Sex differences in computed tomography angiography-derived coronary plaque burden in relation to invasive fractional flow reserve

被引：1

作者：

Han, Donghee ^{[1
]}

van Diemen, Pepijn ^{[2
]}

Kuronuma, Keiichiro ^{[1
]}

Lin, Andrew ^{[3
]}

Motwani, Manish ^{[4
]}

McElhinney, Priscilla ^{[3
]}

Tomasino, Guadalupe Flores ^{[3
]}

Park, Caroline ^{[3
]}

Kwan, Alan ^{[1
]}

Tzolos, Evangelos ^{[1
,5
]}

Klein, Eyal ^{[1
]}

Grodecki, Kajetan ^{[3
]}

Shou, Benjamin ^{[3
]}

Tamarappoo, Balaji ^{[1
,6
]}

Cadet, Sebastien ^{[1
]}

Danad, Ibrahim ^{[2
]}

Driessen, Roel S. ^{[2
]}

Berman, Daniel S. ^{[1
]}

Slomka, Piotr J. ^{[7
]}

Dey, Damini ^{[3
]}

Knaapen, Paul ^{[2
]}

机构：

[1] Cedars Sinai Med Ctr, Smidt Heart Inst, Dept Imaging & Med, Los Angeles, CA USA

[2] Vrije Univ Amsterdam Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[3] Cedars Sinai Med Ctr, Biomed Imaging Res Inst, Los Angeles, CA 90024 USA

[4] Manchester Univ NHS Fdn Trust, Manchester Heart Ctr, Manchester, England

[5] Univ Edinburgh, Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Scotland

[6] Indiana Univ Sch Med, Cardiovasc Inst, Indianapolis, IN USA

[7] Cedars Sinai Med Ctr, Artificial Interlligence Med Program, Los Angeles, CA USA

来源：

JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY | 2023年 / 17卷 / 02期

关键词：

Quantitative plaque analysis; Fractional flow reserve; Sex difference; Computed tomography; CT ANGIOGRAPHY; DISEASE; WOMEN; RISK; DIAGNOSIS; LESIONS;

D O I：

10.1016/j.jcct.2022.12.002

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Distinct sex-related differences exist in coronary artery plaque burden and distribution. We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography (CCTA) in relation to ischemia by invasive fractional flow reserve (FFR). Methods: This post-hoc analysis of the PACIFIC trial included 581 vessels in 203 patients (mean age 58.1 +/- 8.7 years, 63.5% male) who underwent CCTA and per-vessel invasive FFR. Quantitative assessment of total, calcified, non-calcified, and low-density non-calcified plaque burden were performed using semiautomated software. Sig-nificant ischemia was defined as invasive FFR <0.8. Results: The per-vessel frequency of ischemia was higher in men than women (33.5% vs. 7.5%, p < 0.001). Women had a smaller burden of all plaque subtypes (all p < 0.01). There was no sex difference on total, calcified, or non-calcified plaque burdens in vessels with ischemia; only low-density non-calcified plaque burden was significantly lower in women (beta:-0.183, p = 0.035). The burdens of all plaque subtypes were independently associated with ischemia in both men and women (For total plaque burden (5% increase): Men, OR: 1.15, 95%CI: 1.06-1.24, p = 0.001; Women, OR: 1.96, 95%CI: 1.11-3.46, p = 0.02). No significant interaction existed between sex and total plaque burden for predicting ischemia (interaction p = 0.108). The addition of quantitative plaque burdens to stenosis severity and adverse plaque characteristics improved the discrimination of ischemia in both men and women.Conclusions: In symptomatic patients with suspected CAD, women have a lower CCTA-derived burden of all plaque subtypes compared to men. Quantitative plaque burden provides independent and incremental predictive value for ischemia, irrespective of sex.

引用

页码：112 / 119

页数：8

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