南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (7): 988-994.doi: 10.12122/j.issn.1673-4254.2021.07.04

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冠状动脉最大面积狭窄率联合冠周脂肪CT衰减指数可预测冠状动脉血流动力学异常

单冬凯，王更新，王 玺，丁熠璞，陈韵岱，杨俊杰   

  • 出版日期:2021-07-20 发布日期:2021-07-16

Value of maximum area stenosis combined with perivascular fat attenuation index in predicting hemodynamically significant coronary artery disease

  • Online:2021-07-20 Published:2021-07-16

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摘要： 目的 探讨冠状动脉计算机断层扫描造影（CCTA）指标与冠周脂肪CT衰减指数（FAI）在预测冠脉血流动力学异常方面的联合价值。方法 回顾性纳入2017~2019年于解放军总医院接受CCTA检查，并于1月内行有创血流储备分数（FFR）检查的患者。从血管水平检测CCTA指标，包括斑块分布、冠脉血管钙化积分、病变长度、最大直径狭窄率、最大面积狭窄率（MAS）、总斑块负荷，并测量冠周FAI和基于机器学习的CT-FFR。有创FFR≤0.8被认为存在病变特异性的血流动力学异常。结果 回顾性入组99例患者，共计血管124支。从血管水平，FFR≤0.8组的冠脉血管钙化积分，最大直径狭窄率、MAS和总斑块负荷均显著高于FFR>0.8组，冠周FAI（P<0.01）和CT-FFR（P<0.01）差异也存在统计学意义。诊断试验显示，MAS联合冠周FAI的AUC达 到0.818，与CT-FFR相比差异无统计学意义（P=0.076）。结论 MAS与冠周FAI联合应用对鉴别血流动力学意义的冠脉狭窄具有较高的诊断价值，与CT-FFR技术相类似。

关键词: 冠状动脉最大面积狭窄率；CT造影；血流储备分数；脂肪组织；脂肪CT衰减指数

Abstract: Objective To investigate the combined value of coronary computed tomography angiography (CCTA) indicators and perivascular fat attenuation index (FAI) in predicting hemodynamically significant coronary artery disease. Methods We retrospectively analyzed the data of patients undergoing CCTA in Chinese PLA General Hospital from 2017 to 2019, who were also examined for fractional flow reserve (FFR) with invasive coronary angiography within one month before inclusion. The CCTA indicators at the vascular level were measured, including plaque distribution, coronary artery calcification score, lesion length, maximum diameter stenosis, maximum area stenosis (MAS), total plaque burden (TPB), perivascular FAI, and CT-FFR based on machine learning. Lesion-specific hemodynamically significant coronary artery disease was diagnosed for an invasive FFR≤0.8. Results A total of 99 patients with 124 involved coronary arteries were included in this analysis. At the vascular level, according to the results of invasive FFR, coronary artery calcification score, maximum diameter stenosis, MAS and the total plaque burden were significantly higher in patents with a FFR≤0.8 than in those with a FFR>0.8; the perivascular FAI (P<0.01) and CT-FFR (P<0.01) also differed significantly between the two groups. The AUC of MAS combined with perivascular FAI was 0.818, which was not significantly different from that of CT-FFR (P=0.076). Conclusion The combination of MAS and perivascular FAI has good diagnostic performance in predicting hemodynamically significant coronary stenosis, which is comparable with that of CT-FFR.

Key words: maximum area stenosis; CT angiography; fractional flow reserve; adipose tissue; fat attenuation index