冠状动脉临界病变血管内超声检查参数与定量血流分数的相关性研究  

Correlation between intravascular ultrasound assessment and quantitative flow ratio in intermediate coronary artery stenosis

作　　者：耿亮[1] 袁圆 万青 王兴旭 游洁芸 俞帅 韦苇 李纪明[1] 高力明[1] 汪云开[1] 郭蔚 黄瑛 张奇[1] GENG Liang;YUAN Yuan;WAN Qing;WANG Xing-xu;YOU Jie-yun;YU Shuai;WEI Wei;LI Ji-ming;GAO Li-ming;WANG Yun-kai;GUO Wei;HUANG Ying;ZHANG Qi(Department of Cardiology,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院心脏内科,上海200120

出　　处：《中国介入心脏病学杂志》2021年第3期127-132,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金(81870202);上海市浦东新区学科带头人计划(PWRD2018-06)。

摘　　要：目的探讨冠状动脉临界病变血管内超声(IVUS)检查参数与定量血流分数(QFR)的相关性。方法前瞻性连续入选2018年9月至2019年9月于同济大学附属东方医院接受QFR和IVUS检查的116例患者(117处冠状动脉临界病变)。根据QFR评估结果,将患者分为QFR≤0.80组(25处病变)和QFR>0.80组(92处病变),比较两组IVUS检查参数的差异。应用Poisson线性相关性分析以及受试者工作特征(ROC)曲线评估IVUS与QFR的相关性,应用logistic多元回归分析QFR≤0.80的预测因素。结果IVUS检查发现,QFR≤0.80组最小管腔面积(MLA)[(3.1±0.8)mm^(2)比(3.6±1.1)mm^(2),P=0.040]、最小管腔直径(MLD)[(1.8±0.3)mm比(2.0±0.3)mm,P=0.012]显著小于QFR>0.80组,而斑块负荷[(73.5±5.6)%比(68.0±8.4)%,P=0.002]、面积狭窄率[(69.8±8.8)%比(63.8±9.8)%,P=0.007]、斑块偏心指数[(0.83±0.12)比(0.73±0.19),P=0.008]及回声消减斑块比例(52.0%比23.9%,P=0.003)显著高于QFR>0.80组,差异均有统计学意义。Poisson线性相关分析显示,MLA(r=0.259,P=0.005)、MLD(r=0.300,P=0.001)与QFR正相关,而斑块负荷(r=–0.357,P<0.001)以及斑块偏心指数(r=–0.247,P=0.008)与QFR负相关。logistic多因素回归分析表明斑块负荷>70%(OR 4.531,95%CI 1.443~14.222,P=0.010)和斑块偏心指数(OR 1.066,95%CI 1.014~1.121,P=0.012)为QFR≤0.80的独立预测因素。结论冠状动脉临界病变IVUS检查结果中斑块负荷>70%以及斑块偏心指数是QFR≤0.80的独立预测因子。Objective The current study aims to assess the correlation between intravascular ultrasound(IVUS)parameters and quantitative fl ow ratio(QFR).Methods A total of 116 patients with 117 intermediate de novo lesions were consecutively enrolled between September 2018 and September 2019 in our hospital for prospective QFR and IVUS assessments.The lesions were divided into QFR≤0.80 group(n=25)and QFR>0.80 group(n=92).IVUS parameters were compared between two groups.The correlations between anatomical parameters derived from IVUS and QFR measurement were analyzed and multivariate logistic analysis was used to find predictors of QFR≤0.80.Results In general,minimum lumen area(MLA)[(3.1±0.8)mm^(2) vs.(3.6±1.1)mm^(2),P=0.040]and minimum lumen diameter(MLD)[(1.8±0.3)mm vs.(2.0±0.3)mm,P=0.012]were signifi cantly smaller in QFR≤0.80 group,whereas the plaque burden[(73.5±5.6)%vs.(68.0±8.4)%,P=0.002],area stenosis[(69.8±8.8)%vs.(63.8±9.8)%,P=0.007],eccentricity index[(0.83±0.12)vs.(0.73±0.19),P=0.008],and incidence of echo-attenuated plaque(52.0%vs.23.9%,P=0.003)were signifi cantly higher in QFR≤0.80 group.QFR measurement was significantly correlated with MLA(r=0.259,P=0.005),MLD(r=0.300,P=0.001),plaque burden(r=–0.357,P<0.001)and eccentricity index(r=–0.247,P=0.008).Multivariate logistic analysis indicated that plaque burden>70%(OR 4.531,95%CI 1.443–14.222,P=0.010)and eccentricity index(OR 1.066,95%CI 1.014–1.121,P=0.012)were independently related to QFR≤0.80.Conclusions Plaque burden>70%and eccentricity index were independent predictors of QFR≤0.80 in intermediate coronary lesions.

关 键 词：冠状动脉疾病 临界病变 定量血流分数 血管内超声 

分 类 号：R543.3[医药卫生—心血管疾病]