功能性心肌血流指数评价缺血性冠心病可行性分析  

Feasibility of Evaluating Ischemic Coronary Artery Disease by Functional Myocardial Blood Flow Index

作　　者：熊青峰[1] 马小静 陈艳[1] 吕丰甫 郭生鹏 陈浩[1] XIONG Qingfeng;MA Xiaojing;CHEN Yan;LYU Fengfu;GUO Shengpeng;CHEN Hao(Medical Imaging Centre,The Affiliated Asia Heart Hospital of Wuhan University of Science and Technology,Wuhan 430022,Hubei,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院放射科,湖北省武汉市430022

出　　处：《中国循环杂志》2021年第3期266-271,共6页Chinese Circulation Journal

基　　金：武汉市卫健委医学科研项目(WX18C01)。

摘　　要：目的:运用功能性心肌血流指数(MBFI)评价缺血性冠心病(ICAD)可行性分析。方法:回顾性分析冠心病疑似患者行冠状动脉CT血管成像(CCTA)检查,同期接受有创冠状动脉造影(ICA)及导管法心肌血流储备分数(FFR)检查共81例患者,其中男性43例,女性38例,年龄(59.27±9.09)岁;计算MBFI;以FFR≤0.80为金标准,分别以四格表诊断试验确定MBFI与ICA的最佳切点值来判断ICAD;评价MBFI、ICA的ROC曲线特征及诊断准确度。结果:81例患者,CCTA扫描平均剂量为(3.06±1.22)mSv。MBFI、ICA最佳切点值分别为0.074、70%,25例患者FFR≤0.80。MBFI、ICA两者ROC曲线下面积分别为0.825、0.699(Z=2.024,P=0.0429),其敏感度、特异度、阳性预测值、阴性预测值分别为88.00%、80.35%、66.67%、93.75%和76.00%、51.79%、41.30%、82.86%,诊断准确度分别为82.72%、59.26%(χ2=10.753,P<0.01)。33例患者(40.74%,33/81)ICA狭窄程度为65%或70%,其中27例患者(81.82%,27/33)心肌不缺血,运用MBFI值大于0.074可明确23例患者心肌并不缺血(69.70%,23/33)。结论:MBFI属于功能性指标,可用于排查缺血性冠心病。Objectives:To investigate the feasibility of functional myocardial blood flow index(MBFI)to evaluate ischemic coronary artery disease(ICAD).Methods:Data from 81 patients(43 males,mean age:[59.27±9.09]years)with suspected coronary artery disease(CAD)were analyzed retrospectively,patients underwent CCTA,ICA,and FFR examinations within 1 week.MBFI was calculated.Using FFR≤0.80 as the gold standard,after the optimal cut-off value was got with the diagnostic test,the diagnostic performance of MBFI and ICA was compared for ischemic CAD.The ROC curve characteristics and diagnostic accuracy of MBFI and ICA were evaluated.Results:In the 81 cases,the average scan dose of CCTA was(3.06±1.22)mSv.There were 25 cases with FFR≤0.80.The optimal cut-off value of MBFI and ICA was 0.074 and 70%,respectively.The area under the curve(AUC)of MBFI and ICA was 0.825 and 0.699(z=2.024,P=0.0429),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of MBFI and ICA were 88.00%,80.35%,66.67%,93.75%and 76.00%,51.79%,41.30%,82.86%,respectively.The diagnostic accuracy was 82.72%,59.26%(χ2=10.753,P<0.01).There were 33 cases(40.74%,33/81)with the ICA stenosis of 65%or 70%,27 out of 33 cases(81.82%,27/33)with FFR>0.80 were free from myocardial ischemia,and non-ischemia could be defined by MBFI>0.074 in 23 cases(69.70%,23/33).Conclusions:MBFI is a functional index,which can be used to detect myocardial ischemia in patients with CAD.

关 键 词：缺血性冠心病 X线计算机断层摄影术 冠状动脉造影 心肌血流指数 诊断试验 

分 类 号：R541.4[医药卫生—心血管疾病]