基于冠状动脉造影的血流储备分数评估冠状动脉狭窄病变缺血的价值  

Diagnostic accuracy of noninvasive fractional flow reserve based on coronary angiography for ischemic coronary artery

作　　者：周沛 聂文畅 刘健[1] 侯昌 曹成富[1] 李琪[1] 马玉良[1] 卢明瑜[1] 赵红[1] 王伟民[1] ZHOU Pei;NIE Wen-chang;LIU Jian;HOU Chang;CAO Cheng-fu;LI Qi;MA Yu-liang;LU Ming-yu;ZHAO Hong;WANG Wei-min(Department of Cardiology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心血管内科,急性心肌梗死早期预警和干预北京市重点实验室,北京100044

出　　处：《中国介入心脏病学杂志》2022年第4期286-291,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(11832003);北京大学人民医院研究与发展基金项目(RDX2018-09);首都特色临床医学应用发展项目(Z171100001017099)。

摘　　要：目的分析冠心病患者有创血流储备分数(FFR)和基于冠状动脉造影的血流储备分数(caFFR)的检测结果,评估caFFR对冠状动脉狭窄病变缺血的临床诊断价值。方法收集2018年10月至2020年11月于北京大学人民医院择期行冠状动脉造影、FFR检查的冠心病患者,同时对所有患者进行caFFR检查,探讨两者的相关性和caFFR对冠状动脉缺血病变诊断的准确性。结果收集98例患者的100处病变冠状动脉FFR和caFFR数据,FFR平均值为(0.85±0.09),caFFR平均值为(0.84±0.08)。FFR和caFFR平均差值为–0.013(95%一致性界限:–0.150~0.124,P=0.06),两者呈线性相关(r=0.678,P<0.001)。以FFR<0.80为阈值,caFFR诊断冠状动脉功能学缺血的准确性为89.0%[95%置信区间(CI)81.2%~94.4%],受试者工作特征曲线下面积为0.934(95%CI 0.881~0.987,P<0.001)。caFFR最佳截断值为0.815,以caFFR<0.815为冠状动脉功能学缺血的阈值时,caFFR诊断准确性可提高至90.0%(95%CI 82.4%~94.7%),敏感度91.7%(95%CI 71.5%~98.5%),特异度89.5%(95%CI 79.8%~95.0%),阳性预测值73.3%(95%CI 53.8%~87.0%),阴性预测值97.1%(95%CI 89.1%~99.5%)。结论caFFR与FFR有良好的相关性,caFFR在诊断冠状动脉狭窄功能学缺血方面具有较高的准确性。Objective This study aims to compare the results of invasive fractional flow reserve(FFR) and coronary angiography FFR(caFFR) in patients with coronary heart disease to evaluate the diagnostic performance of caFFR for myocardial ischemia. Methods This study enrolled patients with coronary heart disease who underwent elective coronary angiography and FFR examination at Peking University People’s Hospital from October 2018 to November 2020. caFFR was measured to analyze the correlation between caFFR and FFR and evaluate the accuracy of caFFR in the diagnosis of coronary ischemic lesions. Results A total of 98 patients with coronary heart disease(100 lesions)were enrolled in this study. The average of FFR was(0.85±0.09),and the average caFFR was(0.84±0.08). The difference between the average FFR and caFFR was –0.013(95% limits of agreement:–0.150–0.124,P=0.06),with a linear correlation(r=0.678,P<0.001). With caFFR<0.80 as the threshold,the accuracy of caFFR in diagnosing coronary artery ischemia was 89.0%[95% confidence interval(CI)81.2%–94.4%],and the area under the receiver operating characteristic curve was 0.934(95%CI 0.881–0.987,P<0.001). The optimum cutoff of caFFR was 0.815. When with caFFR<0.815 as the threshold,the accuracy of caFFR in diagnosing coronary artery ischemia improved to 90.0%(95%CI 82.4%–94.7%),the sensitivity was 91.7%(95%CI 71.5%–98.5%),the specifi city was 89.5%(95%CI 79.8%–95.0%),the positive predictive value was 73.3%(95%CI 53.8%–87.0%)and the negative predictive value was 97.1%(95%CI 89.1%–99.5%). Conclusions There is a good correlation between caFFR and FFR, and caFFR has high accuracy in diagnosing coronary artery ischemia.

关 键 词：基于冠状动脉造影的血流储备分数 血流储备分数 冠心病 冠状动脉功能学评价 

分 类 号：R542.2[医药卫生—心血管疾病]