不同心动周期冠状动脉CT- FFR差异及其影响因素  

Differences in CT- FFR of coronary arteries with different cardiac cycles and influencing factors

作　　者：张华[1] 王培源 常娜 许天旗 袁宪顺[4] 王锡明[4] ZHANG Hua;WANG Peiyuan;CHANG Na;XU Tianqi;YUAN Xianshun;WANG Ximing(Department of Interventional Radiology,Heze Municipal Hospital,Heze 274000,Shandong,China;Department of Medical Radiology,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,Shandong,China;Jinan Vocational College of Nursing,Jinan 250102,Shandong,China;Department of Medical Radiology,Shandong Provincial Hospital,Jinan 250021,Shandong,China)

机构地区：[1]菏泽市立医院介入科,山东菏泽274000 [2]滨州医学院烟台附属医院医学影像科,山东烟台264100 [3]济南护理职业学院,山东济南250102 [4]山东省立医院医学影像科,山东济南250021

出　　处：《山东大学学报（医学版）》2023年第7期55-62,共8页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(82271993);山东第一医科大学学术提升计划项目(2019QL023)。

摘　　要：目的 探讨冠状动脉CT血管成像血流储备分数(CT-FFR)在舒张期和收缩期的测量差异及其影响因素。方法 回顾性纳入自2019年1月至2020年12月期间,临床怀疑冠心病并进行冠状动脉计算机断层扫描(CCTA)检查显示血管存在单一斑块的患者159例。所有患者分别进行收缩期和舒张期冠状动脉CTA后处理,并计算收缩期和舒张期的CT-FFR(CT-FFR-S和CT-FFR-D)。对不同期相测量值(包括CT-FFR和△CT-FFR)与心率、冠状动脉狭窄程度及斑块类型之间的关系进行评价。采用配对样本t检验比较舒张期和收缩期CT-FFR的差异。结果 159例患者[(58.2±11.0)岁,男性61.0%]的176条血管成功分析。总体而言,CT-FFR-D测量值低于CT-FFR-S(0.74±0.18 vs 0.76±0.16,P=0.019),而△CT-FFR-D高于△CT-FFR-S(0.21±0.17 vs 0.19±0.15,P=0.003)。心率和冠状动脉狭窄程度是导致不同期相CT-FFR和△CT-FFR测量值差异的影响因素。在心率<80的患者中,CT-FFR和△CT-FFR在舒张期和收缩期的差异有统计学意义(P<0.05)。此外,梗阻性病变(狭窄≥50%)的CT-FFR和△CT-FFR在舒张期和收缩期的差异也有统计学意义(P<0.05)。但是,斑块类型对不同期相CT-FFR和△CT-FFR测量值无明显影响(P>0.05)。结论 收缩期和舒张期测量的CT-FFR和△CT-FFR存在差异,且△CT-FFR差异更加显著。不同期相的CT-FFR测量值差异受心率和冠状动脉狭窄程度影响,而与斑块类型无明显相关。Objective To investigate the differences in the measurement of coronary computed tomography fractional flow reserve(CT-FFR) in diastole and systole and the influencing factors.Methods This study retrospectively included 159 patients with clinically suspected coronary artery disease who underwent coronary computed tomography angiography(CTA) during Jan.2019 and Dec.2020 which showed a single plaque in the vessel.Coronary CTA post-processing was performed in both systolic and diastolic phases,and CT-FFR-S and CT-FFR-D were calculated.The relationships between CT-FFR and ΔCT-FFR and heart rate,coronary stenosis degree and plaque type were evaluated.Paired-samples t-test was used to compare the differences between diastolic and systolic CT-FFR.Results A total of 176 vessels from the 159 patients(58.2±11.0 years,61.0% men) were successfully analyzed.Overall,CT-FFR-D was lower than CT-FFR-S(0.74±0.18 vs 0.76±0.16,P=0.019),whereas ΔCT-FFR-D was higher than ΔCT-FFR-S(0.21±0.17 vs 0.19±0.15,P=0.003).Heart rate and degree of coronary artery stenosis were contributing factors to the differences in CT-FFR and ΔCT-FFR between different phases.In patients with heart rate 80,the differences between CT-FFR and ΔCT-FFR in diastole and systole were statistically significant(P<0.05).In addition,the differences between CT-FFR and ΔCT-FFR in diastole and systole were statistically significant(P<0.05) in obstructive lesions(≥50% stenosis).However,plaque type had no significant effects on CT-FFR and ΔCT-FFR in different phases(P>0.05).Conclusion There are differences in CT-FFR and ΔCT-FFR measured in systole and diastole,and the difference in ΔCT-FFR is more significant.The differences in CT-FFR measurements between different phases are affected by heart rate and coronary stenosis,but not by plaque type.

关 键 词：冠状动脉CT血管成像 血流储备分数 收缩期 舒张期 

分 类 号：R445.3[医药卫生—影像医学与核医学]