血流储备分数CT成像预测冠状动脉临界病变患者功能性心肌缺血的临床价值  

Clinical Value of CT-Derived Fractional Flow Reserve in Predicting Functional Myocardial Ischemia in Patients with Coronary Artery Disease

作　　者：刘鹏[1] 孙昊洋[1] 姜顺 LIU Peng;SUN Hao-yang;JIANG Shun(Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, China)

机构地区：[1]山东中医药大学附属医院放射科,济南250011

出　　处：《临床误诊误治》2019年第5期67-72,共6页Clinical Misdiagnosis & Mistherapy

基　　金：山东省自然科学基金(ZR2016HM43)

摘　　要：目的分析血流储备分数CT成像(FFRCT)预测冠状动脉临界病变患者功能性心肌缺血的临床价值。方法选择经冠状动脉造影(CAG)确诊的冠状动脉临界病变116例,皆行冠状动脉CT血管造影(CTA)检查,以CTA图像数据为基础采用计算流体力学造模进行FFRCT,以血流储备分数(FFR)为参考标准,分别以患者例数和血管支数为单位,计算FFRCT对功能性心肌缺血的诊断准确性,采用受试者工作特征(ROC)曲线分析FFRCT对功能性心肌缺血预测效能,使用Delong检验比较两组ROC曲线下面积(AUC),通过Pearson法分析在血管支数水平上FFRCT与FFR相关性,采用Bland Altman法分析二者一致性。结果本组最终纳入研究104例,共计139支血管,以FFR为参考标准,以患者例数为单位,FFRCT诊断功能性心肌缺血的准确度为87.50%,敏感度为75.76%,特异度为92.96%,阳性预测值为83.33%,阴性预测值为89.19%;以血管支数为单位,FFRCT诊断功能性心肌缺血的准确度为84.17%,敏感度为71.11%,特异度为90.43%,阳性预测值为78.05%,阴性预测值为86.73%。ROC曲线分析结果显示,以患者例数和以血管支数为单位,FFRCT预测心肌缺血的ROC AUC分别为0.846和0.740;经Delong检验,二者比较差异无统计学意义(P>0.05)。经Pearson法分析,在血管支数水平上FFRCT与FFR呈正相关;经Bland Altman法分析,FFRCT与FFR间具有良好的一致性。结论 FFRCT能预测冠状动脉临界病变患者功能性心肌缺血,且具有良好诊断效能。ObjectiveTo analyze the clinical value of CT-derived fractional flow reserve (FFRCT) in predicting functional myocardial ischemia in patients with coronary artery disease (CAD).MethodsWe selected 116 cases with critical lesions of coronary artery diagnosed by coronary angiography (CAG), and coronary CT angiography (CTA) was performed. FFRCT was performed using computational fluid dynamics (CFD) modeling based on CTA image data, and fractional flow reserve (FFR) was used as a reference standard. In terms of the number of patients and the number of blood vessels, the diagnostic accuracy of FFRCT for functional myocardial ischemia was calculated. Receiver operating characteristic curve (ROC) was used to analyze the predictive efficacy of FFRCT for functional myocardial ischemia. The Delong test was used to compare the area under the ROC curve (AUC) between the two groups, and the Pearson method was used to analyze the correlation between FFRCT and FFR concerning the number of blood vessels. In addition, the consistency between the two was analyzed using the Bland Altman method. ResultsThis study eventually included 104 cases with a total of 139 blood vessels. With FFR as the reference standard, based on the number of patients, FFRCT was used to diagnose functional myocardial ischemia with an accuracy of 87.50%, sensitivity of 75.76%, specificity of 92.96%, positive predictive value of 83.33%, and negative predictive value of 89.19%. In terms of the number of blood vessels, FFRCT in diagnosis of functional myocardial ischemia had an accuracy of 84.17%, sensitivity of 71.11%, specificity of 90.43%, positive predictive value of 78.05%, and negative predictive value of 86.73%. ROC analysis showed that the AUC of FFRCT in predicting myocardial ischemia was 0.846 and 0.740, respectively, in terms of the number of patients and blood vessels. Delong test showed that there was no significant difference between the two ( P >0.05). After analysis by Pearson method, FFRCT was positively correlated with FFR concerning the number

关 键 词：冠状动脉临界病变 CT血管造影术 血流储备分数 心肌 心肌缺血 

分 类 号：R543.3[医药卫生—心血管疾病]