| Part Ⅰ Study of imaging characteristics of coronary artery and myocardial perfusion in patients with diabetes mellitus by one-stop coronary CT angiography combined with stress CT myocardial perfusion Background Diabetes mellitus(DM)is one of the independent risk factors for coronary artery disease(CAD).DM can damage the function of cardiovascular endothelial cells,and then damage the coronary microcirculation,making it affect the structure and function of the cardiac in the absence of CAD.Most previous studies have evaluated macrovascular disease in DM patients by coronary computed tomography angiography(CCTA)and myocardial microcirculation disorders in DM patients by single photon emission computed tomography.With the advancement of cardiac CT imaging technology,dynamic stress CT myocardial perfusion imaging(CT-MPI)can obtain myocardial functional information through continuous dynamic scanning on the basis of anatomical imaging.At present,there are few studies on the evaluation of coronary artery anatomy and cardiac function in patients with DM by one-stop CCTA combined with stress CT-MPI.Objective To evaluate the characteristics of CT coronary artery,plaque and myocardial perfusion in patients with DM by one-stop CCTA combined with stress CT-MPI.Methods We retrospectively reviewed patients who underwent CCTA combined with stress CT-MPI in the Department of Radiology in the Xijing Hospital from May 2020 to July 2021 due to suspected coronary heart disease.Patients were divided into DM group(102 cases)and non-DM group(262 cases)according to the presence or absence of DM.The CT coronary artery characteristics,plaque quantitative characteristics,high-risk plaque characteristics and CT myocardial perfusion characteristics were compared between the DM group and the non-DM group.Results(1)CT coronary artery characteristics: CACS was significantly higher in DM patients than in those without DM [36.65(0.00-219.90)vs.0.00(0.00-10.60),P<0.001],and the incidences the number of obstructive stenosis vessels were significantly higher than in non-DM patients(1-vessel: 24.5% vs.9.9%,P<0.001;2-vessel: 16.7% vs.8.4%,P=0.022;3-vessel or left main: 8.8% vs.1.5%,P=0.002),The segment involvement score(SIS)[3.00(1.00-6.00)vs.1.00(0.00-3.00),P<0.001] and segment stenosis score(SSS)[6.00(2.00-12.00)vs.2.00(0.00-5.00),P<0.001] were significantly higher in DM patients than in non-DM patients.(2)Plaque quantitative characteristics: the total plaque volume(TPV),total plaque volume burden(TPB),the volume of each plaque component(including lipid plaque,fibrous plaque and calcified plaque),and the ratio of plaque components volume in the DM group were significantly greater than those in non-DM group(all P<0.05).(3)High-risk plaque characteristics: the prevalence of “napkin ring” sign(P=0.019)and low attenuation plaque(P=0.024)was higher in DM groups.(4)CT myocardial perfusion characteristics: global MBF value(P<0.001)was lower in DM group,hypoperfusion myocardial segments and the segments ratio,ischemic myocardial segments and the segments ratio were higher in DM group(all P<0.05).(5)Correlation analysis showed that DM was significantly correlated with CCTA characteristics and abnormal perfusion myocardial segment ratio(r=0.21)(P<0.05),with a weak positive correlation.The correlation between DM and global MBF value was statistically significant,showing a weak negative correlation(r=-0.22,P<0.05).Conclusions DM patients are characterized by higher CACS,greater number of plaques,more severe coronary artery stenosis,heavier TPV and each component volume,heavier TPB and each component volume ratio and more severe myocardial perfusion reduction.There was a correlation between DM and CCTA characteristics and stress CT-MPI characteristics.Part Ⅱ Prognostic Value of Coronary CT Angiography Combined with CT Myocardial Perfusion Imaging Among Patients With and Without DiabetesBackground: Patients with DM have a significantly higher risk of adverse cardiovascular events than those without DM.Accurate assessment of coronary atherosclerotic burden and myocardial perfusion is important for predicting the risk of future cardiovascular events in patients with DM.Several studies have demonstrated that CCTA can provide prognostic value beyond clinical risk factors in patients with DM.However,CCTA cannot evaluate coronary artery lesions with hemodynamic significance,which is very important for clinical decision-making(especially for revascularization).CCTA combined with CT-MPI is currently recognized as an ideal one-stop imaging technology,which can evaluate the anatomical structure of coronary artery and myocardial perfusion in a single examination.Recent studies have shown that abnormal myocardial perfusion assessed by quantitative MBF using stress CT-MPI can improve the risk stratification in patients with obstructive CAD.However,there are limited data on the effect of CCTA combined with stress CT-MPI on the prognosis of patients with DM.Objective: To evaluate the prognostic value of CCTA combined with stress CT-MPI in suspected CAD patients with and without DM.Methods: A total of 334 patients with suspected CAD who underwent CCTA and stress CT-MPI in the Department of Radiology in the Xijing Hospital from May2020 to July 2021 were retrospectively analyzed.Patients were divided into DM group(90 cases)and non-DM group(244 cases)according to the presence or absence of DM.The follow-up information of patients was collected to determine whether the patients had major adverse cardiovascular events(MACEs).Univariate Cox regression analysis was used to evaluate potential risk factors forMACEs,including clinical risk factors(age,gender,body mass index,hypertension,dyslipidemia,smoking history and family history of CAD),CCTA characteristics(CACS,obstructive CAD,number of obstructive vessels,SIS and SSS)and CT-MPI characteristics(global MBF value and abnormal perfusion myocardial segment ratio).Three multivariate Cox proportional hazards models were established in all patients,DM group and non-DM group,respectively.(Model 1: clinical risk factors,model 2: clinical risk factors +CCTA characteristics,model 3: clinical risk factors +CCTA characteristics +CT-MPI characteristics).The Global chi-square test was used to evaluate the predictive performance of the three models for MACEs in all patients,DM group and non-DM group.Results: After a median follow-up of 21 months(interquartile range 19-26months),15 patients of the DM group and 16 patients of the non-DM group experienced MACEs.Multivariable Cox regression analysis showed that abnormal perfusion myocardial segments ratio was associated with MACEs after adjusting for clinical risk factors and CCTA characteristics in all patients(HR:1.019,P=0.001),DM group(HR:1.027,P=0.026)and non-DM group(HR:1.025,P=0.005).By adding CT-MPI characteristics to CCTA characteristics and clinical risk factors,the Global chi-square for predicting MACEs increased from 65.02 to76.25 in all patients(P= 0.001),from 22.60 to 28.25 in DM group(P=0.017)and from 42.46 to 50.83 in non-DM group(P=0.004).Conclusion:(1)After adjusting for clinical risk factors and CCTA characteristics,abnormal perfusion myocardial segments ratio derived from CT-MPI was an independent predictor of MACEs in all patients,DM patients and non-DM patients;(2)abnormal perfusion myocardial segments ratio showed incremental prognostic value over clinical risk factors alone or in combination with CCTA characteristics in all patients,DM patients and non-DM patients. |
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