| 【Objective】In order to find a convenient and valuable coronary heart disease risk factor,this study investigated the relation between coronary heart disease and left ventricular mass,left ventricular mass index,epicardial fat volume as well as aortic plaques in Chinese population,which could enhance the accuracy of coronary heart disease(CHD)risk evaluation and adequately reflect the valuation of single CCTA.【Methods】In this study,232 cases of CCTA examination were collected,with conforming to filter conditions form July 2017 to January 2018.There were 112 males and 120females,and the average age was 61.8 years.It was mentionable that the CCTA examination of all patients collected images by using 256 row CT(Revolution CT,GE Medical Systems,Waukesha,US)and finished complete cardiac cycle scan by Snapshot Pulse.In addition,there were CCTA scan protocol parameters as follows:tube voltage120kv,intelligent tube current,ball tube rotation speed0.28s/360°,thickness of the layer 0.625mm,interlayer spacing 0.625mm,collimation width 2560.625mm,ASiR-V 50%,and the acanning time was about one cardiac cycle length.In this cases the normal tube current was used for 40-80%of the r-r interval,and extremely low tube current was used for the rest.Besides,no matter Scan image reconstruction or Post-processingal measurement and analysis were performed by the same doctor who was familiar with the process of CTA reconstruction.The assessment included calculation and classification of coronary artery calcification(CACS),coronary artery plaque condition,aortic plaque in the scan area,epicardial fat volume,and the measurement of left ventricular parameters.In statistical methods,the quantitative variables used two independent sample t tests,while the two classification variables were tested by chi-square.And then Logistic regression analysis was performed for the variables that were meaningful in single factor analysis,which could evaluate the relation between coronary heart disease and various variables.【Results】In this study the average age±standard deviation was(61.8±11.7),including 112males(48.3%),and average age±standard deviation was(58.9±11.9);120females(51.7%),and the average age±standard deviation was(64.5±10.9).The average value of the body mass index(BMI)±standard deviation was(24.3±4.0)kg/m~2,of which 114 research objects(49.1%)were overweight(BMI 24 kg/m~2),and among them a total of 133 patients(57.3%)had a history of hypertension,and 64patients(27.6%)had a history of diabetes mellitus,and a total of 159 patients(68.5%)were diagnosed with coronary artery disease.Scan found within the scope of aorta plaque,A total of 122 patients(52.6%)were found in the aorta in the scan area.The average rate of heart rate during the scanning±standard deviation was(68.9±13.7)times every min,The average of each stroke output(SV)±standard deviation was(94.4±18.0)ml.The average of the ejection fraction(EF)±standard deviation was(64.0±8.6)%.The average of the epicardial fat volume(EATV)±standard deviation was(104.2±44.1)cm~3.The mean of the volume ratio of the epicardial fat±standard deviation was(12.8±4.4)%.The average number of left ventricular mass(LVM)±standard deviation was(80.6±27.0)g and the average number of left ventricular mass index(LVMI)±standard deviation was(47.8±14.1)g/m~2,among them the male LVM average±standard deviation was(94.7±25.8)g,LVMI was(52.8±12.9)g/m~2,while the female LVM average±standard deviation was(67.5±20.6)g,LVMI was(43.2±13.6)g/m~2.In this study there were 109 objects in non-calcified groups,18 objects in the micro calcification group,49 objects in the mild calcification group,38 objects in the moderate calcification group,and 18 objects in the extensive calcification group.In order to study the relationship between LVMI and different calcification points,the study subjects were divided into no calcification group,micro calcification group,mild calcification group,moderate calcification group and extensive calcification group,with the Rumberger method.The LVMI mean±standard deviation of these five groups was respectively:(45.4±10.5)、(45.9±13.2)、(48.2±13.8)、(48.5±11.4)、(61.8±27.1)g/m~2.And it’s analyzed by variance that F=5.838,P<0.001;After the further examination of the Bonferroni method,we could draw a conclusion that The difference between the average LVMI of the extensive calcification group and the mild calcification group and the moderate calcification group in the non-calcified group has statistical significance,and that the average LVMI of the extensive calcification group was larger than that of the other four groups.However,there was no statistical difference between no calcification group,micro calcification group,mild calcification group and moderate calcification group.The results of single factor analysis of coronary heart disease and various variables showed that there was a statistical difference between coronary heart disease group and normal group in terms of sex,age,hypertension,diabetes mellitus,aortic plaques,epicardial fat volume,left ventricular mass and left ventricular mass index,etc.The results of Logistic regression analysis with Backward:Conditional method showed that coronary heart disease was affected by sex,age,diabetes mellitus,aortic plaque and left ventricular mass index.And the interpretation of these result were as follows:(1)we could konw males were a risk factor for coronary heart disease through the result that the dominance ratio of the male group was 2.524,P<0.05,in addition,the dominance of males with suffering from CHD were 2.524 times as much as women.(2)For every 1 year increased in age,the dominance ratio of coronary heart disease was1.083,P<0.05,which showed that advanced age is a risk factor for coronary heart disease.(3)The dominance ratio of diabetes was 3.456,P<0.05,it could be considered that diabetes was a risk factor for coronary heart disease and that the dominance of objects with suffering from diabetes were 3.456 times as much as normal persons.(4)The dominance ratio of aortic plaque group was 6.260,P<0.05,which showed that aortic plaque was a risk factor for coronary heart disease and that the dominance of objects with suffering from aortic plaque were 6.26 times as much as normal persons.(5)When the left ventricular myocardial mass index increased by 1 units,the odds ratio of coronary heart disease was 1.043,P<0.05,and it could be considered that high LVM was a risk factor for coronary heart disease.According to the standardized regression coefficient,it was known that aortic plaque has the greatest impact on coronary heart disease.What’s more,the coefficient of Nagelkerke R~2 showed that these five independent variables could explain 48.6%of the variation of the result variable,indicating that the fitting effect of the model was better.【Conclusion】High LVMI evaluated by CT was independent risk factor of CHD,and the effect of LVMI on coronary heart disease was greater than that of LVM.Besides the presence of aortic plaques in all variables has the greatest impact on coronary heart disease.Comparing with BMI,Epicardial fat volume may be a more valuable risk factor for coronary heart disease.The single CCTA could not only evaluate the coronary artery condition,but also evaluate the left ventricular dissection and functional parameters as well as the adjacent tissue structure,which could enhance the accuracy of risk assessment of coronary heart disease,and it was no doubt that Single coronary CTA could be more valuable. |
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