首页|基于CCTA的血管周围脂肪衰减指数对冠状动脉慢性全闭塞病变再通的预测价值

基于CCTA的血管周围脂肪衰减指数对冠状动脉慢性全闭塞病变再通的预测价值

扫码查看
目的 探究基于冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)的冠状动脉周围脂肪衰减指数(fat attenuation index,FAI)对冠状动脉慢性全闭塞病变(chronic total occlusion,CTO)再通的预测价值.方法 回顾性分析 2012 年 11 月至 2023 年 6 月期间行CCTA检查并接受经皮冠状动脉介入(percutane-ous coronary intervention,PCI)治疗的冠状动脉完全闭塞患者(n=204)的临床资料,根据手术结果分为成功组(n=144)与失败组(n=60).记录并分析两组患者的临床资料,闭塞段血管FAI,CTO病变的CCTA形态特征,包括病变部位[右冠状动脉(right coronary artery,RCA)、左前降支(left anterior descending artery,LAD)、左回旋支(left circumflex artery,LCX)]、病变长度、病变CT值、病变钙化斑块的体积、病变入口处的残端形态、病变弯曲角度是否>45°、病变是否为负性重构,并进行两组间比较.通过多因素Logistic回归分析筛选影响CTO病变再通的独立因素,并分别建立传统形态学特征模型及联合形态学特征和 FAI的联合模型.通过受试者工作特征(receiver operating characteristic,ROC)曲线评价各模型的预测性能.结果 两组间闭塞段FAI[(-82.33±10.61)HU vs.(-71.70±10.91)HU,P<0.001]、闭塞段CT值[69.85(55.95,86.25)HU vs.58.25(47.00,72.83)HU,P<0.001]、闭塞段血管的钙化体积[20.92(2.25,52.80)mm3 vs.5.69(0.00,25.75)mm3,P<0.001]、闭塞段长度[23.60(13.90,34.50)mm vs.14.65(9.43,19.60)mm,P<0.001]等差异均有统计学意义;其中,闭塞段长度>23.05 mm、闭塞段FAI<-77.50 HU、闭塞段CT值>58.15 HU及闭塞血管负性重构是CTO病变再通失败的独立预测因素,将以上三种形态学特征因素建立传统形态学特征模型,传统形态学特征模型联合闭塞段FAI建立联合模型.联合模型的预测价值优于传统形态学特征模型的预测价值,AUC分别为 0.857、0.787,P<0.001.结论 FAI可以作为预测冠状动脉慢性全闭塞病变PCI手术结果的一个新的预测指标;在传统的影像学特征基础上,FAI能为CTO患者手术结果的预测提供新的增量价值.
Predictive value of perivascular fat attenuation index based on CCTA for revascularization in chronic total occlusion of coronary artery
Objective To evaluate the predictive value of the perivascular fat attenuation index(FAI)based on coro-nary computed tomography angiography(CCTA)for revascularization in chronic total occlusion(CTO)of coronary ar-tery.Methods A total of 204 patients with coronary artery total occlusion and treated with percutaneous coronary inter-vention(PCI)between November 2012 and June 2023 were retrospectively analyzed and divided into the successful group(n=144)and the unsuccessful group(n=60)according to the outcome of the procedure.The general clinical data,FAI of the occluded segment,and the morphological characteristics of CCTA of CTO lesions,including lesion site[right coronary artery(RCA),left anterior descending artery(LAD),left circumflex artery(LCX)],lesion length,lesion CT value,the volume of calcified plaques in the lesion,the stump morphology of the lesion entrance,whether the angle of curvature of the lesion was>45°,and whether the lesion was negatively remodeled,were analyzed and compared between the two groups.Independent factors affecting the revascularization of CTO lesion were screened by binary Logistic regression analysis,and a conventional model of morphological characteristics and a combined model of morphological characteristics and FAI were established.The predictive performance of each model was evaluated by the receiver operating characteristic(ROC)curve.Results The differences in FAI[(-82.33±10.61)HU vs.(-71.70±10.91)HU,P<0.001],CT value[69.85(55.95,86.25)HU vs.58.25(47.00,72.83)HU,P<0.001],calcified volume[20.92(2.25,52.80)mm3 vs.5.69(0.00,25.75)mm3,P<0.001],and length[23.60(13.90,34.50)mm vs.14.65(9.43,19.60)mm,P<0.001]of the occluded segment were all statistically significant.The occluded segment length>23.05 mm,FAI of the occluded segment<-77.50 HU,CT value of the occluded segment>58.15 HU,and negative remodeling of the occluded vessel were identified as independent predictors of failure of CTO lesion revascularization.A conventional morphological characteristics model was established by combining the three morphological characteristics factors,and another model was established by combining the conventional morphological characteristics model with FAI.The combined model demonstrated superior predictive performance for the outcome of revascularization compared to the con-ventional morphological characteristics model,with AUC being 0.857 and 0.787,respectively,P<0.001.Conclusion The FAI may serve as a novel predictor of the outcomes of PCI surgery for CTO of the coronary artery.Based on the conven-tional morphological characteristics,FAI provides a novel approach to predicting the surgical outcomes of CTO patients.

Coronary computed tomography angiographyPericoronary adipose tissueFat attenuation indexChronic total occlusionPercutaneous coronary intervention

杨宝珠、黄书苑、于鑫鑫、邓艳、韩鹏熙、刘晓龙、王锡明

展开 >

山东第一医科大学附属省立医院影像科,山东 济南 250021

山东大学齐鲁医院放射科,山东 济南 250012

山东第一医科大学第一附属医院放射科,山东 济南 250014

济宁医学院附属医院影像科,山东 济宁 272029

展开 >

冠状动脉CT血管成像 冠状动脉周围脂肪 脂肪衰减指数 慢性全闭塞病变 经皮冠状动脉介入

国家自然科学基金

82271993

2024

山东大学学报(医学版)
山东大学

山东大学学报(医学版)

CSTPCD北大核心
影响因子:0.841
ISSN:1671-7554
年,卷(期):2024.62(10)