| Part Ⅰ Quantitative analysis of main components of atherosclerotic plaque by coronary CTAObjective: To explore the value of coronary CT angiography(CCTA)plaque quantitative analysis in the quantification of vulnerable plaques and stable plaques in patients with unstable angina(UAP)and stable angina(SAP).Methods: The 320-row coronary CTA and coronary angiography(CAG)results of 41 patients with angina pectoris(UAP18 and SAP23)in our hospital were collected retrospectively,and plaques have been divided into three groups UAP vulnerable plaque(group I),UAP stable plaque(group II)and SAP stable plaque(group III).The plaque quantitative analysis software was used to quantitatively measure the volume and volume percentage of lipid,fiber and calcification in the plaque segment.The one-way ANOVA test was used to compare the volume and its percentage differences of lipid,fiber and calcification in the three groups,and LSD test was used for pair-wise comparison.The ROC curve was performed to analyze the diagnostic thresholds for the diagnosis of vulnerable plaques and stable plaques,and the corresponding sensitivity,specificity,positive and negative predictive value(PPV & NPV)were calculated.Results: A total of 45 plaques were quantitatively analyzed and studied,with 10 plaques in group I,9 plaques in group II and 26 plaques in group III.Vulnerable plaques and two groups of stable plaques in lipids(49.3% ± 4.1% vs 31.8% ± 6.3%,33.4% ± 6.9%)and calcification(2.9% ± 2.7% vs 13.0% ± 11.8%,17.2 Percentage of %±10.8%)was statistically significant(P<0.05),the percentage of vulnerable lipid plaque was higher than that of stable plaque,and the percentage of calcified vulnerable plaque was lower than stable plaque;The volume of fibers between vulnerable plaques and UAP stable plaques was statistically different(47.5±14.4 vs 74.7±37.5)(P<0.05);There were no significant differences in the percentage of stable plaque between lipids(31.8%±6.3% vs 33.4%±6.9%)and calcification(13.0%±11.8% vs 17.2%±10.8%)(P>0.05).Among the indicators for the diagnosis of vulnerable plaque,the area under the ROC curve of lipid percentage was higher,the AUC was 0.994,and the corresponding lipid volume AUC was 0.811.The vulnerable plaques and stable plaques were judged based on the percentage of lipid ROC curve.The cut-off point of sexual plaque was 44.1%,and its corresponding sensitivity,specificity,PPV and NPV were 1.000,0.885,0.714,1.000,respectively.In addition,the percentage of fiber and fiber percentage,calcification and calcification percentage are only low or no diagnostic value.Conclusion: Coronary artery CTA plaque quantitative analysis technology can be used to measure the main components of coronary plaque,and thus provide clinical basis for plaque identification.Part Ⅱ Preliminary study on the Phase-Volume curve of coronary CTA in patients with reduced left ventricular complianceObjective: Coronary CT angiography(CTA)was used to investigate the Phase-Volume curve of coronary CTA in patients with reduced left ventricular compliance.Methods: The data of 140 patients undergoing 320-slice CT cardiac angiography in our hospital were retrospectively and randomly collected,and the patients were divided into the group with reduced left ventricular compliance(89 cases)and the group without reduced left ventricular compliance(51 cases)for the purpose of echocardiographic diagnosis of decreased left ventricular compliance.According to the RR part of the ecg,12-14 phases were reconstructed at 5% intervals.The left ventricular phase-volume curve was plotted using the coronary CTA cardiac function software,and the diastolic starting point(ES),active end diastolic period(EAD)and diastolic ending point(ED)of the left ventricle were determined,and the difference between total diastolic period(ED and ES)and active diastolic period(EAD and ES)were calculated.The relative parameters(age,ES,EDA,ED,left ventricular total diastolic difference,left ventricular active diastolic difference,left atrial diameter at the beginning of left ventricular diastole,and left atrial diameter at the end of left ventricular active diastole)of the two groups above the coronary CTA were calculated.The paired sample T test was used to compare the two left atrial diameters(left ventricular initial diastolic and left ventricular active end diastolic).ROC curve was used for the statistically different parameters,and AUC > 0.70 was considered to be of diagnostic value.The mean age of the group with reduced left ventricular compliance in the two groups of CTA was slightly older(65.8±10.3)years,but there was no statistically significant difference between the two groups and the control group(62.1±12.4)years(P > 0.05).Secondly,the differences in EAD between the group with reduced left ventricular compliance and the control group(68.2%±6.7% vs 65.6%±6.8%)were statistically significant(P < 0.05),while there were no significant differences in ES(39.1%±6.0% vs 40.9%±6.3%)and ED(83.0%±6.2% vs 81.5%±5.6%)(P > 0.05).The difference in active diastolic period between the two groups of coronary CTA(29.4%±4.1% vs 24.7%±4.3%)was statistically significant(P < 0.05).The area under the ROC curve was 0.78,the cutoff point was 27.5%,and the sensitivity and specificity were 0.72 and 0.76,respectively.The difference in total left ventricular diastolic period between the two groups of coronary CTA(44.1%±7.8% vs 40.7%±8.2%)was statistically significant(P < 0.05).The area under the ROC curve was 0.61,with no diagnostic value.There was no statistically significant difference in the two left atrial diameters(left ventricular initial diastolic diameter and left ventricular active end diastolic diameter,respectively,of 44.0mm±6.1mm vs 44.7mm±5.9mm and 44.2mm±5.9mm vs 44.1mm±6.0mm)between the two groups(P > 0.05).The comparison of paired sample t-test of two left atrial diameters(left ventricular initial diastolic and left ventricular active end diastolic)also showed no statistical significance(t =1.12,P > 0.05).Results:Conclusion: In the coronary CTA Phase-Volume curve,patients with reduced LEFT ventricular compliance showed increased left ventricular active diastolic phase difference and prolonged left ventricular active diastolic time,and the corresponding curve was flat in early and middle diastole,while the control group showed rapid rise,which will provide a new idea for clinical judgment of reduced left ventricular compliance. |
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