摘要
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(percutaneous 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)mm^(3)vs.5.69(0.00,25.75)mm^(3),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�
Objective To evaluate the predictive value of the perivascular fat attenuation index(FAI)based on coronary computed tomography angiography(CCTA)for revascularization in chronic total occlusion(CTO)of coronary artery.Methods A total of 204 patients with coronary artery total occlusion and treated with percutaneous coronary intervention(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)mm^(3)vs.5.69(0.00,25.75)mm^(3),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 c
作者
杨宝珠
黄书苑
于鑫鑫
邓艳
韩鹏熙
刘晓龙
王锡明
YANG Baozhu;HUANG Shuyuan;YU Xinxin;DENG Yan;HAN Pengxi;LIU Xiaolong;WANG Ximing(Department of Radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China;Department of Radiology,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Radiology,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong,China;Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,Shandong,China)
出处
《山东大学学报(医学版)》
CAS
北大核心
2024年第10期98-105,共8页
Journal of Shandong University:Health Sciences
基金
国家自然科学基金(82271993)。
关键词
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
Coronary computed tomography angiography
Pericoronary adipose tissue
Fat attenuation index
Chronic total occlusion
Percutaneous coronary intervention