冠状动脉周围FAI对CT-FFR诊断重度钙化患者冠脉血流动力学异常的增量价值  

Incremental diagnostic value of pericoronary FAI over CT-FFR for diagnosis of abnormal coronary hemodynamics in patients with severe calcification

作　　者：丁熠璞 单冬凯[1] 王玺 杨俊杰[1] 陈韵岱[1] 杨霞[1] Ding Yi-Pu;Shan Dong-Kai;Wang Xi;Yang Jun-Jie;Chen Yun-Dai;Yang Xia(Department of Cardiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]解放军总医院第一医学中心心血管内科,北京100853 [2]南开大学医学院,天津300071

出　　处：《解放军医学杂志》2021年第7期666-672,共7页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点研发计划(2016YFC1300304);北京市科技新星计划(Z181100006218055);全军医学科技青年培育计划孵化项目(16QNP137)~。

摘　　要：目的探讨重度钙化对基于CT的血流储备分数(CT-FFR)诊断血流动力学异常的影响,并研究冠脉周围脂肪衰减指数(FAI)对重度钙化冠脉血管血流动力学异常的诊断价值。方法回顾性分析2017年1月-2019年12月于解放军总医院第一医学中心行有创FFR检查前1个月内进行冠状动脉CT血管造影(CCTA)检查的患者的临床资料。以有创FFR≤0.8作为诊断血流动力学异常性冠心病的金标准,将人群分为FFR≤0.8与FFR>0.8两组,从血管水平测量并比较钙化积分、冠脉狭窄程度、冠脉周围FAI及CT-FFR。根据钙化严重程度的四分位数将人群分组,其中冠状动脉钙化积分(CACS) Q_1~Q_3人群为轻中度钙化组,Q_4人群为重度钙化组,分析两组间及组内单独使用CT-FFR与联合冠脉周围FAI对冠脉血流动力学异常的诊断效能。结果共纳入99例患者总计124支冠脉主支血管,FFR≤0.8组(37支)与FFR>0.8组(87支)在血管水平上的CACS(85.80,95%CI 6.750~0.977 vs.42.50,95%CI 0.600~110.200,P<0.05)、冠脉狭窄程度(63.8%±9.9% vs.57.6%±9.5%,P<0.01)、冠脉周围FAI(–73.3±9.5 vs.–80.6±7.5,P<0.01)及CT-FFR值(0.77±0.04 vs.0.86±0.04,P<0.01)差异均有统计学意义。CT-FFR对重度钙化的诊断效能低于轻中度钙化(AUC=0.767,95%CI 0.581~0.899 vs.AUC=0.936,95%CI 0.865~0.976,P<0.05),而冠脉周围FAI对重度钙化具有良好的诊断效能(AUC=0.850,95%CI 0.676~0.952)。在重度钙化血管中,联合冠脉周围FAI较单独应用CT-FFR的诊断效能提高(AUC=0.917,95%CI 0.760~0.985 vs.AUC=0.767,95%CI 0.581~0.899,P=0.046)。结论对于重度钙化的血管,CT-FFR诊断冠脉显著缺血的效能降低,联合冠脉周围FAI可为血流动力学异常的冠心病的诊断提供增量价值。Objective To explore the impact of severe calcification on the abnormal hemodynamics based on CT-fractional flow reserve(CT-FFR)diagnosis,and evaluate the diagnostic significance of pericoronary fat attenuation index(FAI)on the abnormal hemodynamics of severely calcified coronary artery.Methods The clinical data of patients were retrospectively analyzed who underwent a coronary computed tomography angiography(CCTA)examination within one month before an invasive FFR examination from January 2017 to December 2019 in the First Medical Center of Chinese PLA General Hospital.Regarding invasive FFR≤0.8 as the gold standard of hemodynamically abnormal coronary artery disease(CAD),patients were assigned to FFR≤0.8 group and FFR>0.8 group.The coronary artery calcium score(CACS),degree of major coronary branch stenosis,pericoronary FAI and CT-FFR were measured and compared.Invasive FFR≤0.8 represents the presence of lesion-specific hemodynamic significant CAD. According to the quartiles of CACS, patients were further divided into mildly-moderately calcified (1st-3rd quartiles) and severely calcified (4th quartile) stratification. The diagnostic efficacy for abnormal coronary hemodynamics was analyzed only with CT-FFR and combined with pericoronary FAI detection between the two groups. Results A total of 99 patients with 124 main coronary arteries were included (37 in FFR≤0.8 group, and 87 in FFR>0.8 group). In terms of vascular characteristics, statistically significant differences existed between FFR≤0.8 group and FFR>0.8 group in CACS (85.80, 95%CI 6.750~0.977 vs. 42.50, 95%CI 0.600~110.200, P<0.05), degree of major coronary branch stenosis (63.8%±9.9% vs. 57.6%±9.5%, P<0.01), pericoronary FAI (-73.3±9.5 vs. -80.6±7.5, P<0.01) and CT-FFR (0.77±0.04 vs. 0.86±0.04, P<0.01). The diagnostic efficacy of CT-FFR was lower for severe calcified vessels than for the vessels with mild to moderate calcification (AUC=0.767, 95%CI 0.581~0.899 vs. AUC=0.936, 95%CI 0.865~0.976, P<0.05), while the pericoronary FAI showed

关 键 词：CT血管造影术 血流储备分数 钙化 冠脉周围脂肪衰减指数 

分 类 号：R445.3[医药卫生—影像医学与核医学]