FFR_(CT)对CCTA判定冠状动脉临界狭窄病变血流动力学变化的分析  

Hemodynamical change in-borderline stenotic coronary artery assessed by FFR_(CT) of CCTA

作　　者：王彤宁 刘欣[2] 杨琳[1] 张贺晔 徐磊[1] 范占明[1] WANG Tongning;LIU Xin;YANG Lin;ZHANG Heye;XU Lei;FAN Zhanming(Department of Radiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100000, China;Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences;Health Information Computing School of Biomedical Engineering, Sun Yat-Sen University)

机构地区：[1]首都医科大学附属北京安贞医院,北京100029 [2]中国科学院深圳先进技术研究院 [3]中山大学生物医学工程学院

出　　处：《国际医学放射学杂志》2018年第3期268-271,312,共5页International Journal of Medical Radiology

基　　金：国家重点研发计划项目(2016YFC1300301)

摘　　要：目的评价基于冠状动脉CT血管成像(CCTA)的冠状动脉血流储备分数(FFR_(CT))对CCTA判定临界狭窄病变冠状动脉血流动力学变化的诊断价值。方法回顾性分析了18例同时进行CCTA和有创冠状动脉造影(ICA)的病人,男13例,女5例,年龄49~76岁,平均(61±9)岁。选择冠状动脉临界狭窄病变(狭窄率为50%~70%)为靶血管,经ICA测定血流储备分数(FFR);记录CCTA影像数据,计算FFR_(CT)。FFR及FFR_(CT)均以≤0.80表示受累冠状动脉出现血流动力学改变并需要进一步治疗。以FFR为金标准,计算CCTA及FFR_(CT)的诊断准确度、敏感度、特异度、阴性预测值及阳性预测值,通过绘制受试者操作特征(ROC)曲线并采用Bland-Altman分析及Spearman相关分析评价CCTA狭窄及FFR_(CT)对冠状动脉缺血的诊断效能。结果 18例病人共27段冠状动脉接受评价,以FFR为金标准,FFR_(CT)诊断准确度88.9%,敏感度100%,特异度62.5%,阳性预测值86.4%,阴性预测值100%;FFR_(CT)与FFR呈中等程度相关(r=0.663,P<0.001);Bland-Altman分析显示FFR_(CT)与FFR的一致性较好(95%CI:-0.23~0.20),96.3%(26/27)的点落在一致性界限内,3.7%(1/27)的点在95%一致性界限外。FFR_(CT)ROC曲线下面积大于CCTA的(分别为0.947、0.500,P<0.001)。结论对于冠状动脉临界狭窄病变血流动力学变化的评价,FFR_(CT)能够提高CCTA在冠状动脉临界狭窄病变缺血方面的诊断能力。Objective To evaluate the diagnostic value of coronary computed tomography angiography（CCTA）-fractional flow reserve（FFRCT） for hemodynamic changes in borderline stenotic coronary artery. Methods A total of 18 patients（13 male and 5 female, age range 49 to 76 years old） who underwent CCTA and invasive coronary angiography（ICA）were retrospectively studied. A maximal diameter reduction in coronary artery between 50% to 70% was regarded as target vessel, and fractional flow reserve（FFR） was measured by ICA, FFRCTwas calculated from data of CCTA in the selected target vessels. Regarding 0.80 as borderline value for both FFR and FFRCT. A value below 0.80 indicates hemodynamic change in the affected coronary artery and needs further treatment. The diagnostic accuracy, sensitivity, specificity, negative predictive value and positive predictive value of FFRCTand CCTA were calculated with FFR as golden standard. Diagnostic efficiency for coronary artery ischemia by CCTA stenosis and FFRCTwere compared using receiver operating characteristic（ROC）curve, Bland-Altman analysis and Spearman analysis. Results All of 27 vessels from 18 patients were eligible for analysis as target vessels. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FFRCTwere 88.9%, 100%, 62.5%, 86.4%, and 100%, respectively. FFR and FFRCTshowed intermediate correlation（r =0.663, P〈0.001）. Bland-Altman analysis presented good concordance between FFRCTand FFR（95% CI：-0.23 to 0.20）,96.3% of the points（26/27） fell in the 95% limit of agreement,and 3.7% of the points（1/27） fell out of the 95% limit ofagreement. ROC curve indicated that AUC of FFRCTwas larger than that of CCTA（AUCs were 0.947, 0.500, respectively; P〈0.001）. Conclusion For the evaluation of hemodynamic changes in borderline stenotic coronary artery, FFRCTis able to improve the diagnostic performance in comparison to CCTA alone.

关 键 词：FFRCT 冠状动脉临界狭窄病变 血流动力学变化 

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