基于冠状动脉慢性完全闭塞病变多模态影像数据预测临床分层治疗效果的可行性研究

Coronary chronic total occlusion (CTO) is defined as a lesion of coronary artery with 100% blockage and over 3 months, of all the ischemia heard diseases, the morbidity of CTO is higher and cure rate is lower, and it’s easy to be re-blocked, so it’s one of the challenges of coronary heart diseases. Percutaneous coronary intervention (PCI) is the main treatment of CTO, but the success rate is only about 50%, and the incidence of major adverse cardiac events (MACE) is higher. The project is elicited by the following questions: Is there any different prognosis with different treatments, what are the key factors of PCI, whether the details of CTO can be used to predict the efficacy. Some scholars have pointed out that the prognosis may depend on the details of CTO (morphological features, revascularization and so on) and viability of myocardium. However, it’s still lack of the examination to recognize CTO lesions by non-invasive medical imaging techniques. According to our previous studies, high revolution CT can be used to evaluate the ingredient and burden of coronary arterial plaques, CT-FFR can be used to reflect the hemodynamic of coronary arteries. Combined with myocardial perfusion of CT, MR, PET and biomarkers of blood, viability of myocardium and risk of plaques can be evaluated. We aim to recognize the structural and functional characters of CTO by non-invasive medical imaging techniques, compared with pathology, and then evaluate the efficacy of treatment, finally achieve the goal of prediction efficacy preoperatively.

冠状动脉慢性完全闭塞（CTO）是冠脉100%闭塞且闭塞时间超过3个月的病变，发病率较高、治疗难度大，且再发病率和再闭塞率高，是冠心病治疗的难题之一。经皮冠状动脉介入治疗（PCI）是CTO治疗的主要方法，但成功率仅约50%，且后期主要不良心血管事件（MACE）发生率较高。不同治疗方法预后有无差别，影响PCI治疗成功的关键因素有哪些，能否通过无创检查评估CTO内部细节，在术前预测疗效，是本项目出发点。有学者提出，CTO内部特点（组织学成分及有无新生血管形成等）及相应心肌存活状态与预后有关，但目前尚缺乏识别CTO内部细节的检查方法。申请人前期研究发现，高分辨CT可评估斑块成分及负荷等，CT-FFR可反映冠脉流体力学，再结合CT、MR、PET心肌灌注及生物标志物评估心肌存活状态及斑块风险。本课题旨在与病理对照，从影像上明确CTO病变结构及功能特点，进而评估分层治疗效果，实现术前预测疗效的目的。

冠状动脉慢性完全闭塞（CTO）是冠脉100%闭塞且闭塞时间超过3个月的病变，发病率较高、治疗难度大，且再发病率和再闭塞率高，是冠心病治疗的难题之一。经皮冠状动脉介入治疗（PCI）是CTO治疗的主要方法，但成功率仅约50%，且后期主要不良心血管事件（MACE）发生率较高。不同治疗方法预后有无差别，影响PCI治疗成功的关键因素有哪些，能否通过无创检查评估CTO内部细节，在术前预测疗效，是本项目出发点。有学者提出，CTO内部特点（组织学成分及有无新生血管形成等）及相应心肌存活状态与预后有关，但目前尚缺乏识别CTO内部细节的检查方法。本研究分5个部分实现了多模态影像对评估冠脉疾病的诊断、治疗方式的选择和随访心血管事件的可行性，同时获得了不同扫描模式、不同扫描启动方案、不同影像技术指标对冠脉CTO的诊断及手术指导价值。本项目证明了血管周围脂肪、血流储备指数、血管影像基本形态及成分特点、临床指标、斑块进展及MRI成像技术在冠脉疾病的临床价值，并不断在此基础上进行技术的延展和创新，不断的为临床认识和治疗冠脉CTO病变提供了完善的技术支持、个性化诊断方案、指导临床治疗等价值。