Xi Yan, Xu Yi, Shu Zheng
Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Front Artif Intell. 2024 Oct 23;7:1446640. doi: 10.3389/frai.2024.1446640. eCollection 2024.
This study utilized artificial intelligence (AI) to quantify coronary computed tomography angiography (CCTA) images, aiming to compare plaque characteristics and CT-derived fractional flow reserve (FFR-CT) in type 2 diabetes mellitus (T2DM) patients with or without hypertension (HTN).
A retrospective analysis was conducted on 1,151 patients with suspected coronary artery disease who underwent CCTA at a single center. Patients were grouped into T2DM ( = 133), HTN ( = 442), T2DM (HTN+) ( = 256), and control ( = 320). AI assessed various CCTA parameters, including plaque components, high-risk plaques (HRPs), FFR-CT, severity of coronary stenosis using Coronary Artery Disease Reporting and Data System 2.0 (CAD-RADS 2.0), segment involvement score (SIS), and segment stenosis score (SSS). Statistical analysis compared these parameters among groups.
The T2DM (HTN+) group had the highest plaque volume and length, SIS, SSS, and CAD-RADS 2.0 classification. In the T2DM group, 54.0% of the plaque volume was noncalcified and 46.0% was calcified, while in the HTN group, these values were 24.0 and 76.0%, respectively. The T2DM (HTN+) group had more calcified plaques (35.7% noncalcified, 64.3% calcified) than the T2DM group. The average necrotic core volume was 4.25 mm in the T2DM group and 5.23 mm in the T2DM (HTN+) group, with no significant difference ( > 0.05). HRPs were more prevalent in both T2DM and T2DM (HTN+) compared to HTN and control groups ( < 0.05). The T2DM (HTN+) group had a higher likelihood (26.1%) of FFR-CT ≤0.75 compared to the T2DM group (13.8%). FFR-CT ≤0.75 correlated with CAD-RADS 2.0 (OR = 7.986, 95% CI = 5.466-11.667, cutoff = 3, < 0.001) and noncalcified plaque volume (OR = 1.006, 95% CI = 1.003-1.009, cutoff = 29.65 mm, < 0.001). HRPs were associated with HbA1c levels (OR = 1.631, 95% CI = 1.387-1.918).
AI analysis of CCTA identifies patterns in quantitative plaque characteristics and FFR-CT values. Comorbid HTN exacerbates partially calcified plaques, leading to more severe coronary artery stenosis in patients with T2DM. T2DM is associated with partially noncalcified plaques, whereas HTN is linked to partially calcified plaques.
本研究利用人工智能（AI）对冠状动脉计算机断层扫描血管造影（CCTA）图像进行量化，旨在比较合并或不合并高血压（HTN）的2型糖尿病（T2DM）患者的斑块特征和CT衍生的血流储备分数（FFR-CT）。
对在单一中心接受CCTA检查的1151例疑似冠状动脉疾病患者进行回顾性分析。患者被分为T2DM组（n = 133）、HTN组（n = 442）、T2DM（HTN+）组（n = 256）和对照组（n = 320）。AI评估了各种CCTA参数，包括斑块成分、高危斑块（HRP）、FFR-CT、使用冠状动脉疾病报告和数据系统2.0（CAD-RADS 2.0）评估的冠状动脉狭窄严重程度、节段累及评分（SIS）和节段狭窄评分（SSS）。统计分析比较了各组之间的这些参数。
T2DM（HTN+）组的斑块体积和长度、SIS、SSS以及CAD-RADS 2.0分类最高。在T2DM组中，54.0%的斑块体积为非钙化，46.0%为钙化，而在HTN组中，这些值分别为24.0%和76.0%。T2DM（HTN+）组的钙化斑块（35.7%非钙化，64.3%钙化）比T2DM组更多。T2DM组的平均坏死核心体积为4.25 mm，T2DM（HTN+）组为5.23 mm，无显著差异（P > 0.05）。与HTN组和对照组相比，HRP在T2DM组和T2DM（HTN+）组中更常见（P < 0.05）。与T2DM组（13.8%）相比，T2DM（HTN+）组FFR-CT≤0.75的可能性更高（26.1%）。FFR-CT≤0.75与CAD-RADS 2.0相关（OR = 7.986，95%CI = 5.466 - 11.667，截断值 = 3，P < 0.001）和非钙化斑块体积相关（OR = 1.006，95%CI = 1.003 - 1.009，截断值 = 29.65 mm，P < 0.001）。HRP与糖化血红蛋白水平相关（OR = 1.631，95%CI = 1.387 - 1.918）。
CCTA的AI分析确定了定量斑块特征和FFR-CT值的模式。合并HTN会加剧部分钙化斑块，导致T2DM患者的冠状动脉狭窄更严重。T2DM与部分非钙化斑块相关，而HTN与部分钙化斑块相关。
