The efficacy of vascular and plaque characteristics of coronary CT angiography in evaluating myocardial ischemia in coronary atherosclerotic heart disease

Shi Biao; Ruan Weisheng; Ma Xiaoxuan

doi:10.3760/j.issn.1673-4777.2024.11.003

Abstract：Objective To analyze the efficacy of vascular and plaque characteristics of coronary computed tomography angiography(CCTA)in evaluating myocardial ischemia in patients with coronary atherosclerotic heart disease(CHD).Methods The clinical data of 70 patients with suspected or confirmed CHD who underwent invasive coronary angiography(ICA)in Zhangjiakou First Hospital,Hebei Province from November 2021 to October 2023 were retrospectively analyzed.All patients underwent CCTA,ICA and fractional flow reserve(FFR)examination in turn.Myocardial FFR measured by pressure guidewire under ICA guidance was used as the gold standard,and all diseased vessels were divided into the ischemia group(FFR≤0.8)and the non-ischemia group(FFR＞0.8),including 32 patients(37 diseased vessels)in the ischemia group and 38 patients(44 diseased vessels)in the non-ischemia group.The plaque characteristics(plaque burden,non-calcified plaque volume percentage,calcified plaque volume percentage,lesion length,high-risk signs of plaque)and the degree of arterial stenosis in left main coronary artery,anterior descending artery,right coronary artery were compared between the two groups.Logistic regression analysis was used to analyze the relationship between CCTA stenosis rate,plaque characteristics and myocardial ischemic lesions.The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of different indicators for myocardial ischemic lesions.Results The incidences of CT high-risk plaque and napkin ring sign in the ischemia group were higher than those in the non-ischemia group,while the incidences of low-density plaque and positive remodeling were lower than those in the non-ischemia group(all P＜0.05).There was a significant difference in the degree of arterial stenosis between the two groups(Z=9.275,P＜0.001).Multivariate Logistic regression analysis showed that the risk factors of myocardial ischemia included CCTA stenosis rate,lesion length and CT high-risk plaque(odds ratio=3.796,1.029,2.463,respectively;all P＜0.05).The diagnostic efficacy of CCTA(≥50％stenosis)combined with CT high-risk plaque and lesion length was higher than that of CCTA(≥50％stenosis)or ICA(≥50％stenosis)alone(area under the curve:0.715 vs 0.626,0.665,both P＜0.05).Conclusion The predictive factors of myocardial ischemia in CHD include CCTA stenosis rate,lesion length and CT high-risk plaque.The combined application of the three can greatly improve the diagnostic efficiency of myocardial ischemia.