期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 58, 期 17, 页码 1807-1816出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2011.06.051
关键词
atherosclerosis; coronary computed tomography angiography; myocardial flow reserve; positron emission tomography
资金
- Ministry of Education, Culture, Sports, Science and Technology, Japan [20790871]
- Society of Nuclear Medicine Wagner-Torizuka Fellowship
- Mochida Memorial Foundation for Medical and Pharmaceutical Research
- National Institutes of Health [T32 HL094301]
- Grants-in-Aid for Scientific Research [20790871] Funding Source: KAKEN
Objectives The purpose of this study was to quantify the effects of coronary atherosclerosis morphology and extent on myocardial flow reserve (MFR). Background Although the relationship between coronary stenosis and myocardial perfusion is well established, little is known about the contribution of other anatomic descriptors of atherosclerosis burden to this relationship. Methods We evaluated the relationship between atherosclerosis plaque burden, morphology, and composition and regional MFR (MFR(regional)) in 73 consecutive patients undergoing Rubidium-82 positron emission tomography and coronary computed tomography angiography for the evaluation of known or suspected coronary artery disease. Results Atherosclerosis was seen in 51 of 73 patients and in 107 of 209 assessable coronary arteries. On a per-vessel basis, the percentage diameter stenosis (p = 0.02) or summed stenosis score (p = 0.002), integrating stenoses in series, was the best predictor of MFR(regional). Importantly, MFR(regional) varied widely within each coronary stenosis category, even in vessels with nonobstructive plaques (n = 169), 38% of which had abnormal MFR(regional) (<2.0). Total plaque length, composition, and remodeling index were not associated with lower MFR. On a per-patient basis, the modified Duke CAD (coronary artery disease) index (p = 0.04) and the number of segments with mixed plaque (p = 0.01) were the best predictors of low MFR(global). Conclusions Computed tomography angiography descriptors of atherosclerosis had only a modest effect on downstream MFR. On a per-patient basis, the extent and severity of atherosclerosis as assessed by the modified Duke CAD index and the number of coronary segments with mixed plaque were associated with decreased MFR. (J Am Coll Cardiol 2011;58:1807-16) (C) 2011 by the American College of Cardiology Foundation
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