Abstract:

Objective　To investigate the value of quantitative coronary CT angiography (CTA) parameters in predicting myocardial ischemic events in patients with coronary heart disease. Methods　A retrospective analysis of 110 patients with coronary heart disease treated in Hanzhong Central Hospital from November 2021 to June 2022. Based on the results of the blood flow reserve fraction test, the patients were divided into two groups: an ischemic group (75 cases) and a non-ischemic group (35 cases). In the ischemia group, there were 46 males and 29 females, 34 ≥60 years old and 41 <60 years old. In the non-ischemic group, there were 18 males and 17 females, 19 ≥60 years old and 16 <60 years old. Coronary CTA was conducted using a Canon 640-slice CT scanner. The total plaque volume, length, diameter stenosis, and joint prediction coefficient were compared between the two groups. The efficacy of the variables in predicting myocardial ischemia was analyzed using the receiver operating characteristic curve (ROC). The patients were followed up for 1 year, and major adverse cardiovascular events (MACE) were counted. According to the occurrence of MACE, the patients were divided into a MACE group (31 cases) and a non-MACE group (79 cases). The predictive value of the predictive coefficients for MACE was analyzed. Results　In the ischemic group, the total plaque volume, length, diameter stenosis, and joint prediction coefficient were (98.21±9.21) mm³, (4.79±1.67) mm, (19.80±4.47)%, and -3.84±2.33, respectively, and the above indexes in the non-ischemic group were (75.89±13.99) mm³, (3.44±1.10) mm, (13.16±4.09)%, and 2.91±2.81, respectively, with statistically significant differences (t=8.606, 5.011, 7.708, and -12.370, all P<0.001). The areas under the curves (AUCs) of the total plaque volume, length, diameter stenosis, and joint prediction coefficient in predicting myocardial ischemia were 0.898, 0.748, 0.859, and 0.968, respectively, and the AUC of the prediction coefficient was greater than those of the total plaque volume, length, and diameter stenosis, with statistically significant differences (all P<0.05). The prediction coefficient of the MACE group was -3.69[-5.16, -2.27], which was lower than that of the non-MACE group -1.81[-4.11, 2.75], with a statistically significant difference (Z=3.009, P=0.002). ROC analysis showed that the AUC of the predictive coefficient in predicting MACE in patients with coronary heart disease was 0.690. Conclusion　The combination of plaque CTA quantitative parameters with prediction coefficients is an effective method for predicting myocardial ischemic injury in patients with coronary heart disease. This approach is more accurate than relying on a single parameter and provides a valuable reference for clinical practice.

Key words:

Coronary heart disease, Myocardial ischemia, Coronary artery, CT angiography, Prediction

摘要：

目的　探讨冠状动脉CT血管成像（CTA）定量参数预测冠心病患者心肌缺血事件的价值。方法　本研究为回顾性分析。选取2021年11月至2022年6月汉中市中心医院收治的110例冠心病患者作为研究对象。根据血流储备分数检测结果，将患者分为缺血组（75例）和非缺血组（35例）。缺血组男46例，女29例，≥60岁34例，<60岁41例。非缺血组男18例，女17例，≥60岁19例，<60岁16例。使用佳能640层CT进行冠状动脉CTA检查。比较两组患者的斑块总体积、长度、直径狭窄度和联合预测系数。使用受试者操作特征曲线（ROC）分析变量预测心肌缺血的效能。对所有患者进行1年随访（至2023年6月），统计随访期间主要心血管不良事件（MACE）。根据MACE发生情况将患者分为MACE组（31例）和非MACE组（79例）。分析预测系数在MACE中的预测价值。统计学方法采用秩和检验、χ²检验、t检验。结果　缺血组患者的斑块总体积、斑块长度、直径狭窄度和预测系数分别为（98.21±9.21）mm³、（4.79±1.67）mm、（19.80±4.47）%、-3.84±2.33，非缺血组上述指标分别为（75.89±13.99）mm³、（3.44±1.10）mm、（13.16±4.09）%、2.91±2.81，差异均有统计学意义（t=8.606、5.011、7.708、-12.370，均P<0.001）。斑块总体积、斑块长度、直径狭窄度和预测系数的曲线下面积（AUC）分别为0.898、0.748、0.859和0.968，预测系数AUC均大于斑块总体积、斑块长度、直径狭窄度，差异均有统计学意义（均P<0.05）。MACE组患者的预测系数为-3.69［-5.16，-2.27］，低于非MACE组患者的-1.81［-4.11，2.75］，差异有统计学意义（Z=3.009，P=0.002）。ROC分析结果显示，预测系数预测冠心病患者发生MACE的AUC为0.690。结论　CTA斑块定量参数联合预测系数能有效预测冠心病患者心肌缺血损伤，优于单一参数。

关键词:

冠心病, 心肌缺血, 冠状动脉CT血管成像, 预测