Iraqi Nadia, Nørgaard Bjarne L, Dey Damini, Abdulla Jawdat
Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Eur Radiol. 2025 Mar 27. doi: 10.1007/s00330-025-11516-1.
To evaluate the association between plaque characteristics and burden by coronary computed tomography angiography (CCTA) and ischemia determined by invasively measured fractional flow reserve (FFR), and whether the addition of plaque characteristics improves ischemia discrimination beyond coronary stenosis alone.
A systematic literature review and meta-analysis of studies from PubMed, EMBASE, and the Cochrane Library databases, published between January 2005 and October 2024 were conducted to assess the relationship between quantitative and qualitative coronary plaque characteristics and invasive FFR. Pooled analyses were performed using weighted mean difference for plaque volumes with 95% confidence intervals and odds ratios for qualitative plaque findings.
A total of 29 studies involving 4416 patients (mean age 63 ± 9 years and 71% male) with predominantly stable coronary artery disease were included. Data on 3923 lesions and 3520 vessels were pooled. Total plaque, non-calcified plaque, and percent aggregate plaque volumes, as well as percent plaque burden, were inversely associated with FFR at both per-lesion and per-vessel levels (all, p-values < 0.05). The presence of high-risk plaque characteristics, including low-attenuation plaque, napkin-ring sign, and spotty calcification, were more frequently observed in lesions and vessels with FFR ≤ 0.80 (all, p-values < 0.05). Among plaque volumes, the percent aggregate plaque volume consistently improved ischemia discrimination independently of stenosis.
CCTA-derived quantification of plaque volumes and identification of high-risk plaque characteristics are associated with ischemia and significantly enhance discrimination of ischemia-causing lesions independently of coronary stenosis severity.
Question Plaque characteristics have been suggested as the missing link between coronary artery stenosis severity and ischemia. Findings High-risk plaque characteristics and larger coronary plaque volumes are associated with ischemia (FFR ≤ 0.80). Clinical relevance The addition of CCTA-derived plaque assessment improved the discrimination of ischemia compared with stenosis evaluation alone. Combining coronary stenosis and plaque assessment may improve the non-invasive assessment of patients with coronary artery disease and gatekeeping to the catheterization laboratory.
通过冠状动脉计算机断层扫描血管造影（CCTA）评估斑块特征与负荷之间的关联，以及通过有创测量的血流储备分数（FFR）确定的缺血情况，并探讨添加斑块特征是否能在仅考虑冠状动脉狭窄的基础上提高对缺血的鉴别能力。
对2005年1月至2024年10月期间发表在PubMed、EMBASE和Cochrane图书馆数据库中的研究进行系统文献综述和荟萃分析，以评估冠状动脉斑块的定量和定性特征与有创FFR之间的关系。使用加权平均差计算斑块体积的95%置信区间，并对定性斑块发现计算比值比进行汇总分析。
共纳入29项研究，涉及4416例患者（平均年龄63±9岁，71%为男性），主要为稳定型冠状动脉疾病。汇总了3923个病变和3520条血管的数据。在病变和血管水平上，总斑块、非钙化斑块、总斑块体积百分比以及斑块负荷百分比均与FFR呈负相关（所有p值<0.05）。在FFR≤0.80的病变和血管中，更频繁地观察到高危斑块特征，包括低密度斑块、餐巾环征和斑点状钙化（所有p值<0.05）。在斑块体积中，总斑块体积百分比始终能独立于狭窄程度提高对缺血的鉴别能力。
CCTA得出的斑块体积定量和高危斑块特征识别与缺血相关，并能在不考虑冠状动脉狭窄严重程度的情况下显著增强对缺血性病变的鉴别能力。
问题 斑块特征被认为是冠状动脉狭窄严重程度与缺血之间缺失的环节。研究结果 高危斑块特征和较大的冠状动脉斑块体积与缺血（FFR≤0.80）相关。临床意义 与单独的狭窄评估相比，添加CCTA得出的斑块评估可改善对缺血的鉴别。结合冠状动脉狭窄和斑块评估可能会改善对冠状动脉疾病患者的无创评估以及进入导管实验室的把关。
