| BackgroundAt present,there are two commonly used methods to check the degree of coronary artery stenosis in clinical practice,one is digital subtraction angiography(DSA),which is the gold standard for the diagnosis of arterial stenosis,and this is an invasive examination,which requires minimally invasive surgery in a professional catheterization laboratory to complete.Theother is CT coronary angiography(CTA),which is a non-invasive operation.It injects contrast agent into the body,observes the morphology and trend of coronary vessels,determines the location and degree of stenosis,and has a similar effect as DSA.Coronary CTA has limited accuracy in predicting myocardial ischemia,and in addition to luminal stenosis,other parameters of coronary plaque morphology and composition help to assess downstream myocardial ischemia.With the integration of coronary CTA and adenosine stress CT myocardial perfusion(CTP),reliable information about coronary artery anatomy and function can be obtained in a single procedure,and its good clarity and accuracy have been able to meet clinical requirements,and it is widely used in outpatient or ward clinics due to its small risk of complications.ObjectiveTo investigate the diagnostic value of cardiac quantitative CTA combined with adenosine-loaded myocardialCTP one-stop examination in the severity of coronary stenosis,plaque composition and morphology and downstream myocardial ischemia.MethodsA total of 84 patients with coronary plaque after DSA examination were selected from July 2017 to June 2018 in our hospital.The age ranged from 50to74 years,with an average of(62.5+10.5)years.There were 40 males and 44 females.Continuous coronary CTA and adenosine-loaded myocardial CTP scans were performed in these patients,and automatic quantitative analysis(quantitative CTA)of all coronary lesions was performed to obtain coronary CTA stenosis.Downstream myocardial ischemia was assessed by visual analysis of static and stress CTP images.Quantitative CTA parameters of lesions(with or without downstream myocardial ischemia)were determined by independent sample t-test or Mann-Whitney test according to specific needs.Multivariate logistic regression analysis was used to analyze the significant differences in plaque characteristics between ischemic lesions and non-ischemic lesions,with ischemia as the dependent variable ResultsA totalof 146 coronary arteries in 84 patients had one or more coronary plaques,of which 31(21%)were related to ischemia,of which 9%(6/67),18%(9/51),57%(16/28)were downstreamischemia in lesions with stenosis rates<50%,50%-70%,and>70%.In addition,the average plaque load,plaque volume,plaque length,maximum plaque thickness,and dense calcium volume of ischemia-related plaques were significantly higher than those of non-ischemia-related plaques,however,only stenosis severity(%)(OR1.06;95%CI 1.02-1.10;P=0.006)and lesion length(mm)(OR1.26;95% CI1.02-1.55;P=0.029)were independently correlated,with statistical significance.Conclusions(1)Coronary artery CTA combined with adenosine loaded myocardial perfusion one-stop examination is an effective method for the evaluation of myocardial ischemia,and At the same time,it provides a convenient and potential screening technique for clinical evaluation of left ventricular function.(2)The severity of coronary artery stenosis and the length of the lesion are independent correlated factors of myocardial ischemia. |
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