Predictive Value of CCTA Plaque Characteristics for the Progression and Prognosis of Coronary Artery Stenosis
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摘要:
目的：探讨冠状动脉CTA（CCTA）斑块定性、定量特征在预测冠状动脉管腔狭窄程度进展及预后的价值。方法：回顾性分析济宁市第一人民医院2018年5月至2023年8月行2次CCTA检查的患者66例，分为管腔狭窄非进展组和进展组，将患者CCTA图像传入人工智能软件进行斑块分析，共检出斑块87个。分析参数包括一般临床资料、斑块性质、狭窄范围、斑块长度、钙化成分CT值及体积、非钙化成分CT值及体积、低密度成分CT值及体积、斑块总体积、总钙化积分、钙化斑块等效质量、重构指数、低密度斑块、正性重构、“餐巾环征”、点状钙化。分别比较斑块进展组和非进展组以及存在易损斑块和非易损斑块患者的预后情况。结果：与狭窄非进展组相比，进展组糖尿病、易损斑块比例高于非进展组；进展组钙化积分、斑块钙化成分体积、钙化成分占比和钙化斑块等效质量低于非进展组且点状钙化发生率高于非进展组。多因素Logistic回归显示糖尿病（OR值=3.67，95% CI：1.21~11.11）、易损斑块（OR值=3.97，95% CI：1.32~11.94）、点状钙化（OR值=5.73，95% CI：2.03~16.17）为狭窄进展的独立危险因素，钙化成分体积（OR值=0.986，95% CI：0.976~0.997）为狭窄进展的独立保护因素。生存分析曲线显示，非进展组无MACE生存率高于进展组；非易损斑块组无MACE生存率高于易损斑块组。结论：糖尿病、易损斑块、点状钙化为狭窄进展的独立危险因素，钙化成分体积为狭窄进展的独立保护因素，冠状动脉CTA斑块定性、定量特征在预测冠状动脉管腔狭窄进展及预后中有较好的临床价值。
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关键词:
- 冠状动脉CT血管造影 /
- 冠心病 /
- 斑块进展
Abstract:Objective: To investigate the value of qualitative and quantitative plaque characteristics on coronary computed tomography angiography (CCTA) in predicting coronary stenosis progression and prognosis. Methods: This retrospective study analyzed the data of66 patients who underwent two CCTA examinations in Jining First People’s Hospital from May 2018 to August 2023. Patients were categorized into non-progressive and progressive groups. CCTA images were processed with an artificial intelligence software for plaque analysis, identifying 87 plaques. Analysis parameters included general clinical data; plaque characteristics; stenosis range; plaque length; CT values and volumes of calcified, non-calcified, and low-density components; total plaque volume; total calcification score; equivalent mass of calcified plaque; remodeling index; low-density plaque; positive remodeling; “napkin-ring sign;” and punctate calcification. Prognoses were compared between the progression and non-progression groups and between the vulnerable and non-vulnerable plaque groups. Results: The progression group had a higher proportion of patients with diabetes and vulnerable plaques compared to the non-progression group. The calcification score, calcified component volume, proportion of calcified components, and equivalent mass of calcified plaque in the progression group were lower than those in the non-progression group, whereas punctate calcification incidence was higher than that in the non-progression group. Multivariate logistic regression analysis indicated that diabetes (odds ratio OR=3.67, 95% confidence interval CI: 1.21~11.11), vulnerable plaque (OR=3.97, 95% CI: 1.32~11.94), and punctate calcification (OR=5.73, 95% CI: 2.03~16.17) were independent risk factors for stenosis progression, whereas calcification volume (OR=0.986, 95% CI: 0.976~0.997) was an independent protective factor. Survival analysis curve revealed that major adverse cardiovascular event-free survival rate was significantly lower in the progression group than in the non-progression group and similarly lower in the vulnerable plaque group than in the non-vulnerable plaque group. Conclusions: Diabetes, vulnerable plaques, and punctate calcification are independent risk factors for coronary stenosis progression, whereas calcified component volume is an independent protective factor. The qualitative and quantitative characteristics of plaques on coronary CTA provide a good clinical value for predicting the progression and prognosis of coronary stenosis.
