European Radiology:CCTA预测斑块进展和主要不良心脏事件(MACE)究竟有何优点和挑战?

2022-03-15 shaosai MedSci原创

据统计,冠状动脉疾病(CAD)仍然是全世界范围内造成死亡和残疾的主要原因之一。动脉粥样硬化斑块的表型与临床症状相关,因为易损斑块容易破裂,可导致主要不良心脏事件(MACE)。

统计冠状动脉疾病(CAD)仍然是全世界范围内造成死亡和残疾的主要原因之一。动脉粥样硬化斑块的表型与临床症状相关,因为易损斑块容易破裂,可导致主要不良心脏事件(MACE)。另外,已经证明心外膜脂肪组织(EAT)与腹内脂肪有相同的胚胎学起源,而腹内脂肪与CAD有关。这就说明了对未来有动脉硬化进展和MACE风险的患者进行准确识别和风险分层的重要性。除了血管内超声(IVUS)、血管内光学相干断层扫描(IVOCT)和有创冠状动脉造影(ICA)等侵入性技术外,冠状动脉计算机断层扫描(CCTA)是一种非侵入性的成像方法,可以对冠状动脉斑块进行定性和定量评估。之前的一项荟萃分析显示,与IVUS相比,CCTA的特征与冠状动脉斑块的测量之间有很高的相关性。因此,CCTA作为一种无创的斑块评估工具迅速崛起。

近日,发表在European Radiology杂志的一项研究探讨了以CCTA为工具寻找斑块定量(变化)和定性特征以及EAT体积变化作为斑块进展或MACE的预测因素,并概述了使用序列无创成像方法评估心血管预后的挑战和优势

本研究在PubMed、Embase、Web of Science、Cochrane Library和Emcare进行了文献检索。所有观察性队列研究都使用Newcastle-Ottawa量表(NOS)进行质量评估。然后将NOS得分转换为医疗研究和质量机构(AHRQ)的标准:好、一般和差。 

本综述共分析了36篇文章,其中3篇为荟萃分析,1篇为技术论文。与定性的斑块特征相比,定量的基线斑块特征似乎更能预测MACE和/或斑块的进展。 

 

 患者示例,在基线(A)和随访扫描(B)之间有6年的扫描间隔。显示的为左主干(LM)和左前降支(LAD)动脉共有三个新形成的钙化斑块:一个在LM,两个在LAD的近端段。在这种情况下,CX的分支可以作为一个解剖学上的标志,通过视觉分析进行联合登记。橙色的线标志着血管外壁,黄色的线是冠状动脉的管腔。

本研究对利用连续CCTA进行研究的文献进行批判性回顾,发现主要是定量的基线斑块特征和定量的斑块变化可以预测MACE和斑块的进展,与定性的斑块特征相反。

原文出处

F Y van Driest,C M Bijns,R J van der Geest,et al.Utilizing (serial) coronary computed tomography angiography (CCTA) to predict plaque progression and major adverse cardiac events (MACE): results, merits and challenges.DOI:10.1007/s00330-021-08393-9

