Correlation Between The Overall Burden Of Small Cerebral Vascular Disease And Coronary Atherosclerosis

Objective:To explore the correlation between coronary atherosclerosis related indicators and the overall burden of small cerebral vascular disease（CSVD）.Methods:The patients who underwent coronary CTA,cranial MRI and carotid ultrasound in the two weeks from January 2020 to December 2022 were collected.the overall burden of CSVD of patients was scored according to the Chinese Expert Consensus on Diagnosis and Treatment of Cerebrovascular Diseases 2021.According to score,the subjects were divided into 4 groups（0 points,1 points,2 points and group 3-4points）,and the clinical baseline data of all subjects were collected.The CCTA image was imported into the post-processing workstation to obtain coronary atherosclerosis related indicators,including total plaque number,calcified plaque number,mixed plaque number,non calcified plaque number,Gensini score,coronary artery calcification score（CACS）,the degree of stenosis and CT blood flow reserve score(FFR_CT)at the most obvious stenosis of the three main coronary branches,and the fat attenuation index（FAI）around the proximal end of the three coronary arteries.Analysis of variance,Kruskal Wallis rank sum test,chi square test and Fisher exact test were used to compare the differences between groups,and Spearman correlation was used to analyze the correlation between each index and the overall burden of CSVD.All the subjects were further divided into high group（3-4 points）and low group（0-2 points）.The differences between groups were analyzed by using independent sample t-test,Mann-Whitney test and Chi-square test,and the effective predictors of high overall burden score of CSVD were further determined by binary logistic regression analysis.The predictive effectiveness of each model on high overall burden score of CSVD was evaluated by the receiver operating characteristic（ROC）curve.Results:1.169 patients with CSVD were finally included,including 45 patients with CSVD score 0,43 patients with CSVD score 1,41 patients with CSVD score 2,and40 patients with CSVD score 3-4.（1）Analysis of differences between groups of CSVD subgroups:compared among the four groups,age,hypertension grade,serum homocysteine（Hcy）,total plaque number,calcified plaque number,mixed plaque number,maximum stenosis degree,Gensini score,CACS,FFR_CT（FFR-LAD,FFR-RCA,FFR-minimum）and FAI（FAI-LAD,FAI-LCX,FAI-RCA）had significant differences（all P<0.05）,and the other indicators had no significant differences between groups（all P>0.05）.Compared with CSVD 0 group,the age of CSVD 3-4 group,the proportion of hypertension grade 2-3,Hcy,total plaque number,calcified plaque number,mixed plaque number,maximum stenosis degree,Gensini score,CACS,FAI（FAI-LAD,FAI-LCX,FAI-RCA）were significantly increased,while FFR_CT（FFR-LAD,FFR-RCA,FFR-minimum）was significantly decreased.（2）Correlation analysis:Spearman correlation analysis showed that age,hypertension grade,total plaque number,maximum stenosis degree,Gensini score,CACS were positive correlated with CSVD burden score（r_s=0.406,0.529,0.350,0.380,0.395,0.358,all P<0.05）,and and FFR-minimum was negative correlated with CSVD burden score（r_s=-0.464,P<0.05）。However,Hcy,the number of calcified plaques,the number of mixed plaques,FFR-LAD,FFR-RCA and FAI（FAI-LAD,FAI-LCX,FAI-RCA）had a weak correlation with CSVD burden score（r_s<0.3,P<0.05）.2.According to the overall burden score of CSVD,the subjects were divided into high group（3-4 points）and low group（0-2 points）,with 40 cases in high group and129 cases in low group.（1）Analysis of differences between groups:There were statistically significant differences between the two groups in gender ratio,hypertension grade,total plaque number,maximum stenosis degree,Gensini score,CACS,FFR-RCA and FFR-minimum（all P<0.05）,and there were no statistically significant differences in other indicators between the two groups（all P>0.05）.（2）Binary logistic regression analysis:The variables with P<0.05 in inter-group comparison were included in multivariate binary logistic regression analysis,which showed that hypertension grade（OR=2.367,95%CI:1.440-3.892,P=0.001）and FFR-minimum（OR=0.916,95%CI:0.845-0.993,P=0.033）were effective predictors of the overall high burden score of CSVD,while the maximum stenosis degree,Gensini score,CACS and FFR-RCA were not effective predictors of the overall high burden score of CSVD（all P>0.05）.（3）ROC analysis showed that the area under the curve（AUC）of the combined model of hypertension classification and FFR-minimum was the highest（AUC=0.811,95%CI:0.745-0.868,P<0.05）for the risk prediction effectiveness of the overall high burden score of CSVD,followed by hypertension classification（AUC=0.759,95%CI:0.688-0.822,P<0.05）,and FFR-minimum（AUC=0.752,95%CI:0.680-0.815,P<0.05）.The sensitivity and specificity of the combined model of hypertension grade and FFR-minimum were 92.5%and 59.7%respectively;The sensitivity and specificity of hypertension grading were 90%and 56.59%;The sensitivity and specificity of FFR-minimum were 80%and 58.1%.Conclusion:In patients with CSVD,there is a certain correlation between coronary atherosclerosis and the overall burden of CSVD:the number of total coronary artery plaque,the degree of maximum stenosis,the Gensini score,CACS and the overall burden of CSVD have a moderate positive correlation,while FFR-minimum and the overall burden of CSVD have a moderate negative correlation;Hypertension grade and FFR-minimum are effective predictors of the overall high burden score of CSVD patients,which can be helpful for early intervention of high-risk patients with CSVD.