Diagnostic Value Of Coronary CTA-centric Non-invasive Imaging For Atherosclerotic Diseases

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Diagnostic value of 256-slice coronary CT angiography for coronary artery diseaseBackground and aims:With the improvement of people's living standard and the change of dietary structure,coronary heart disease has the characteristics of high incidence,high morbidity and high disability rate,and the mortality rate is also increasing year by year.Coronary angiography has been regarded as the "golden standard" for evaluating coronary artery stenosis for a long time.It is the most important method to diagnose coronary artery disease,but it is also an invasive examination with potential risks.Coronary CT angiography is one of the most important non-invasive methods for evaluating coronary artery disease.This study was aimed to explore the value of coronary CT angiography in the detection of coronary artery disease,and to analyze the relationship between plaque characteristics and coronary artery stenosis.Methods:This study included patients who received 256-slice coronary CT angiography and coronary angiography(within 2 weeks)at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to December 2018.Clinical baseline data,results of coronary CTA and coronary angiography were recorded.With the results of coronary angiography as the gold standard,the sensitivity(Se),specificity(Sp),positive predictive value(PPV),negative predictive value(NPV)and AUC value of CTA in diagnosis of coronary stenosis ?50%and ?75%at patient level,vessel level and segment level were calculated respectively.Coronary variation was recorded under coronary CTA and coronary angiography.The plaque characteristics of each segment under coronary CTA were recorded and the relationship between plaque and coronary stenosis was analyzed.Results:A total of 284 patients,1122 vessels,and 4212 segments were included in the study.Among 284 patients,241 patients had coronary stenosi^50%.CCTA showed that 222 patients had the same results as CAG,and the diagnostic coincidence rate was 92.1%.According to CAG,The Se and PPV of CCTA were 0.91(95%Cl,0.88-0.95)and 0.83(95%Cl,0.81-0.90)respectively.Among 1136 vessels,456 had coronary stenosis?50%by CCTA and 381 vessels were found by CAG.The coincidence rate was 83.6%.With CAG as the standard,the AUC of CCTA in diagnosing stenosis?50%at vessel level was 0.81(95%CI,0.79-0.84).The AUC values of LM,LAD,LCX and RCA were 0.70(95%CI,0.54-0.85),0.64(95%CI,0.57-0.72),0.81(95%CI,0.75-0.86)and 0.80(95%CI,0.75-0.86),respectively.Se?Sp?PPV and NPV of CCTA at vessel level were 0.81(95%CI,0.77-0.84),0.81(95%CI,0.78-0.83),0.75(95%Cl,0.71-0.79)and 0.86(0.83-0.88),respectively.Se,Sp,PPV,and NPV of CCTA diagnosing stenosis?50%at vessel level were 0.81(95%CI,0.77-0.84),0.81(95%CI,0.78-0.83),0.75(95%CI,0.71-0.79)and 0.86(95%CI,0.83-0.88).In 4260 segments,a total of 848 had stenosis?50%.CCTA found that 653 segments were consistent with CAG results,with a compliance rate of 77.0%.With CAG as the standard,the AUC of the CCTA diagnosing stenosis?50%at segment level was 0.84(95%CI,0.81-0.85).And the AUC of the proximal and middle segments,and the distal segments stenosis?50%were 0.81(95%CI,0.79-0.83),0.83(95%CI,0.80-0.86),respectively.Se,Sp,PPV,and NPV of CCTA diagnosing stenosis?50%at segment level were 0.76(95%CI,0.73-0.70),0.90(95%CI,0.89-0.91),0.67(95%CI,0.65-0.70),0.93(95%CI,0.92-0.93).Se,Sp,PPV and NPV of CCTA diagnosing proximal and middle stenosis?50%at segment level were 0.81(95%CI,0.78-0.82),0.80(95%CI,0.78-0.82),0.64(95%CI,0.61-0.68),0.90(95%CI,0.89-0.92),respectively.The Se,Sp,PPV and NPV of distal segments stenosis?50%diagnosed by CCTA were 0.69(95%CI,0.73-0.79),0.95(95%CI,0.95-0.96),0.74(95%CI,0.69-0.79)and 0.94(95%CI,0.93-0.95),respectively.Among 284 patients,167 had coronary stenosis?75%,259 vessels had stenosis?75%and 455 segments had stenosis?75%.CCTA found 139 patients,167 vessels and 265 segments were consistent with CAG results.The coincidence rates were 83%,64%and 58%respectively.With CAG as the standard,the AUC of diagnosing coronary stenosis?75%by CCTA was 0.70(95%CI,0.64-0.77),0.76(95%CI,0.73-0.80)and 0.77(95%CI,0.74-0.80),respectively,at patient,vessel and segment level.In terms of patient level,Se,Sp,PPV and NPV of CCTA diagnosing segment stenosis?75%were 0.82(95%CI,0.77-0.88),0.59(95%CI,0.50-0.68),0.73(95%CI,0.67-0.80),0.70(95%CI,0.61-0.80),respectively.In terms of vessel level,SE,Sp,PPV and NPV in diagnosing vessel stenosis?75%by CCTA