冠状动脉周围脂肪衰减指数与急性冠状动脉综合征患者的斑块参数及狭窄严重程度相关：一项横断面研究

Pericoronary fat attenuation index is associated with plaque parameters and stenosis severity in patients with acute coronary syndrome: a cross-sectional study.

作者信息

Zhang Runzhi, Ju Zhiguo, Li Yuanyuan, Gao Yan, Gu Hui, Wang Ximing

机构信息

Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

College of Medical Imaging, Shanghai University of Medicine and Health Science, Shanghai, China.

出版信息

J Thorac Dis. 2022 Dec;14(12):4865-4876. doi: 10.21037/jtd-22-1536.

BACKGROUND

The pericoronary fat attenuation index (FAI) is a novel imaging biomarker of coronary inflammation, which is closely related to development and progression of coronary artery disease (CAD). However, there are limited reports on whether elevated pericoronary FAI values from coronary computed tomography angiography (CCTA) were associated with plaque parameters and coronary stenosis in patients with acute coronary syndrome (ACS). We aimed to assessed that FAI helps to identify high risk of CAD.

METHODS

The clinical diagnosis confirmed to the American Heart Association guidelines for ACS. The lesion-specific pericoronary FAI and plague parameters were measured using QAngioCT software. Using a Hounsfield unit (HU) of -70.1 as the threshold value, lesions with a lesion-specific pericoronary FAI value ≥-70.1 HU were allocated to the FAI-positive group and those with a FAI value <-70.1 HU were allocated to the FAI-negative group. The patients were divided into four stenosis groups according to the coronary angiography (CAG) results, and differences in the FAI values among the four groups were analyzed.

RESULTS

A retrospective analysis of 127 ACS patients, including 299 lesions, who underwent CCTA and CAG successively was conducted. The prevalence of vulnerable plaques increased significantly in the FAI-positive group (49.35% 23.87%, P<0.001). The area under the curve (AUC) of FAI in the diagnosis of vulnerable plagues was 0.810. Plaques were closer to the coronary ostium [3.32 (2.83, 4.29) 4.17 (3.33, 4.95) cm, P<0.001] and more often located in the bifurcated segments of the vessels (50.65% 32.43%, P=0.004) in the FAI-positive group than the FAI-negative group. The FAI-positive group also had a higher percentage of diameter stenosis than the FAI-negative group [80.00% (65.00%, 90.00%) 60.00% (40.00%, 85.00%), P<0.001]. FAI values were higher in stenoses with a diameter ≥50% than stenoses with a diameter <50%.

CONCLUSIONS

The FAI was identified as a novel imaging biomarker of coronary inflammation that is correlated with vulnerable plaque features and stenosis severity.

背景

冠状动脉周围脂肪衰减指数（FAI）是一种新型的冠状动脉炎症成像生物标志物，与冠状动脉疾病（CAD）的发生和发展密切相关。然而，关于冠状动脉计算机断层扫描血管造影（CCTA）中升高的冠状动脉周围FAI值是否与急性冠状动脉综合征（ACS）患者的斑块参数和冠状动脉狭窄相关的报道有限。我们旨在评估FAI是否有助于识别CAD的高风险。

方法

临床诊断符合美国心脏协会ACS指南。使用QAngioCT软件测量病变特异性冠状动脉周围FAI和斑块参数。以-70.1亨氏单位（HU）作为阈值，病变特异性冠状动脉周围FAI值≥-70.1 HU的病变被分配到FAI阳性组，FAI值<-70.1 HU的病变被分配到FAI阴性组。根据冠状动脉造影（CAG）结果将患者分为四个狭窄组，并分析四组之间FAI值的差异。

结果

对127例先后接受CCTA和CAG的ACS患者进行回顾性分析，共包括299个病变。FAI阳性组易损斑块的患病率显著增加（49.35%对23.87%，P<0.001）。FAI诊断易损斑块的曲线下面积（AUC）为0.810。与FAI阴性组相比，FAI阳性组的斑块更靠近冠状动脉开口[3.32（2.83，4.29）对4.17（3.33，4.95）cm，P<0.001]，且更常位于血管的分叉段（50.65%对32.43%，P=0.004）。FAI阳性组的直径狭窄百分比也高于FAI阴性组[80.00%（65.00%，90.00%）对60.00%（40.00%，85.00%），P<0.001]。直径≥50%的狭窄处FAI值高于直径<50%的狭窄处。