ATP负荷超声心动图与压力导丝评估冠状动脉血流储备功能的对照研究  

Diagnostic accuracy of adenosine triphosphate stress echocardiography derived coronary flow reserve for detecting fractional flow reserve using the pressure wire

作　　者：殷拥军[1] 张宏才[1] 伍洲[1] 文霞[1] 郑雅琳 康彧[2] 张嬿[2] 孔令秋[1] 

机构地区：[1]成都中医药大学附属医院心内科,610072 [2]成都中医药大学附属医院超声科,610072

出　　处：《中华超声影像学杂志》2016年第7期558-562,共5页Chinese Journal of Ultrasonography

基　　金：国家十二五科技支撑计划项目（2013BA102802）;国家卫计委应用基础研究课题（YYJC20120110）;成都中医药大学青年基金项目（ZRM201314）

摘　　要：目的以压力导丝所测血流储备分数（FFR）为对照，探讨ATP负荷超声心动图在冠状动脉血流储备（CFR）评估中的诊断价值。方法选取78例行冠状动脉造影提示前降支临界病变的患者，术中即刻分别在ATP负荷下使用压力导丝与超声心动图评估CFR。采用ROC曲线分析ATP负荷超声心动图试验测定CFR预测FFR水平的价值。结果压力导丝显示FFR〉0.80（A组）43例，FFR〈0.75（B组）35例。A组CFR为（3．02±1．85），B组CFR为（2．13±0．79），二者差异有统计学意义（P〈0．05）。以CFR〉2．0为截点，诊断FFR〉0．80的曲线下面积为0．81（95％CI0．75～0．89），其敏感性为58％，特异性为81％，诊断准确性为73％；以CFR〈2．0为截点，诊断FFR〈0．75的曲线下面积为0．86（95％CI0．83～0．94），其敏感性为83％，特异性为85％，诊断准确性为83％。结论ATP负荷超声心动图检测CFR对冠状动脉FFR水平有较好的预测价值。Objective To test the consistency of coronary flow reserve （CFR） derived by adenosine triphosphate （ATP） stress echocardiography and fractional flow reserve（FFR） using the pressure wire. Methods A total of 78 patients were inrolled. The ATP stress pressure guide wire and eehocardiography were performed immediately after the coronary angiography to assess CFR. ROC curve analysis was used to test the value of CFR for detecting FFR levels. Results All the patients were divided into group A （FFR〉 0.80, n =43） and group B （FFR〈0.75, n = 35）. CFR was significantly different between two groups [（3.02 ± 1.85） vs （2.13 ± 0.79）, P 〈0.05], With ROC analysis, CFR〈2.0 was the best cutoff value for diagnosing FFR〈0.75, the area under the curve was 0.86（95%CI 0, 83-0. 94） , with a sensitivity of 83%, a specificity of 85% and anaceuracy of 83%. CFR〉2.0 was the best cutoff value for diagnosing FFR〉 0.80,the area under the curve was 0.81 （95%CI 0.75-0.89）,with a sensitivity of 58 %,a specificity of 81%and anaccuracy of 73%. Conclusions CFR measured by ATP stress echocardiography is a valuable tool for detecting FFR using the pressure wire.

关 键 词：超声心动描记术 冠状动脉血流储备 冠状动脉狭窄 

分 类 号：R540.45[医药卫生—心血管疾病] R541.4[医药卫生—内科学]