Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Avenue, Wuchang District, Wuhan 430077, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan 430022, China.
Clin Radiol. 2023 Dec;78(12):e1048-e1056. doi: 10.1016/j.crad.2023.08.024. Epub 2023 Sep 20.
To investigate the prognostic value of quantitative plaque volume on coronary computed tomography (CT) angiography (CTA) combined with CT fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE) in suspected coronary artery disease (CAD) patients.
Patients who underwent coronary CTA with clinically suspected CAD were enrolled retrospectively in this study. Patients' baseline, Framingham Risk Score (FRS), coronary CTA plaque assessment, and CT-FFR were analysed retrospectively. Study outcomes included rehospitalisation and MACE (ST-segment elevation myocardial infarction, unstable angina, or non-ST-segment elevation myocardial infarction, revascularisation, and cardiac death).
There were 251 patients in the study, with a follow-up period of 1-6.58 years. Mean age was 61.16 ± 10.45 years and 146 (58%) patients were male. Higher CT-adapted Leaman score and quantitative plaque volume were found in patients with FRS >0.2 regardless of categorical or continuous variables. Coronary scores, quantitative plaque parameters, and CT-FFR were associated with MACE and rehospitalisation in univariate analysis. In model 1, CT-FFR was associated with MACE in multivariate Cox analysis when adjusted for FRS and CT-adapted Leaman score. Quantitative plaque parameters including calcified plaque volume, fibro-fatty plaque volume, low-attenuation plaque volume, non-calcified plaque volume, and total plaque volume were significantly associated with MACE and improved overall prognostic performance in a model adjusted for CT-FFR.
Additional quantitative plaque volume and CT-FFR further improve the predictive incremental value based on risk factor scores for prognostic prediction in patients. Adding quantitative plaque volume combined with CT-FFR analysis to anatomical and clinical assessment will be further beneficial to predict patients' prognosis of MACE.
探讨冠状动脉计算机断层扫描血管造影（CTA）联合 CT 血流储备分数（CT-FFR）定量斑块体积对疑似冠心病（CAD）患者主要不良心脏事件（MACE）的预后价值。
本研究回顾性纳入了接受冠状动脉 CTA 检查的疑似 CAD 患者。回顾性分析患者的基线资料、弗莱明汉风险评分（FRS）、冠状动脉 CTA 斑块评估和 CT-FFR。研究结局包括再住院和 MACE（ST 段抬高型心肌梗死、不稳定型心绞痛或非 ST 段抬高型心肌梗死、血运重建和心脏性死亡）。
本研究共纳入 251 例患者，随访时间为 1-6.58 年。平均年龄为 61.16±10.45 岁，146 例（58%）为男性。无论采用分类变量还是连续变量，FRS＞0.2 的患者的 CT 适应型 Leaman 评分和定量斑块体积更高。在单因素分析中，冠状动脉评分、定量斑块参数和 CT-FFR 与 MACE 和再住院相关。在模型 1 中，在调整 FRS 和 CT 适应型 Leaman 评分后，多因素 Cox 分析显示 CT-FFR 与 MACE 相关。调整 CT-FFR 后，包括钙化斑块体积、纤维脂肪斑块体积、低衰减斑块体积、非钙化斑块体积和总斑块体积在内的定量斑块参数与 MACE 显著相关，并改善了整体预后性能。
定量斑块体积和 CT-FFR 进一步提高了基于危险因素评分的预测模型对预后的预测能力。将定量斑块体积与 CT-FFR 分析相结合，纳入解剖学和临床评估，将进一步有助于预测患者 MACE 的预后。