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图 1 男性，50岁。（a）为基线CCTA显示管腔轻度狭窄。（b）为12个月后随访CCTA显示管腔中度狭窄。对比两次检查该斑块狭窄进展变化率为55.5%，其中长度增加7.8 mm，斑块体积增加49.4 mm3
Figure 1. A 50-year-old man. (a) baseline CCTA demonstrates mild luminal stenosis. (b) CCTA indicates that moderate lumen stenosis is present after 12 months.The plaque stenosis has progressed by 55.5%, increasing in length by 7.8 mm and in volume by 49.4 mm
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图 2 不同参数预测冠状动脉病变进展的ROC曲线
Figure 2. ROC curves of different parameters predicting the progression of coronary artery disease
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图 3 Kaplan–Meier生存曲线评估进展组和非进展组间无MACE事件生存率，易损斑块和非易损斑块间无MACE事件生存率
Figure 3. Kaplan-Meier survival curve assessing the incidence of non-MACEs between the progressive and non-progressive groups
表 1 进展组与非进展组之间基线临床特征的比较
Table 1 Comparison of baseline clinical features between the progressive and non-progressive groups
临床特征 组别 统计检验 无狭窄进展（n=38） 狭窄进展（n=28） t/x2/z P 年龄/（岁，$\bar x\pm s $） 55.6±8.2 56.5±7.3 −1.12 0.236 BMI 24.6（22.1，28.6） 24.9（22.9，27.7） −0.18 0.859 性别/（例，%） 男 25（65.8） 15（53.6） 1.01 0.227 女 13（34.2） 13（46.4） 高血压/（例，%） 有 21（55.3） 20（71.4） 1.79 0.140 无 17（44.7） 8（28.6） 糖尿病/（例，%） 有 16（42.1） 20（71.4） 5.59 0.017 无 22（57.9） 8（28.6） 高血脂/（例，%） 有 14（36.8） 12（42.9） 0.24 0.405 无 24（63.2） 16（57.1） 吸烟史/（例，%） 有 18（47.4） 7（25.0） 3.43 0.054 无 20（52.6） 21（75.0） 症状/（例，%） 心绞痛 16（42.1） 12（42.9） － 0.652* 不典型的心绞痛胸痛 8（21.1） 9（32.1） 胸闷或心悸 7（18.4） 5（17.9） 无症状 6（15.8） 2（7.1） 易损斑块/（例，%） 有 10（26.3） 16（57.1） 6.42 0.021 无 28（73.7） 12（42.9） 总钙化积分 145.6（13.4，270.7） 43.3（4.6，101.3） −2.38 0.017 
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表 2 进展组与非进展组之间基线CT特征的比较
Table 2 Comparison of baseline CT features between the progressive and non-progressive groups
CT特征 组别 统计检验 非进展组（n=47） 进展组（n=40） t/x2/z P 斑块性质/例 非钙化斑块 4 4 混合斑块 32 29 − 0.782* 钙化斑块 11 7 狭窄范围/例 局限性狭窄 12 13 节段性狭窄 24 21 1.16 0.601 弥漫性狭窄 11 6 斑块长度/mm 19.2（10.8，30.3） 15.8（9.4，24） −1.32 0.190 钙化成分CT值/HU 432.0±146.6 389.5±121.9 −1.45 0.148 钙化成分体积/mm3 51.4（12.7，89.4） 17.2（6.7，35.1） −2.44 0.014 钙化成分占比（%） 0.5（0.3，0.8） 0.3（0.1，0.7） −2.04 0.042 非钙化成分CT值/HU 103.4±28.5 98.9±33.3 −0.84 0.407 非钙化成分体积/mm3 41.7（14.9，91.7） 40.3（19.1，90） −0.38 0.712 非钙化成分占比（%） 0.5（0.3，0.8） 0.7（0.4，0.9） −1.80 0.072 低密度成分CT值/HU 8（0，15） 8（0，13） −0.68 0.498 低密度成分体积/mm3 1.8（0，16.7） 3.6（0.2，20.6） −0.66 0.510 低密度成分占比（%） 0.03（0，0.1） 0.05（0.003，0.2） −1.03 0.305 斑块总体积/mm3 106.2（45.6，224.6） 64.4（39.1，168.5） −1.39 0.167 钙化斑块等效质量 9.5（1.6，28.1） 5.1（0.7，12.1） −2.08 0.037 重构指数 0.9（0.8，1.1） 0.9（0.8，1） −0.19 0.850 低密度斑块/（例，%） 有 11（23.4） 4（10.0） － 0.154* 无 36（76.6） 36（90.0） 正性重构/（例，%） 有 9（19.1） 7（17.5） 0.039 1.000 无 38（80.9） 33（82.5） 餐巾环征/（例，%） 有 8（17.0） 9（22.5） 0.410 0.593 无 39（83.0） 31（77.5） 点状钙化/（例，%） 有 23（48.9） 33（82.5） 10.610 0.002 无 24（51.1） 7（17.5） 注：*采用Fisher检验。
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表 3 不同参数对冠状动脉病变进展的预测价值
Table 3 Predictive values of different parameters for the progression of coronary artery disease
特征 曲线下面积 标准误 P 95% CI 最佳截断值 敏感度 特异度 糖尿病 0.65 0.069 0.043 0.512~0.781 有 0.579 0.714 易损斑块 0.66 0.070 0.031 0.521~0.795 有 0.615 0.700 总钙化积分 0.67 0.067 0.018 0.540~0.804 106.985 0.605 0.821 钙化成分体积 0.65 0.059 0.015 0.537~0.768 50.225 0.511 0.850 钙化成分占比 0.63 0.060 0.042 0.509~0.745 0.385 0.681 0.575 钙化斑块等效质量 0.63 0.060 0.038 0.513~0.746 17.345 0.468 0.850 点状钙化 0.67 0.058 0.007 0.554~0.782 有 0.825 0.511
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表 4 采用逐步法Logistic回归筛选出预测狭窄进展的独立影响因素
Table 4 Stepwise Logistic regression was used to screen independent factors influencing stenosis progression
危险因素 β值 标准误 OR值 95% CI P lower upper 糖尿病 1.300 0.565 3.668 1.211 11.110 0.022 易损斑块 1.379 0.562 3.973 1.321 11.944 0.014 钙化成分体积 −0.014 0.005 0.986 0.976 0.997 0.009 点状钙化 1.745 0.530 5.727 2.028 16.174 0.001 注：β值为回归系数，OR值为优势比，CI为可信区间。
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