采用计算机断层扫描技术对早发冠心病患者的冠状动脉斑块进行表型分析。
Phenotyping coronary plaque by computed tomography in premature coronary artery disease.
机构信息
ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France.
INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France.
出版信息
Eur Heart J Cardiovasc Imaging. 2024 Jan 29;25(2):257-266. doi: 10.1093/ehjci/jead212.
AIMS
Premature coronary artery disease (CAD) is an aggressive disease with multiple recurrences mostly related to new coronary lesions. This study aimed to compare coronary plaque characteristics of individuals with premature CAD with those of incidental plaques found in matched individuals free of overt cardiovascular disease, using coronary computed tomography angiography (CCTA).
METHODS AND RESULTS
Of 1552 consecutive individuals who underwent CCTA, 106 individuals with history of acute or stable obstructive CAD ≤45 years were matched by age, sex, smoking status, cardiovascular heredity, and dyslipidaemia with 106 controls. CCTA were analysed for Coronary Artery Disease Reporting and Data System score, plaque composition, and high-risk plaque (HRP) features, including spotty calcification, positive remodelling, low attenuation, and napkin-ring sign. The characteristics of 348 premature CAD plaques were compared with those of 167 incidental coronary plaques of matched controls. The prevalence of non-calcified plaques was higher among individuals with premature CAD (65.1 vs. 30.2%, P < 0.001), as well as spotty calcification (42.5 vs. 17.9%, P < 0.001), positive remodelling (41.5 vs. 9.4%, P < 0.001), low attenuation (24.5 vs. 3.8%, P < 0.001), and napkin-ring sign (1.9 vs. 0.0%). They exhibited an average of 2.2 (2.7) HRP, while the control group displayed 0.4 (0.8) HRP (P < 0.001). Within a median follow-up of 24 (16, 34) months, individuals with premature CAD and ischaemic recurrence (n = 24) had more HRP [4.3 (3.9)] than those without ischaemic recurrence [1.5 (1.9)], mostly non-calcified with low attenuation and positive remodelling.
CONCLUSION
Coronary atherosclerosis in individuals with premature CAD is characterized by a high and predominant burden of non-calcified plaque and unusual high prevalence of HRP, contributing to disease progression with multiple recurrences. A comprehensive qualitative CCTA assessment of plaque characteristics may further risk stratify our patients, beyond cardiovascular risk factors.
目的
早发冠心病（CAD）是一种侵袭性疾病，多数与新的冠状动脉病变相关，其具有多次复发的特点。本研究旨在通过冠状动脉计算机断层扫描血管造影术（CCTA）比较早发 CAD 患者与无明显心血管疾病的偶然斑块患者的冠状动脉斑块特征。
方法和结果
在 1552 例连续接受 CCTA 的患者中，106 例年龄、性别、吸烟状况、心血管遗传和血脂异常相匹配的≤45 岁急性或稳定型阻塞性 CAD 病史患者与 106 例对照者相匹配。对 CCTA 进行冠状动脉疾病报告和数据系统评分、斑块成分和高危斑块（HRP）特征分析，包括点状钙化、正性重构、低衰减和餐巾环征。比较了 348 例早发 CAD 斑块与 167 例匹配对照者偶然的冠状动脉斑块的特征。早发 CAD 患者中非钙化斑块的发生率更高（65.1%比 30.2%，P<0.001），点状钙化（42.5%比 17.9%，P<0.001）、正性重构（41.5%比 9.4%，P<0.001）、低衰减（24.5%比 3.8%，P<0.001）和餐巾环征（1.9%比 0.0%）也更高。他们平均有 2.2（2.7）个 HRP，而对照组显示 0.4（0.8）个 HRP（P<0.001）。在中位数为 24（16，34）个月的随访中，有缺血复发的早发 CAD 患者（n=24）有更多的 HRP[4.3（3.9）]，而无缺血复发的患者为[1.5（1.9）]（P<0.001），主要是非钙化斑块，伴有低衰减和正性重构。
结论
早发 CAD 患者的冠状动脉粥样硬化的特点是高负荷、主要是非钙化斑块，以及异常高的 HRP 发生率，导致疾病多次复发。对斑块特征进行全面的定性 CCTA 评估可能会进一步对我们的患者进行危险分层，而不仅仅是基于心血管危险因素。
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