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    2022-12-13 yb6560
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    2022-06-01 feather89
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    2022-11-10 shanyongle
  4. [GetPortalCommentsPageByObjectIdResponse(id=1996455, encodeId=aea719964555a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Dec 13 16:29:28 CST 2022, time=2022-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729436, encodeId=12971e29436bb, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Wed Jun 01 15:29:28 CST 2022, time=2022-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656101, encodeId=f898165610101, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Thu Nov 10 07:29:28 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1975616, encodeId=43ff19e561683, content=<a href='/topic/show?id=10352326507' target=_blank style='color:#2F92EE;'>#主要不良心脏事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23265, 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content=<a href='/topic/show?id=cf6d51401d9' target=_blank style='color:#2F92EE;'>#心脏事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51401, encryptionId=cf6d51401d9, topicName=心脏事件)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Sun Nov 20 00:29:28 CST 2022, time=2022-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203940, encodeId=88271203940c7, content=再详细些, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sat Mar 19 01:39:06 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968094, encodeId=23c919680940d, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Tue Jun 21 01:29:28 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330222, encodeId=3b8813302223e, content=<a href='/topic/show?id=a91c5e92328' target=_blank style='color:#2F92EE;'>#斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57923, encryptionId=a91c5e92328, topicName=斑块)], attachment=null, authenticateStatus=null, 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1996455, encodeId=aea719964555a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Dec 13 16:29:28 CST 2022, time=2022-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729436, encodeId=12971e29436bb, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, 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content=<a href='/topic/show?id=cf6d51401d9' target=_blank style='color:#2F92EE;'>#心脏事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51401, encryptionId=cf6d51401d9, topicName=心脏事件)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Sun Nov 20 00:29:28 CST 2022, time=2022-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203940, encodeId=88271203940c7, content=再详细些, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sat Mar 19 01:39:06 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968094, encodeId=23c919680940d, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Tue Jun 21 01:29:28 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330222, encodeId=3b8813302223e, content=<a href='/topic/show?id=a91c5e92328' target=_blank style='color:#2F92EE;'>#斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57923, encryptionId=a91c5e92328, topicName=斑块)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575226, encodeId=316a15e52261d, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=)]
    2022-06-13 windight
  6. [GetPortalCommentsPageByObjectIdResponse(id=1996455, encodeId=aea719964555a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Dec 13 16:29:28 CST 2022, time=2022-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729436, encodeId=12971e29436bb, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, 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content=<a href='/topic/show?id=cf6d51401d9' target=_blank style='color:#2F92EE;'>#心脏事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51401, encryptionId=cf6d51401d9, topicName=心脏事件)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Sun Nov 20 00:29:28 CST 2022, time=2022-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203940, encodeId=88271203940c7, content=再详细些, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sat Mar 19 01:39:06 CST 2022, time=2022-03-19, status=1, ipAttribution=), 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  7. [GetPortalCommentsPageByObjectIdResponse(id=1996455, encodeId=aea719964555a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Dec 13 16:29:28 CST 2022, time=2022-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729436, encodeId=12971e29436bb, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, 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createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575226, encodeId=316a15e52261d, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=)]
    2022-03-19 forvalen

    再详细些

    0

  8. 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createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575226, encodeId=316a15e52261d, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Wed Mar 16 09:29:28 CST 2022, time=2022-03-16, status=1, ipAttribution=)]
    2022-06-21 wshxjq
  9. 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  10. 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    2022-03-16 lfyang

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根据目前的指南,冠状动脉CT血管成像(CCTA)是评估冠状动脉疾病(CAD)的首选无创成像技术。除了解剖学上的狭窄分级,CCTA还能对作为不良冠状动脉事件前兆的动脉粥样硬化斑块进行量化和定性。

European Radiology:对于胸痛患者来说,CTA可以做到的可以更多!

冠状动脉计算机断层扫描(CTA)和有创冠状动脉造影(ICA)都是评估心脏和冠状动脉解剖和病理的首选检查手段。然而,CTA是一种影像学的、无创技术,而ICA是一种心脏学的、有创技术。

Radiology:可卡因吸食及HIV感染对CAD的影响

虽然心血管危险因素和不良临床预后之间的联系已在多项研究中证实,但却无法解释个体间预后的显著差异。

Radiology:计算机辅助识别肺结节虽好,仍需慎用!

应用于胸部CT扫描的计算机辅助检测(CAD)系统可作为第二阅读器检测有意义的结节,并有助于减少结节漏诊情况的发生,特别是在减少错误和提高工作效率方面效果显著。

Radiology:在看主动脉瓣钙化时,别忘了再看看它!

主动脉瓣狭窄是一种由主动脉瓣硬化引起的渐进性疾病,其特点是主动脉瓣小叶的钙化和增厚,从而导致最终的瓣口梗阻。主动脉瓣钙化(AVC)及其进展是主动脉瓣狭窄的一个重要特征,其与病情的恶化直接相关。

JACC:血流储备分数指导的多血管冠状动脉疾病患者的治疗效果

在多血管CAD患者中,没有发现证据表明FFR指导的治疗策略在1年的随访中能降低缺血性心血管事件或死亡的风险。