| Background coronary atherosclerotic heart disease(CAD)has become one of the major causes of death worldwide due to changes in living standards and dietary habits,and coronary artery inflammation plays an important role in the development of coronary heart disease.Epicardial adipose tissue(EAT)can secrete inflammatory factors and cytokines,which play an important role in the formation of atherosclerosis and the progression of atherosclerotic plaques,and EAT is closely correlated with the calcification and stenosis of coronary arteries.At present,epicardial adipose tissue volume(EATV)has been used for quantification.coronary angiography(CAG)is the gold standard in the clinical diagnosis of coronary heart disease,but it is not easy to be widely practiced due to factors such as trauma,surgical risk,high cost,and specific requirements on equipment and venues.Coronary CT Computed Tomography(CCTA)is widely used in clinical evaluation of coronary artery stenosis rate due to its advantages of convenience,non-invasive,and high accuracy.Ccta replaces coronary Angiography as the gold standard for screening and stratification of CAD patients.And determine the next treatment plan.Studies have shown that CCTA has a diagnostic accuracy of 90% compared to CAG.However,the diagnostic accuracy of CCTA in patients with moderate-to-severe calcification was not high,and the diagnostic specificity decreased from90% to 44%.Therefore,it is urgent to find an effective means to improve the diagnosis of coronary artery stenosis in patients with moderate and severe calcification.Objective This study aims to explore the relationship between epicardial adipose tissue and the degree of coronary artery calcification and stenosis,and further explore the value of combining clinical indicators,EATV and CCTA models in the diagnosis of the degree of coronary artery stenosis in CAD patients with different degrees of calcification,and finally select the optimal model to evaluate the rate of coronary artery stenosis in different calcification groups,especially in the moderate-to-severe calcification group.In order to find a method to accurately diagnose the rate of coronary vessel stenosis in CAD patients with moderate and severe calcification,so as to guide clinical selection of the most appropriate treatment plan.Methods 65 patients diagnosed with coronary heart disease who underwent CCTA and coronary angiography in the First Clinical Medical College of China Three Gorges University from August 2021 to August 2022 were retrospectively collected.General clinical data,laboratory test indicators,coronary Agatston score,CT angiography and coronary angiography data were collected.According to Agatston score,the patients were divided into mild,moderate and severe calcification groups.Then,CCTA images of patients in the three groups were measured on the post-processing workstation to obtain epicardial fat volume and density,and the consistency of diagnosis of CCTA and CAG among patients in each group was compared.Four models of EATV,CCTA,EATV combined with CCTA and clinical indicators combined with CCTA and EATV were established.The diagnostic efficacy of four models on the severity of coronary artery stenosis was analyzed.Results(1)The sex difference among different calcification groups was statistically significant(P=0.041).In the mild calcification group,there were 14 males and 15 females.In the moderate and severe calcification groups,there were significantly more males than females.The difference of triglyceride between mild and moderate calcification groups was statistically significant(P=0.029).(2)There was significant difference in epicardial fat volume between groups with different degrees of calcification(P=0.002).(3)There was no consistency between CCTA and CAG in the diagnosis of LAD stenosis degree in moderate calcification group(Kappa=0.123),and there was no statistical significance(P=0.314).There was no consistency between CCTA and CAG in the diagnosis of LAD stenosis degree in severe calcification group(Kappa=0.257),and no statistical significance(P=0.051).There was no consistency between CCTA and CAG in the diagnosis of LCX stenosis degree in the severe calcification group(Kappa=0.207),and there was no statistical significance(P=0.146).In the severe calcification group,there was no consistency between CCTA and CAG in the diagnosis of RCA stenosis degree(Kappa=0.130),and no statistical significance(P=0.297).(4)Multifactor analysis of severity of coronary artery stenosis showed that EATV andα-hydroxybutyrate dehydrogenase were independent risk factors for evaluating coronary artery severity(P < 0.05).(5)EATV had a moderate positive correlation with the degree of coronary artery stenosis,and the correlation coefficient was 0.512.(6)In the mild calcification group,the area under curve(AUC)of EATV for predicting coronary artery severity was 0.850(P < 0.05),95%CI was 0.658--1.000,sensitivity was 83.3%,specificity was 83.3%,and critical value was 71.21cm3.The area under curve(AUC)of CCTA for predicting coronary severity was 0.846(P< 0.05),95%CI was 0.673--1.000,sensitivity was100%,specificity was 62.5%,and the critical value was 17.The area under curve(AUC)of EATV+CCTA combined model was 0.833(P< 0.05),95%CI was 0.618-1.000,sensitivity was60%,specificity was 100%,and the critical value was 0.43.The area under the curve(AUC)of clinical indicators +EATV+CCTA model was 0.917(P < 0.05),95%CI was 0.798-1.000,sensitivity was 80%,specificity was 91.7%,and the critical value was 0.25.In the moderate calcification group,the area under curve(AUC)of EATV for predicting coronary severity was 0.886(P < 0.05),95%CI was 0.719-1.000,sensitivity was 75%,specificity was 100%,and the critical value was 72.67cm3.The area under curve(AUC)of CCTA for predicting coronary severity was 0.778(P < 0.05),95%CI was 0.5655-0.991,sensitivity was 100%,specificity was 63.6%,and the critical value was 16.75.The area under the curve(AUC)of EATV+CCTA model was 0.909(P < 0.05),95%CI was 0.772--1.000,sensitivity was 75%,specificity was 100%,and the critical value was 0.72.The area under curve(AUC),95%CI,sensitivity,specificity,and critical value of coronary artery severity predicted by the combined clinical indicators +EATV+CCTA model were 0.920(P < 0.05),0.793--1.000,75%,100%,and 0.70 respectively.In the severe calcification group,the area under curve(AUC)of EATV for predicting coronary severity was 0.865(P < 0.05),95%CI was0.688-1.000,sensitivity was 100%,specificity was 76.9%,and the critical value was65.18cm3.The area under curve(AUC)of CCTA for predicting coronary severity was 0.692(P < 0.05),95%CI was 0.421-0.964,sensitivity was 100%,specificity was 46.2%,and the critical value was 21.00.The area under the curve(AUC)of EATV+CCTA model was 0.942(P < 0.05),95%CI was 0.832-1.000,sensitivity was 100%,specificity was 84.6%,and the critical value was 0.23.The combined clinical indicators +EATV+CCTA model predicted the area under curve(AUC)of coronary artery severity was 0.981(P < 0.05),95%CI was0.923-1.000,sensitivity was 100%,specificity was 92.3%,and the critical value was 0.23.Conclusion clinical indicators(α-hydroxybutyrate dehydrogenase)combined with EATV and CCTA model established in this study is expected to provide incremental information for the diagnosis of coronary artery stenosis in CAD patients with different degrees of calcification,especially in moderate-to-severe calcification,so as to improve the accuracy of CCTA diagnosis of coronary artery stenosis rate in moderate-to-severe calcification CAD patients.In addition,In this study,general data,serological indicators and imaging parameters of groups with different degrees of calcification were analyzed,and independent risk factors related to coronary artery severity were screened out,which could provide reference for clinical diagnosis and treatment,guide surgical treatment and systematic treatment decision-making,so as to achieve the purpose of accurate diagnosis,precision medicine and personalized diagnosis and treatment. |
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