Objective:To investigate the value of coronary computed tomography angiography(CCTA) combined with four-dimensional speckle tracking echocardiography (4D-STE) for prognosticating major adverse cardiac events(MACE) of patients with coronary plaque.Methods: 209 patients with atherosclerosis of coronary artery, who were diagnosed by CCTA, were implemented clinical risk stratification according to "Chinese Guidelines for Prevention of Cardiovascular Diseases". CCTA imaging was analyzed and the degree of coronary artery stenosis was quantitatively assessed and graded. 4D-STE images were collected and their dependent variables were measured, and the activity of left ventricular wall was evaluated. The occurrence of MACE was followed up. Besides, there were three models for prognosticating MACE were established: model 1(CCTA grading), model 2(CCTA grading combined with index of 4D-STE) and model 3 (CCTA grading combined with 4D-STE and clinical risk stratification). Finally, the efficiency of prognosticating for MACE of the three models were assessed as above results.Results: There were 46 patients (22.0％) had experienced the MACE at the end point of following up. The results of Cox regression model analysis for clinical risk stratification, CCTA grading and 4D-STE index indicated that the prognosticating value of CCTA grading was obviously higher than that of 4D-STE and clinical risk stratification(HR=12.39). The area under curve(AUCs) of receiver operating characteristic(ROC) among the three model groups were 0.842, 0.924, and 0.940, respectively, and the AUCs both of model 2 and model 3 were higher than that of model 1. And the differences of AUCs among the three models were significant(Z=0.0975,Z=0.144,P<0.001), and the difference of AUCs between model 2 and model 3 was no significant(Z=0.0465,P>0.05).Conclusion: The new modality of CCTA combined with 4D-STE can achieve higher prognosticating efficiency. It can provide a basis for the standardization of prevention of cardiovascular disease and is expected to be popularized in clinical practice.%目的:探讨冠状动脉CT血管造影(CCTA)和四维斑点跟踪超声心动图(4D-STE)对冠状动脉斑块患者主要不良心脏事件(MACE)的预测价值.方法:选取209例接受CCTA检查发现有冠状动脉粥样硬化斑块的患者,参照"中国心血管病预防指南"进行临床危险分层.分析患者CCTA图像,定量评定冠状动脉管腔狭窄程度并分级.采集4D-STE图像,测量其应变指标,评价左心室壁活动度.随访病例MACE发生情况,建立预测MACE的三个模型:CCTA分级(model 1)、CCTA分级+4D-STE指标(model 2)和CCTA分级+4D-STE指标+临床危险分层(model 3),评估三个模型对MACE的预测效能.结果:随访结束时,46例患者(占22.0％)发生MACE.临床危险分层、CCTA分级和4D-STE指标的Cox回归模型分析显示,CCTA分级预测MACE的价值明显高于4D-STE和临床危险分级(HR=12.39).三个模型受试者工作特性(ROC)曲线下面积(AUC)分别为0.842、0.924和0.940,联合模型model 2和model 3的AUC明显大于model 1,model 2和model 3,与model 1比较差异有统计学意义(Z=0.0975,Z=0.144;P<0.001),model 2与model 3的AUC比较差异无统计学意义(Z=0.0465,P>0.05).结论:CCTA和4D-STE联合使用可以获得更高的预测效能,为心血管病防治的规范化提供依据,可以在临床推广使用.
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