Centre for Cardiovascular Innovation and Center for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Division of Cardiology and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Centre for Cardiovascular Innovation and Center for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Division of Cardiology and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Imaging. 2024 Feb;17(2):165-175. doi: 10.1016/j.jcmg.2023.05.011. Epub 2023 Jul 5.
With growing adoption of coronary computed tomographic angiography (CTA), there is increasing evidence for and interest in the prognostic importance of atherosclerotic plaque volume. Manual tools for plaque segmentation are cumbersome, and their routine implementation in clinical practice is limited.
The aim of this study was to develop nomographic quantitative plaque values from a large consecutive multicenter cohort using coronary CTA.
Quantitative assessment of total atherosclerotic plaque and plaque subtype volumes was performed in patients undergoing clinically indicated coronary CTA, using an Artificial Intelligence-Enabled Quantitative Coronary Plaque Analysis tool.
A total of 11,808 patients were included in the analysis; their mean age was 62.7 ± 12.2 years, and 5,423 (45.9%) were women. The median total plaque volume was 223 mm (IQR: 29-614 mm) and was significantly higher in male participants (360 mm; IQR: 78-805 mm) compared with female participants (108 mm; IQR: 10-388 mm) (P < 0.0001). Total plaque increased with age in both male and female patients. Younger patients exhibited a higher prevalence of noncalcified plaque. The distribution of total plaque volume and its components was reported in every decile by age group and sex.
The authors developed pragmatic age- and sex-stratified percentile nomograms for atherosclerotic plaque measures using findings from coronary CTA. The impact of age and sex on total plaque and its components should be considered in the risk-benefit analysis when treating patients. Artificial Intelligence-Enabled Quantitative Coronary Plaque Analysis work flows could provide context to better interpret coronary computed tomographic angiographic measures and could be integrated into clinical decision making.
随着冠状动脉 CT 血管造影（CTA）的广泛应用，越来越多的证据表明动脉粥样硬化斑块体积具有预后意义，人们对其也越来越感兴趣。用于斑块分割的手动工具繁琐，其在临床实践中的常规实施受到限制。
本研究旨在使用冠状动脉 CTA 从大型连续多中心队列中开发基于列线图的定量斑块值。
使用人工智能驱动的定量冠状动脉斑块分析工具对接受临床指征冠状动脉 CTA 的患者进行总动脉粥样硬化斑块和斑块亚型体积的定量评估。
共纳入 11808 例患者进行分析；其平均年龄为 62.7 ± 12.2 岁，5423 例（45.9%）为女性。中位数总斑块体积为 223mm（IQR：29-614mm），男性参与者（360mm；IQR：78-805mm）明显高于女性参与者（108mm；IQR：10-388mm）（P < 0.0001）。总斑块在男性和女性患者中均随年龄增长而增加。年轻患者中非钙化斑块的患病率更高。按年龄组和性别报告了总斑块体积及其各成分在每十分位数的分布。
作者使用冠状动脉 CTA 的结果开发了实用的基于年龄和性别的动脉粥样硬化斑块测量分层百分位列线图。在治疗患者时，应考虑年龄和性别对总斑块及其各成分的影响，以便进行风险获益分析。人工智能驱动的定量冠状动脉斑块分析工作流程可以为更好地解释冠状动脉 CT 血管造影测量值提供依据，并可以整合到临床决策中。
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