全病变血流储备分数梯度可预测心肌血流异常:基于冠状动脉CT血管造影  

Global trans-lesional computed tomography-derived fractional flow reserve can predict abnormal myocardial blood flow:based on coronary artery CT angiography

作　　者：纪欣强 赵润涛 单冬凯[2] 刘子暖 王玺 李涛[3] 杨俊杰[2] 王凡[4] JI Xinqiang;ZHAO Runtao;SHAN Dongkai;LIU Zinuan;WANG Xi;LI Tao;YANG Junjie;WANG Fan(Medical School of Chinese PLA,Chinese PLA General Hospital,Beijing 100853,China;Senior Department of Cardiology,The Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Radiology,the First Medical Center,Beijing 100853,China;Department of Cardiology,the Second Medical Center,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第六医学中心心血管病医学部,北京100048 [3]解放军总医院第一医学中心放射诊断科,北京100853 [4]解放军总医院第二医学中心心内科,北京100853

出　　处：《分子影像学杂志》2023年第5期779-786,共8页Journal of Molecular Imaging

基　　金：国家重点研发计划课题(2021YFC2500505)。

摘　　要：目的通过比较全病变梯度冠状动脉电子计算机断层扫描血流储备分数(GlobalΔCT-FFR)与心肌血流量的关系,探讨GlobalΔCT-FFR在预测心肌血流异常方面的价值。方法回顾性纳入2019~2021年因疑似冠状动脉疾病行动态CT心肌灌注+冠状动脉CT血管造影“一站式”检查的患者76例共228支冠状动脉血管。采用Spearman相关分析GlobalΔCT-FFR与心肌血流量(MBF)的相关性。以MBF为参考标准,分别从患者水平和血管水平评价GlobalΔCT-FFR、CT-FFR和冠状动脉CT血管造影直径狭窄率(DS)对心肌血流异常的敏感度、特异性、诊断准确性、阳性预测值及阴性预测值,绘制ROC曲线并计算曲线下面积。结果在患者水平,GlobalΔCT-FFR与MBF呈中度负相关关系(r=-0.51,P<0.05),CT-FFR与MBF呈弱正相关关系(r=0.33,P<0.05);在血管水平,GlobalΔCT-FFR与MBF呈中度负相关关系(r=-0.47,P<0.05),CT-FFR与MBF呈弱正相关关系(r=0.39,P<0.05)。在患者水平,GlobalΔCT-FFR、CT-FFR、DS的曲线下面积分别为0.82(95%CI:0.72~0.90,P<0.05)、0.71(95%CI:0.59~0.81,P<0.05)、0.65(95%CI:0.53~0.76,P<0.05);在血管水平,GlobalΔCT-FFR、CT-FFR、DS的ROC曲线下面积分别为0.87(95%CI:0.75~0.86,P<0.05)、0.78(95%CI:0.72~0.83,P<0.05)、0.71(95%CI:0.65~0.77,P<0.05)。ROC曲线对比:在患者水平,GlobalΔCT-FFR诊断效能优于CT-FFR、DS(P=0.0471、P<0.0001);在血管水平,GlobalΔCT-FFR与CT-FFR、DS诊断效能的差异无统计学意义(P=0.5237、P=0.0530)。结论GlobalΔCT-FFR对心肌血流异常具有较好的诊断价值,有望成为心肌血流定量测量的替代指标。Objective To assess the predictive capability of GlobalΔCT-FFR in determining abnormal myocardial blood flow through an examination of the correlation between GlobalΔCT-FFR and myocardial blood flow.Methods A retrospective inclusion was conducted on a cohort of 76 patients who underwent dynamic computed tomographic myocardial perfusion+coronary computed tomographic angiography between 2019 and 2021,as a result of suspected coronary artery disease.The relationship between GlobalΔCT-FFR and myocardial blood flow(MBF)was assessed using Univariate Spearman correlation.We were assessed the sensitivity,specificity,diagnostic accuracy,positive predictive value,and negative predictive value of GlobalΔCT-FFR,CT-FFR and coronary computed tomographic angiography diameter stenosis(DS)for myocardial blood flow abnormalities at both per-patient and per-vessel level,utilizing MBF as a reference standard.The ROC curve was constructed,and the area under the curve(AUC)was calculated.Results At the per-patient level,there was a moderate negative correlation between GlobalΔCT-FFR and mean MBF(r=-0.51,P<0.05),CT-FFR exhibited a weak positive correlation with mean MBF(r=0.33,P<0.05).At the per-vessel level,GlobalΔCT-FFR showed a moderate negative correlation with mean MBF(r=-0.47,P<0.05),CT-FFR demonstrated a weak positive correlation with mean MBF(r=0.39,P<0.05).At the per-patient level,the AUC for GlobalΔCT-FFR,CT-FFR,and DS was found to be 0.82(95%CI:0.72-0.90,P<0.05),0.71(95%CI:0.59-0.81,P<0.05)and 0.65(95%CI:0.53-0.76,P<0.05),respectively.At the per-vessel level,the AUC for GlobalΔCT-FFR,CT-FFR,and DS was determined to be 0.81(95%CI:0.75-0.86,P<0.05),0.78(95%CI:0.72-0.83,P<0.05)and 0.71(95%CI:0.65-0.77:P<0.05),respectively.In the evaluation of ROC curves,GlobalΔCT-FFR exhibited superior performance compared to CT-FFR and DS in per-patient analysis(P=0.0471,P<0.0001).In per-vessel analysis,GlobalΔCT-FFR demonstrated similar performance to CT-FFR and DS(P=0.5237,P=0.0530).Conclusion The diagnostic performance of GlobalΔC

关 键 词：冠状动脉疾病 血流储备分数 动态CT心肌灌注 心肌血流量 

分 类 号：R541.4[医药卫生—心血管疾病]