were 0.63(95%CI,0.58-0.69),0.88(95%CI,0.85-0.90),0.62(95%CI,0.56-0.68),0.88(95%CI,0.86-0.90),respectively.At segmental level,Se,Sp,PPV and NPV of segment stenosis?75%by CCTA were 0.57(95%CI,0.53-0.62),0.94(95%CI,0.94-0.95),0.59(95%CI,0.55-0.64),0.94(95%CI,0.93-0.95),respectively.There were signifieant differences in stenosis eaused by different plaques(?2=47.77,P=<0.001).The non-calcified plaque group had the severest stenosis,followed by mixed plaque,and the lightest was calcified plaque.CCTA found 34 cases of coronary artery variation,including 30 cases of myocardial bridge.CAG revealed 21 cases of coronary artery variation,including 18 cases of myocardial bridge.Conclusion:This study found that 256-slice coronary CT angiography had a superior diagnostic performance for coronary stenosi?50%and?75%at vessel level and segment level,especially with high specificity and negative predictive value.Coronary stenosis is mainly involved in the proximal and middle segments of the anterior descending branch.The diagnosis of 256-slice coronary CT angiography has a higher sensitivity and specificity in the diagnosis of the proximal and middle segment.Coronary CT angiography can help determine the nature of coronary atherosclerotic plaque.Among them,the stenosis of the calcified plaque is mild,and the stenosis of the non-calcified plaque is the most severe.Coronary CT angiography is a safe and accurate non-invasive means for screening and diagnosing coronary variability.Part? Study on the correlation between peripheral arterial plaque and coronary atherosclerosis by ultrasound and coronary CT angiographyBackground and aims:Atherosclerosis is a multi-vessel bed disease.Ultrasound is a non-invasive,safe and easy means of early detection of carotid and lower extremity atherosclerotic plaques.The examination of peripheral arterial vessels can be used as a non-invasive method for early assessment of vascular disease.Coronary CT angiography has a good diagnostic performance in the evaluation of coronary vascular stenosis.Therefore,this study used coronary CTA to represent the degree of coronary stenosis,to explore the correlation between peripheral arterial plaque and coronary heart disease,eoronary artery stenosis,and the number of coronary vessels involved in the coronary artery disease,in order to attach more importance of peripheral artery plaque and play a role in preventing and avoiding the occurrence of cardiovascular and cerebrovascular adverse events.Methods:This study included patients between the ages of 40 and 75 who received carotid ultrasound,lower extremity arterial ultrasound and coronary CT angiography at the First Affmliated Hospital of Zhejiang University School of Medicine January 1,2018 to April 30,2018.Patients with no vascular lesions detected by carotid ultrasound and lower extremity arterial ultrasound were included in the "non-peripheral arterial plaque group".Patients with only carotid artery lesions detected by ultrasound were included in the "carotid plaque group".Patients who had only lower extremity artery lesions detected by ultrasound were included in the "lower extremity artery plaque group".And patients with vascular lesions detected by both carotid and lower extremity arterial ultrasound were included in the "peripheral multi-artery plaque group".The correlation between peripheral arterial lesions and coronary heart disease,the degree of coronary artery stenosis,and the number of coronary lesions involved in the vessel were explored by comparison between groups and correlation analysis.ResultsBetween January 1 and April 30,2018,among the patients attending the First Affiliated Hospital of Zhejiang University School of Medicine,a total of 744 patients aged 40-75 years underwent carotid ultrasound,lower extremity arterial ultrasound,and coronary CTA.485 were hospitalized and 259 were outpatients.Patients with no plaque detected by carotid and lower extremity arterial ultrasound was 282(37.9%);197(26.5%)patients with plaque or stenosis detected by carotid ultrasound alone;96(12.9%)patients with plaque or stenosis detected by lower extremity artery ultrasound alone;and 169(22.7%)patients with plaque or stenosis detected by both carotid ultrasound and lower extremity artery ultrasound.The distribution of hypertension(?2=66.445,P<0.001),diabetes mellitus(?2=15.745,P=0.001),smoking history(?2=8.383,P=0.039)and drinking history(?2=10.700,P=0.013)in different groups of peripheral plaque in hospitalized patients were different.In non-peripheral plaque group,carotid