de Knegt Martina C, Linde Jesper J, Sigvardsen Per E, Engstrøm Thomas, Fuchs Andreas, Jensen Andreas K, Elming Hanne, Kühl J Tobias, Hansen Peter R, Høfsten Dan E, Kelbæk Henning, Nordestgaard Børge G, Hove Jens D, Køber Lars V, Kofoed Klaus F
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
J Cardiovasc Comput Tomogr. 2024 Mar-Apr;18(2):203-210. doi: 10.1016/j.jcct.2024.01.014. Epub 2024 Feb 5.
We examined obstructive and nonobstructive plaque volumes in populations with subclinical and clinically manifested coronary artery disease (CAD) using quantitative computed tomography (QCT).
855 participants with CAD (274 asymptomatic individuals, 254 acute chest pain patients without acute coronary syndrome (ACS), and 327 patients with ACS) underwent QCT of proximal coronary segments to assess participant-level plaque volumes of dense calcium, fibrous, fibrofatty, and necrotic core tissue.
Nonobstructive (<50% stenosis) plaque volumes were greater than obstructive plaque volumes, irrespective of population (all p<0.0001): Asymptomatic individuals (mean (95% CI)): 218 [190-250] vs. 16 [12-22] mm; acute chest pain patients without ACS: 300 [263-341] vs. 51 [41-62] mm; patients with ACS: 370 [332-412] vs. 159 [139-182] mm. After multivariable adjustment, nonobstructive fibrous and fibrofatty tissue volumes were greater in acute chest pain patients without ACS compared to asymptomatic individuals (fibrous tissue: 122 [107-139] vs. 175 [155-197] mm, p<0.01; fibrofatty tissue: 44 [38-50] vs. 71 [63-80] mm, p<0.01. Necrotic core tissue was greater in ACS patients (29 [26-33] mm) compared to both asymptomatic individuals (15 [13-18] mm, p<0.0001) and acute chest pain patients without ACS (21 [18-24] mm, p<0.05). Nonobstructive dense calcium volumes did not differ between the three populations: 29 [24-36], 29 [23-35], and 41 [34-48] mm, p>0.3 respectively.
Nonobstructive CAD was the predominant contributor to total atherosclerotic plaque volume in both subclinical and clinically manifested CAD. Nonobstructive fibrous, fibrofatty and necrotic core tissue volumes increased with worsening clinical presentation, while nonobstructive dense calcium tissue volumes did not.
我们使用定量计算机断层扫描（QCT）检查了亚临床和临床表现为冠状动脉疾病（CAD）人群中的阻塞性和非阻塞性斑块体积。
855名CAD患者（274名无症状个体、254名无急性冠状动脉综合征（ACS）的急性胸痛患者和327名ACS患者）接受了近端冠状动脉节段的QCT检查，以评估参与者层面致密钙、纤维、纤维脂肪和坏死核心组织的斑块体积。
无论人群如何，非阻塞性（<50%狭窄）斑块体积均大于阻塞性斑块体积（所有p<0.0001）：无症状个体（均值（95%CI））：218[190 - 250] vs. 16[12 - 22]mm；无ACS的急性胸痛患者：300[263 - 341] vs. 51[41 - 62]mm；ACS患者：370[332 - 412] vs. 159[139 - 182]mm。多变量调整后，无ACS的急性胸痛患者的非阻塞性纤维和纤维脂肪组织体积大于无症状个体（纤维组织：122[107 - 139] vs. 175[155 - 197]mm，p<0.01；纤维脂肪组织：44[38 - 50] vs. 71[63 - 80]mm，p<0.01）。ACS患者的坏死核心组织大于无症状个体（15[13 - 18]mm，p<0.0001）和无ACS的急性胸痛患者（21[18 - 24]mm，p<0.05）。三个群体的非阻塞性致密钙体积无差异：分别为29[24 - 36]、29[23 - 35]和41[34 - 48]mm，p>0.3。
在亚临床和临床表现为CAD的人群中，非阻塞性CAD是总动脉粥样硬化斑块体积的主要贡献因素。非阻塞性纤维、纤维脂肪和坏死核心组织体积随临床表现恶化而增加，而非阻塞性致密钙组织体积则不然。
