严重急性呼吸综合征冠状病毒2感染与冠状动脉CT血管造影中动脉粥样硬化斑块进展及不良心血管事件的关联

SARS-CoV-2 Infection Association with Atherosclerotic Plaque Progression at Coronary CT Angiography and Adverse Cardiovascular Events.

作者信息

Dai Neng, Tang Xianglin, Hu Yiqing, Lu Hao, Chen Zhangwei, Duan Shaofeng, Guo Weifeng, Edavi Pranav Prakash, Yu Yongfu, Huang Dong, Qian Juying, Ge Junbo

机构信息

From the Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China (N.D., X.T., Y.H., H.L., Z.C., D.H., J.Q., J.G.); National Clinical Research Center for Interventional Medicine, 180 Fenglin Rd, Xuhui District, Shanghai 200032, China (N.D., X.T., Y.H., H.L., Z.C., D.H., J.Q., J.G.); GE HealthCare China, Shanghai, China (S.D.); Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (W.G.); Shanghai Medical College, Fudan University, Shanghai, China (P.P.E.); and School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China (Y.Y.).

出版信息

Radiology. 2025 Feb;314(2):e240876. doi: 10.1148/radiol.240876.

DOI:10.1148/radiol.240876

PMID:39903078

Abstract

Background Patients with acute SARS-CoV-2 infection are reportedly at increased risk for future cardiovascular events; the mechanism underlying this risk remains unclear. Purpose To evaluate the impact of SARS-CoV-2 infection on coronary inflammation and plaques by using coronary CT angiography (CCTA) and the impact on clinical outcomes. Materials and Methods This retrospective analysis of a prospective study included consecutive patients who underwent serial CCTA between September 2018 and October 2023. The quantitative total and compositional percent atheroma volume (PAV) and annualized PAV change, presence of high-risk plaque, and attenuation of lesion-specific pericoronary adipose tissue (PCAT) at baseline and follow-up were compared between lesions in patients with and without SARS-CoV-2 infection. Relationships between SARS-CoV-2 infection and target lesion failure, which is a composite of cardiac death, target lesion myocardial infarction, and clinically driven target lesion revascularizations, were assessed with Cox models and log-rank tests. Results In 803 patients (mean age, 63.9 years ± 10.1 [SD]; 543 [67.6%] male patients), 2108 coronary artery lesions were evaluated in patients with SARS-CoV-2 infection ( = 690) and 480 coronary artery lesions were evaluated in patients without SARS-CoV-2 infection ( = 113). Compared with lesions in patients without SARS-CoV-2 infection, lesions in patients with SARS-CoV-2 infection demonstrated more rapid progression of overall PAV (0.90% per year ± 0.91 vs 0.62% per year ± 0.68, respectively; < .001) and noncalcified PAV (0.78% per year ± 0.79 vs 0.42% per year ± 0.45, respectively; < .001). The incidence of becoming high-risk plaque (21.0% [442 of 2108] vs 15.8% [76 of 480]; = .03) and PCAT attenuation of -70.1 HU or higher (27.1% [571 of 2108] vs 19.8% [95 of 480]; < .001) at follow-up was also greater in lesions in patients with SARS-CoV-2 infection ( < .001), despite similar prevalence at baseline. Lesions in patients with COVID-19 had a higher risk of target lesion failure (10.4% vs 3.1%, respectively; adjusted hazard ratio, 2.90; 95% CI: 1.68, 5.02; < .001). Conclusion SARS-CoV-2 infection was associated with a more rapid progression of lesion-based plaque volume and an increase in incidence of becoming high-risk plaque. Coronary plaques among patients who experienced COVID-19 were more prone to having an elevated risk of target lesion failure. Clinical trial registration no. NCT05380622 © RSNA, 2025 See also the editorial by Weir-McCall and Bell in this issue.

摘要

背景据报道，急性SARS-CoV-2感染患者未来发生心血管事件的风险增加；这种风险背后的机制尚不清楚。目的利用冠状动脉CT血管造影（CCTA）评估SARS-CoV-2感染对冠状动脉炎症和斑块的影响以及对临床结局的影响。材料与方法这项对一项前瞻性研究的回顾性分析纳入了2018年9月至2023年10月期间连续接受系列CCTA检查的患者。比较了SARS-CoV-2感染患者和未感染患者病变在基线和随访时的定量总动脉粥样硬化体积和成分百分比动脉粥样硬化体积（PAV）、年化PAV变化、高危斑块的存在情况以及病变特异性冠状动脉周围脂肪组织（PCAT）的衰减情况。采用Cox模型和对数秩检验评估SARS-CoV-2感染与靶病变失败（心脏死亡、靶病变心肌梗死和临床驱动的靶病变血运重建的复合终点）之间的关系。结果在803例患者（平均年龄63.9岁±10.1[标准差]；543例[67.6%]为男性患者）中，对SARS-CoV-2感染患者（n = 690）的2108处冠状动脉病变和未感染SARS-CoV-2患者（n = 113）的480处冠状动脉病变进行了评估。与未感染SARS-CoV-2的患者的病变相比，感染SARS-CoV-2的患者的病变显示出总体PAV进展更快（分别为每年0.90%±0.91和每年0.62%±0.68；P <.001）和非钙化PAV进展更快（分别为每年0.78%±0.79和每年0.42%±0.45；P <.001）。随访时，感染SARS-CoV-2患者的病变成为高危斑块的发生率（21.0%[2108处中的442处]对15.8%[480处中的76处]；P =.03）以及PCAT衰减达到-70.1 HU或更高的发生率（27.1%[2108处中的571处]对19.8%[480处中的95处]；P <.001）也更高，尽管基线时患病率相似。COVID-19患者的病变发生靶病变失败的风险更高（分别为10.4%对3.1%；调整后的危险比，2.90；95%可信区间：1.68，5.02；P <.001）。结论 SARS-CoV-2感染与基于病变的斑块体积进展更快以及成为高危斑块的发生率增加有关。经历过COVID-19的患者的冠状动脉斑块更容易出现靶病变失败风险升高。临床试验注册号：NCT05380622 © RSNA，2025 另见本期Weir-McCall和Bell的社论。