plaque group,lower extremity plaque group and peripheral multi-artery plaque group,coronary CTA showed that the main coronary stenosis?50%accounted for 2.8%,7.6%,20.8%and 60.9%,respectively(?2?251.488,P<0.001).In the non-peripheral plaque group,CTA showed 67.7%,29.4%,2.1%and 0.7%of normal,mild,moderate and severe coronary stenosis,respectively.In the peripheral multi-artery plaque group,CTA showed that normal,mild,moderate and severe coronary stenosis were 8.9%,30.2%,42.0%and 18.9%,respectively.The distribution of coronary stenosis was also different in the population with different distribution of peripheral artery plaque(?2=300.108,P<0.001).With the increase of peripheral plaque involvement sites,coronary CTA showed more severe coronary stenosis(r=0.564,P<0.001;r=0.621,P<0.001).In the non-peripheral plaque group,the number of single,two branches and three branches lesions was 1.4%,0.4%and 1.1%,respectively.In the peripheral multi-artery plaque group,the number of single,two branches and three branches lesions was 24.3%,20.7%and 15.4%,respectively.Coronary CTA showed that the number of vessels involved in coronary artery lesions was different in each group with different distribution of peripheral artery plaques(?2?263.682,P<0.001).With the increase of peripheral plaque,the more blood vessels involved in coronary lesions(r=0.535,P<0.001;r=0.579,P<0.001).Conclusion:Atherosclerosis is a multi-vessel bed disease.Peripheral artery plaque reflects the existence of coronary atherosclerosis to a certain extent.Compared with people without peripheral plaque,patients with peripheral artery plaque have a larger number of coronary heart disease,more severe coronary stenosis and more prone to multiple vessel lesions.Especially patients with both carotid plaque and lower extremity plaque should pay more attention to cardiovascular health and take the initiative to carry out cardiovascular examination in time.Hypertension,diabetes mellitus,smoking history and drinking history are risk factors for atherosclerosis.Carotid and lower extremity artery ultrasonography can also be added to routine physical examination for patients over 40 years old without symptoms of myocardial ischemia in order to detect and treat coronary heart disease early and reduce the risk of adverse cardiac events.Part ? Diagnostic accuracy of CT-derived Fractional Flow Reserve for coronary artery disease:a Meta-analysisBackground and aims:Current guidelines recommend Fractional Flow Reserve(FFR)as an indicator of myocardial ischemic function to guide the strategy of revascularization.But FFR is an invasive examination that needs to be performed with coronary angiography.CT-FFR is based on coronary CTA images,and the FFR value is calculated by simulating real coronary blood flow with hydrodynamic calculation method.Since the emergence of CT-FFR in 2011,many studies have assessed the accuracy and specificity of CT-FFR in the diagnosis of coronary artery disease by referring to invasive FFR.This meta-analysis reviewed previous relevant studies and combined the results to assess the diagnostic performance of CT-FFR for coronary heart disease.Methods:In this study,PUBMED,MEDLINE(web of science)and EMBASE were searched to collect relevant literature published from January 2011 to December 2018.The combined sensitivity and specificity of the diagnosis of CT-FFR was calculated at patient level and vessel level.The corresponding SROC was drawn and the AUC value was calculated to evaluate the diagnostic performance of CT-FFR.ResultsA total of 1712 patients,2828 vessels or lesions were included in this study.Based on patient level analysis,the sensitivity,specificity and diagnostic odds ratio(DOR)of CT-FFR in assessing coronary artery stenosis were 0.89(95%CI,0.85-0.92),0.78(95%CI,0.70-0.85)and 27.56(95%CI,15.82-48.00),respectively.The positive likelihood ratio(PLR)was 4.02(95%Cl,2.85-5.67)and the negative likelihood ratio(NLR)was 0.15(95%CI,0.11-0.20).Based on vascular level analysis,the sensitivity,specificity and DOR of CT-FFR in assessing coronary artery stenosis were 0.86(95%CI,0.83-0.89),0.79(95%CI,0.74-0.83)and 23.42(95%Cl,15.63-35.08),respectively.PLR was 4.08(95%CI,3.21-5.17)and NLR was 0.17(95%CI,0.14-0.22).AUC values at patient level and vascular level were 0.91(95%Cl,0.88-0.93)and 0.89(95%CI,0.86--0.92),respectively.Conclusion:CT-FFR has a good diagnostic value for coronary stenosis lesions.It also has an important guiding significance in making treatment strategies for patient with coronary heart disease.