冠状动脉CT血流储备分数在冠状动脉狭窄功能学评价中的应用价值  

Application value of fractional flow reserve(FFR)in the functional evaluation of coronary artery stenosis by computed tomography(CT)

作　　者：李杨[1] 冯磊 齐德林 丁瑞田 刘燕晖[1] 李超 张子畅 李洪利[1] Li Yang;Feng Lei;Qi Delin;Ding Ruitian;Liu Yanghui;Li Chao;Zhang Zichang;Li Hongli(Department of Cardiac Surgery,Capital Medical University,Beijing,100053;不详)

机构地区：[1]首都医科大学宣武医院心脏外科,北京100053

出　　处：《中国循证心血管医学杂志》2023年第6期716-720,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨冠状动脉CT血流储备分数(FFR)对于冠状动脉(冠脉)狭窄功能学评估中的应用价值。方法收集首都医科大学宣武医院于2018年1月至2022年6月收治的有冠脉粥样硬化性心脏病(冠心病)史或临床疑似冠心病者,行冠脉CT成像(CCTA)检查,冠脉直径狭窄40%~90%;行有创性冠脉造影(ICA)FFR准确评估狭窄程度,并以SPECT/MPI为心肌缺血评估标准,计算冠脉CT-FFR、CCTA及ICA三种评估方法的敏感度、特异度、阳性预测值、阴性预测值及准确度。并绘制ROC曲线,计算曲线下面积(AUC)。结果共纳入65例患者,共135支冠脉病变。冠脉CT-FFR评估冠脉功能性狭窄的敏感度、特异度、阳性预测值、阴性预测值及准确度,分别为90.5%(57/63)、95.8%(69/72)、95.0%(57/60)、89.3(59/66)和93.3%(126/135);冠脉CT-FFR的AUC值为0.92(95%CI:0.84~0.99),显著高于CCTA的0.79(95%CI:0.65~0.87),差异有统计学意义(P<0.05);与ICA-FFR的AUC值0.87(95%CI:0.67~0.92)相比,差异无统计学意义(P>0.05)。结论无创的冠脉CT-FFR对于评估冠脉功能性狭窄显著优于单纯的CCTA检查,可替代ICA-FFR,具有良好的临床应用前景。Objective To investigate the value of fractional flow reserve(FFR)in the functional evaluation of coronary artery stenosis by computed tomography(CT).Methods We collected patients with coronary artery disease(CAD)history or clinically suspected CAD from Xuanwu Hospital of Capital Medical University from January 2018 to June 2022.They underwent CCTA,which showed that the diameter of the coronary arteries was narrowed between 40%and 90%.Invasive coronary angiography(ICA)was performed for FFR accurate evaluation of the severity of the narrowing,and SPECT/MPI was used as the standard for myocardial ischemia assessment.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of the three assessment methods(CCTA-FFR,CCTA,and ICA)were calculated.The area under the receiver operating characteristic curve(AUC)was also calculated.Results A total of 65 patients with 135 coronary artery lesions were included in this study.There was no statistical difference in gender and complications(P>0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of coronary CT-FFR in evaluating functional coronary stenosis were 90.5%(57/63),95.8%(69/72),95.0%(57/60),89.3(59/66)and 93.3%(126/135),respectively.The AUC value of coronary CT-FFR was(0.92,95%CI:0.84~0.99),which was significantly higher than that of CCTA(0.79,95%CI:0.65-0.87),with statistical significance(P<0.05).The AUC value of coronary CT-FFR is similar to that in ICA-FFR(0.87,95%CI:0.67~0.92)without statistical significance(P>0.05).Conclusion Non-invasive coronary CT-FFR is significantly better than CCTA alone in the evaluation of functional coronary stenosis and can replace ICA-FFR.CT-FFR has a good prospect of clinical application.

关 键 词：冠状动脉 血流储备分数(FFR) 诊疗价值 

分 类 号：R543.3[医药卫生—心血管疾病]