rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2016-97-4-197-205rentrad-153Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHВозможности компьютерно-томографической коронароангиографии, выполненной на двухэнергетическом компьютерном томографе, в прогнозировании успеха реваскуляризации хронических тотальных окклюзийDual-Source-CT coronary angiography for predicting success of revascularization in chronic total occlusionshttps://orcid.org/0000-0003-1769-4953ReinartzS.D.ReinartzS.D.

MD, Radiologist,

Pauwelsstrasse 30, 52074 Aachen

MD, Radiologist,

Pauwelsstrasse 30, 52074 Aachen

Sebastian.D.Reinartz@rwth-aachen.deReithS.ReithS.

MD, Cardiologist,

Pauwelsstrasse 30, 52074 Aachen

MD, Cardiologist,

Pauwelsstrasse 30, 52074 Aachen

KoosR.KoosR.

MD, Professor, Cardiologist,

Pauwelsstrasse 30, 52074 Aachen

MD, Professor, Cardiologist,

Pauwelsstrasse 30, 52074 Aachen

https://orcid.org/0000-0002-9771-4637SuciganK. M.SuciganK.M.

Technician Working,

Pauwelsstrasse 30, 52074 Aachen

Technician Working,

Pauwelsstrasse 30, 52074 Aachen

KuhlC. K.KuhlC.K.

MD, Professor, Radiologist,

Pauwelsstrasse 30, 52074 Aachen

MD, Professor, Radiologist,

Pauwelsstrasse 30, 52074 Aachen

https://orcid.org/0000-0001-8077-9306MahnkenA. H.MahnkenA.H.

Department of Diagnostic and Interventional Radiology, MD, Professor, Radiologist,

Biegenstrasse 10, 35032 Marburg

Department of Diagnostic and Interventional Radiology, MD, Professor, Radiologist,

Biegenstrasse 10, 35032 Marburg

University Hospital, RWTH Aachen UniversityГерманияUniversity Hospital, RWTH Aachen UniversityGermanyUniversity Hospital, Marburg UniversityГерманияUniversity Hospital, Marburg UniversityGermany201613092016974197205Copyright © Reinartz S., Reith S., Koos R., Sucigan K.M., Kuhl C.K., Mahnken A.H., 20162016Reinartz S., Reith S., Koos R., Sucigan K.M., Kuhl C.K., Mahnken A.H.Reinartz S., Reith S., Koos R., Sucigan K., Kuhl C., Mahnken A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/153

Цель исследования – предсказать успех чрескожной реканализации хронических тотальных окклюзий (ХТО) коронарных артерий (КА) по данным компьютерно-томографической (КТ) коронароангиографии (КАГ), выполненной на двухэнергетическом компьютерном томографе (ДЭКТ) с помощью простой системы подсчета баллов.

Материал и методы

Материал и методы. Для оценки приемлемости проведения чрескожной реканализации ХТО КА проведен анализ КТ- признаков ХТО у 25 пациентов, которым была выполнена ДЭКТ-КАГ за период с ноября 2009 г. по июнь 2014 г. Технический успех процедуры или ее осложнения были зафиксированы документально. Для подсчета вероятности успеха реваскуляризации ХТО использована шкала оценки, основывающаяся на данных 12 параметров КТ-изображений, полученных при ДЭКТ-КАГ. С помощью бинарной линейной регрессии были рассчитаны так называемая аахенская прогностическая шкала (AC-CTO-try), а также упрощенная прогностическая модель (sCTO-try), которые сравнивались с японской шкалой (J-CTO score) путем подсчета площади под ROC-кривыми.

Результаты

Результаты. В 88% случаев ХТО локализовались в правой КА, средняя протяженность окклюзии составила 4,6 ± 2,7 cм. 68% (17/25) были оценены как сложные и очень сложные сегменты по Японской шкале оценки ХТО (J-CTO). Основываясь на результатах предложенной нами КТ-оценки ХТО, эндоваскулярное вмешательство было рекомендовано 9 пациентам, в то время как реваскуляризация была предпри- нята в 64% случаев (у 16 из 25 пациентов), при этом доля успеха составила 56% (9/16). Отрицательная предсказательная ценность безуспешности реваскуляризации достигла 75%. Площадь под ROC-кривой при использовании упрощенной прогностической модели (sCTO-try) составила 0,892.

Заключение

Заключение. ДЭКТ-КАГ позволяет визуализировать окклюзированные сегменты КА и предоставляет возможность оценки вероятности безуспешности попытки реваскуляризации КА при ХТО с помощью системы подсчета баллов (CTO-try score). Упрощенная прогностическая модель (sCTO-try), откалиброванная для нашей когорты пациентов, может быть использована для прогнозирования успеха попытки реваскуляризации ХТО КА.

Objective. 25 consecutive patients underwent cardiac CT between November 2009 and September 2012 to evaluate configuration of chronic total occlusion (CTO) of a coronary artery to assess eligibility of percutaneous recanalization. Material and methods. Between 11/2009 and 06/2014 25 consecutive patients underwent DSCT-CA for evaluation of CTO. Technical success and complication rate of revascularization procedures were documented. For image analysis the datasets of 12 parameters were used to calculate CTO-try score. By calibration to the study cohort the AC-CTO-try and simplified CTO-try score were constructed respectively and compared to J-CTO by the area under the ROC-curve. Results. 88% of CTOs involved the right coronary artery (RCA) with a mean length of 4.6 ± 2.7 cm. 68% (17/25) were stratified as difficult or very difficult CTO-segments by J-CTO. Based on CTO-try an intervention was recommended in 9/25 patients, while revascularization was attempted in 16/25 (64%) patients with a success rate of 56% (n = 9/16). Negative predictive value for revascularization failure was 75%. By using sCTOtry, discrimination between success and failure of the intervention was measured with an AROC = 0.892. Conclusions. DSCT-CA permits visualization of the occluded vessel segment and provides a tool for assessing the probability of revascularization failure based on the CTO-try score. SCTOtry, calibrated to our cohort and expertise, can be used for predicting success of recanalization attempt.

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The authors declare that there are no conflicts of interest present.