1.12-5.63，=0.025）。根据 Lp(a)和高风险特征进行的 4 组分类中，高 Lp(a)且≥3 个高风险特征的患者发生主要不良心血管事件的风险最高（25.9%；总体<0.001）。因果中介分析表明，Lp(a)预后效应的约 40%由高风险特征介导。
Lp(a)水平与冠状动脉计算机断层血管造影的高风险特征相关，包括形态、生理和炎症特征以及主要不良心血管事件。这种影响部分是由炎症和易损斑块介导的。
gov；独特标识符：NCT05323227。
