心外膜脂肪体积与冠状动脉血管病变严重程度评估及预后的相关性研究
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南京医科大学第一附属医院

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江苏省卫生厅重点项目


Correlation of severity assessment of coronary vascular lesions, patient prognosis and epicardial adipose tissue volume with coronary heart disease.
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The First Affiliated Hospital of Nanjing Medical University

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    摘要:

    目的:基于冠心病患者的冠状动脉CT血管造影(Coronary CT Angiography,CCTA)探究心外膜脂肪组织参与CT疑诊冠心病患者进行冠状动脉造影(coronary angiography ,CAG)决策的增量意义;明确冠状动脉粥样硬化心脏病患者心外膜脂肪体积(epicardial adipose tissue volume, EATV),管周脂肪厚度(Perivascular adipose tissue thickness,PATT)与其冠状动脉血管病变严重程度的相关性,评估EATV联合临床相关指标预测病人预后的效能。方法:选取我院81例进行双源冠状动脉CT及冠状动脉造影术的冠心病患者,统计所有患者基础基线资料及临床处理方式,基于医院影像系统统计EATV、PATT、SYNTAX评分,随访患者出院后6个月时间内不良心血管事件包括心血管相关性死亡,心肌梗死,支架再植入,心血管相关疾病再入院,稳定型心绞痛及不稳定性心绞痛发作情况。通过线性回归模型和多元logistic回归模型分析描述EATV对CCTA疑诊冠心病患者进一步进行CAG 的辅助意义及EATV和PATT与SYNTAX评分的相关性,构建基于EATV和相关临床指标预测冠心病患者预后的模型。结果:①EATV可提高CCTA疑诊冠心病患者进行CAG检查的阳性处理价值(AUC=0.5623上升至AUC=0.7705);②Pearson相关统计示:该入组冠心病患者EATV与SYNTAX评分呈正相关(r=0.828,P<0.001),EATV及经身体质量指数(Body Mass Index,BMI)标化的 normalized EATV均与患者的SYNTAX评分成正相关(r=0.774,P<0.001);③ EATV联合临床指标:性别、LADHU(前降支冠状动脉管周脂肪HU数值)、LVDd(左室舒张期横径) (AUC=0.775)较SYNTAX评分(AUC=0.7065)可更准确预测冠心病患者出院后心血管事件的发生。结论: EATV与CAD密切相关,对CCTA拟诊冠心病患者的临床决策具有指导意义。它与SYNTAX评分呈正相关,对冠心病的预后评估具有预测价值。

    Abstract:

    Objective: We intended to explore the significance that epicardial adipose tissue (EAT) could provide in decision-making on whether the patient should further undergo the coronary angiography when they were suspected of diagnosing coronary artery disease(CAD based on coronary CT angiography (CCTA). We further analyzed the correlation of epicardial adipose tissue volume (EATV) and perivascular adipose tissue thickness (PATT) with the severity of coronary vascular disease-SYNTAX score in patients with coronary atherosclerotic heart disease. We also explored the difference in sensitivity and specificity of EAT combined with clinically relevant indicators compared to the SYNTAX score alone in predicting the prognosis of patients. Methods: Our research involved a total of 81 patients with coronary heart disease who underwent coronary CT angiography (CCTA) and coronary angiography in our hospital. The characteristics and treatment of all patients were collected, and EATV, PATT, and SYNTAX scores were calculated based on the patients, imaging data. All patients were followed up six months after discharge, and adverse cardiovascular events, including cardiovascular-related death, myocardial infarction, stent reimplantation, cardiovascular-related disease readmission, stable angina, and unstable angina attacks, were recorded during the follow-up. The logistic regression model was used to analyze the decision-making significance of EATV for further coronary angiography(CAG)in patients with suspected coronary heart disease diagnosed by CCTA. We described the association of EATV with SYNTAX scores using person correlation analysis. We constructed a predictive model for the prognosis of patients with CAD based on EATV and related clinical indicators. Results: ①EATV could improve the positive predictive value of clinical intervention after CAG examination in CCTA patients suspected of CAD (AUC rise to 0.7705 from 0.5623). ② Pearson correlation statistics showed that EATV was positively correlated with SYNTAX score (r=0.828, P<0.001), and the correlation persisted after EAT was standardized for BMI (r=0.774, P<0.001). ③EATV combined with clinical indicators: gender, LADHU (anterior descending branch adipose tissue Hounsfield unit), and LVDd (left ventricular diastolic diameter) could predict the occurrence of cardiovascular events after discharge (AUC=0.775). The prediction accuracy of this model was higher than that of SYNTAX alone (AUC=0.7065). Conclusion: EATV was closely related to CAD and had guiding significance for clinical decision-making of patients with suspected coronary heart disease on CT. It was positively correlated with the SYNTAX score and had predictive relevance for the prognosis evaluation of coronary heart disease.

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  • 收稿日期:2022-06-07
  • 最后修改日期:2022-12-22
  • 录用日期:2023-08-09
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