Ramasamy Anantharaman, Parasa Ramya, Sokooti Hessam, Zhang Xiaotong, Tanboga Ibrahim Halil, Kitslaar Pieter, Broersen Alexander, Rathod Krishnaraj S, Amersey Rajiv, Jain Ajay, Ozkor Mick, Reiber Johan H C, Dijkstra Jouke, Serruys Patrick W, Moon James C, Mathur Anthony, Torii Ryo, Pugliese Francesca, Baumbach Andreas, Bourantas Christos V
Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, London, United Kingdom.
EuroIntervention. 2024 Dec 2;20(23):e1465-e1475. doi: 10.4244/EIJ-D-24-00096.
Coronary computed tomography angiography (CCTA) has been proposed as an alternative to intravascular imaging for assessing plaque pathology.
We aimed to assess the efficacy of CCTA against near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) in evaluating atheroma burden and composition and for guiding coronary interventions.
Seventy patients with a chronic coronary syndrome were recruited and underwent CCTA and NIRS-IVUS. The imaging data were matched, and the estimations of lumen, vessel wall and plaque dimensions and composition of the two modalities were compared. The primary endpoint of the study was the efficacy of CCTA in detecting lipid-rich plaques identified by NIRS-IVUS. Secondary endpoints included the performance of CCTA in evaluating coronary artery pathology in the studied segments and its value in stent sizing, using NIRS-IVUS as the reference standard.
In total, 186 vessels were analysed. The attenuated plaque volume on CCTA had weak accuracy in detecting lipid-rich plaques (58%; p=0.029). Compared to NIRS-IVUS, CCTA underestimated the lumen volume (309.2 mm vs 420.4 mm; p=0.001) and plaque dimensions (total atheroma volume 116.1 mm vs 292.8 mm; p<0.001 and percentage atheroma volume 27.67% vs 41.06%; p<0.001) and overestimated the lipid component (lipid core burden index 48.6 vs 33.8; p=0.007). In the 86 lesions considered for revascularisation, CCTA underestimated the reference vessel area (8.16 mm vs 12.30 mm; p<0.001) and overestimated the lesion length (23.5 mm vs 19.0 mm; p=0.029) compared to NIRS-IVUS.
CCTA has limited efficacy in assessing plaque composition and quantifying lumen and plaque dimensions and tissue types, which may potentially impact revascularisation planning.
冠状动脉计算机断层扫描血管造影（CCTA）已被提议作为评估斑块病理学的血管内成像替代方法。
我们旨在评估CCTA与近红外光谱 - 血管内超声（NIRS-IVUS）在评估动脉粥样硬化负荷和成分以及指导冠状动脉介入治疗方面的疗效。
招募了70例慢性冠状动脉综合征患者，对其进行CCTA和NIRS-IVUS检查。对成像数据进行匹配，并比较两种检查方式对管腔、血管壁和斑块尺寸及成分的评估。该研究的主要终点是CCTA检测NIRS-IVUS识别出的富含脂质斑块的疗效。次要终点包括以NIRS-IVUS作为参考标准，CCTA在评估研究节段冠状动脉病理学方面的表现及其在支架尺寸确定中的价值。
共分析了186条血管。CCTA上衰减斑块体积在检测富含脂质斑块方面准确性较低（58%；p = 0.029）。与NIRS-IVUS相比，CCTA低估了管腔体积（309.2 mm对420.4 mm；p = 0.001）和斑块尺寸（总动脉粥样硬化体积116.1 mm对292.8 mm；p < 0.001，动脉粥样硬化体积百分比27.67%对41.06%；p < 0.001），并高估了脂质成分（脂质核心负荷指数48.6对33.8；p = 0.007）。在考虑血运重建的86个病变中，与NIRS-IVUS相比，CCTA低估了参考血管面积（8.16 mm对12.30 mm；p < 0.001），并高估了病变长度（23.5 mm对19.0 mm；p = 0.029）。
CCTA在评估斑块成分、量化管腔和斑块尺寸以及组织类型方面疗效有限，这可能会对血运重建规划产生潜在影响。
