老年冠心病患者冠状动脉造影血流储备分数与导丝血流储备分数诊断价值的评价  

An evaluation of the diagnostic value of coronary angiography-based fractional flow reserve versus the wire-based fractional flow reserve in elderly patients with stable ischemic heart disease

作　　者：艾虎[1] 郑耐心[1] 李乐 杨国建[1] 李辉[1] 唐国栋[1] 张慧平[1] 赵迎 孙福成[1] Ai Hu;Zheng Naixin;Li Le;Yang Guojian;Li Hui;Tang Guodong;Zhang Huiping;Zhao Ying;Sun Fucheng(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第4期459-463,共5页Chinese Journal of Geriatrics

基　　金：北京医院临床研究121工程资助项目(BJ-2019-193)。

摘　　要：目的:评价老年冠心病患者冠状动脉造影血流储备分数(caFFR)与导丝血流储备分数(FFR)的诊断价值。方法:回顾性分析2015年1月至2019年12月在北京医院行经导丝FFR检查的稳定性冠心病患者168例(血管数186支),将入选患者冠状动脉造影图像及匹配的稳态主动脉压送至核心实验室,盲法下进行caFFR测定。根据年龄将入选患者分为非老年组(<65岁,93例)和老年组(≥65岁,75例),分析caFFR在非老年与老年组患者中与导丝FFR的相关性、一致性,并导丝FFR≤0.8作为研究参考标准,比较caFFR在两组间的诊断价值。结果:老年组患者caFFR与导丝FFR具有良好的相关性和一致性(r=0.796,P<0.01);caFFR在非老年组和老年组的诊断准确性91.9%比93.1%、敏感性91.8%比93.2%、特异性92.3%比93.0%、阳性预测值97.1%比91.1%、阴性预测值80.0%比92.9%,差异无统计学意义(均P>0.05)。caFFR诊断的受试者工作特征曲线下面积(AUC)非老年组为0.964,老年组为0.972,两组相比差异无统计学意义(Z=0.00823,95%CI:-0.037~0.052;P>0.05)。结论:在老年冠心病患者中,caFFR与导丝FFR具有良好的相关性、一致性,诊断价值与非老年人相似。Objective To evaluate the diagnostic value of coronary angiography-based fractional flow reserve(caFFR)versus a wire-based fractional flow reserve(FFR)in elderly patients with stable ischemic heart disease.Methods A total of 168 patients(186 vessels)who underwent a pressure wire(PW)-based FFR measurement from Jan.2015 to Dec.2019 in Beijing hospital were enrolled and analyzed retrospectively.Coronary angiography images and matched steady-state aortic pressure of patients were sent to the core laboratory for caFFR measurement under the blind method.All patients were divided into the non-elderly group(<65 years,n=93)and the elderly group(≥65 years,n=75).The diagnostic value of caFFR was evaluated by using the wire-based FFR cut-off value of≤0.80 as the reference standard.The correlation and consistency of caFFR and wire-based FFR were analyzed,and compared between the non-elderly and elderly groups.Results The caFFR had a good correlation and consistency with wire-based FFR in the elderly group(r=0.796,P<0.01).In non-aged versus elderly groups,diagnostic accuracy of caFFR was 91.9%versus 93.1%,diagnostic sensitivity of caFFR was 91.8%vs.93.2%,diagnostic specificity of caFFR was 92.3%vs.93.0%,all P>0.05.The area under the receiver-operating characteristic curve of caFFR had no significant difference between the non-elderly and elderly patients(0.964 vs.0.972,Z=0.00823,95%CI:-0.037-0.052,P>0.05).Conclusions The caFFR has a good diagnostic correlation and consistency with wire-based FFR in the elderly group,and caFFR's diagnostic performance in the elderly is similar to that in the non-elderly patients.

关 键 词：冠状动脉疾病 血流储备分数 计算流体力学 

分 类 号：R541.4[医药卫生—心血管疾病]