Quantitative Coronary Plaque Analysis And The Diagnostic Performance For Myocardial Ischemic Injury

Objective To analyze the quantitative features of coronary plaque and evaluate the diagnostic performance of quantitative coronary plaque features for myocardial ischemic injury in patient with suspected coronary artery disease.Methods Retrospectively collected one hundred and nine target vessels of one hundred and nine patients in 742 patients with suspected coronary artery disease,who successively underwent coronary CT angiography and invasive coronary angiography in Shandong Provincial Hospital from June 2018 to September 2019.Elevated myocardial enzyme with segmental wall motion abnormalities(SWMA)in ultrasound were defined as myocardial ischemic injury,which was the standard of dividing the sample into two groups,group of myocardial ischemic injury(n=75)and group of patients without myocardial ischemic injury(n=34),respectively.CCTA images of each target vessel were quantitatively analyzed by the semi-automated plaque analysis software to acquire the following indicators:minimal lumen area(MLA),plaque length(PL),total plaque volume(TPV),total plaque burden(TPB),calcified plaque volume(CPV),calcified plaque ratio(CPR),fibrous plaque volume(FPV),fibrous plaque ratio(FPR),lipid plaque volume(LPV),lipid plaque ratio(LPR),napkin-ring sign(NRS),spotty calcification(SC)、remodeling index(RI)and eccentric index(EI).Chi-square,Mann-Whitney U tests,logistic regression and receiver operating characteristic curve were used for statistical analysis.Results For the stenosis of coronary artery,MAS%(85.00%(80.00%,92.00%))in myocardial ischemic group was larger than that of the group without myocardial ischemic injury(63.00%(60.00%,65.00%)),which was statistically significant(Z=-4.32,P=0.001).For the quantitative plaque features,TPV(150.13(104.44,202.20)mm3),TPB(75.67%±9.90%),FPV(95.73(66.57,134.23)mm3),LPV(32.18(18.93,54.55)mm3),LPR(25.13%±13.71%)in the group with myocardial ischemic injury were larger than those in group without myocardial ischemic injury(109.94(79.39,121.67)mm3、65.37%±6.94%、67.35(57.67,90.11)mm3、16.64(13.26,24.73)mm3、18.44%±7.09%)respectively,which were statistically significant(Z=-2.59,P=0.010;t=3.11,P=0.003;Z=-2.16,P=0.031;Z=-2.18,P=0.029;t=2.19,P=0.037)respectively.In logistic regression analysis,MAS%(OR=1.55,P=0.021)was independent significant predictors of myocardial ischemic injury.For predicting lesion specific myocardial ischemic injury,the AUC of MAS%、LPV、LPR、TPV、TPB、FPV were 0.84、0.82、0.77、0.72、0.74、0.67,respectively,which were all statistically significant(P<0.05).Conclusion In quantitative plaque analysis by coronary CT angiography,MAS%、TPV、TPB、FPV、LPV、LPR are affecting factors of myocardial ischemic injury.MAS%is independent significant predictors of myocardial ischemic injury.MAS%and LPV have higher diagnostic accuracy in myocardial ischemic injury.