Tomizawa Nobuo, Fujimoto Shinichiro, Mita Tomoya, Takahashi Daigo, Nozaki Yui, Fan Ruiheng, Kudo Ayako, Kawaguchi Yuko, Takamura Kazuhisa, Hiki Makoto, Kurita Mika, Kumamaru Kanako K, Watada Hirotaka, Minamino Tohru, Aoki Shigeki
From the Department of Radiology (N.T., R.F., K.K.K., S.A.), Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K., K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Radiol Cardiothorac Imaging. 2023 Aug 24;5(4):e230016. doi: 10.1148/ryct.230016. eCollection 2023 Aug.
To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus.
This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis.
Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec; IQR: 730-1253 vs 443 sec; IQR: 295-602; < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; = .004).
In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL. Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve © RSNA, 2023.
探讨在2型糖尿病患者中，涡度是否比高危斑块（HRP）和病变长度（LL）能更好地预测功能性斑块进展。
这项单中心前瞻性研究纳入了61名参与者（平均年龄61岁±9[标准差]；43名男性参与者），他们在2015年10月至2020年3月期间接受了为期2年的系列冠状动脉CT血管造影检查，初始CT显示狭窄率为20%-70%。记录以下HRP特征的数量：低衰减、正向重塑、斑点状钙化和餐巾环征。使用无网格模拟计算涡度。CT血流储备分数下降大于0.05表明存在功能进展。使用HRP、LL和涡度的模型通过受试者操作特征曲线分析进行比较。
在评估的94条血管中，25条血管（27%）显示出功能进展。有功能进展的血管在远端狭窄处的涡度更高（984秒；四分位间距：730-1253 vs 443秒；四分位间距：295-602；P<.001），高于无进展的血管。涡度的受试者操作特征曲线下面积（0.91；95%可信区间：0.84，0.97）高于HRP和LL（0.69；95%可信区间：0.56，0.82；P<.01）。涡度的诊断准确性（85%；94条血管中的80条；95%可信区间：76，92）高于HRP和LL（72%；94条血管中的68条；95%可信区间：62，81；P=.004）。
在2型糖尿病患者中，远端狭窄处的涡度比HRP和LL能更好地预测功能性斑块进展。冠状动脉、涡度、功能性斑块进展、2型糖尿病、脉管系统、CT血管造影、计算流体动力学、血流储备分数 ©RSNA，2023
