静息全周期比值和定量血流分数评价冠状动脉临界病变准确性的对比研究  

Comparison of quantitative fl ow ratio and resting full-cycle ratio for evaluating physiological function of intermediate coronary lesions

作　　者：张瑞涛[1] 田振宇 周继升 郭丽君[1] 徐昕晔[1] ZHANG Rui-tao;TIAN Zhen-yu;ZHOU Ji-sheng;GUO Li-jun;XU Xin-ye(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,State Key Laboratory of Vascular Homeostasis and Remodeling,NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科、血管医学研究所、血管稳态与重构全国重点实验室、国家卫生健康委心血管分子生物学与调节肽重点实验室、心血管受体研究北京市重点实验室,北京100191

出　　处：《中国介入心脏病学杂志》2023年第10期721-727,共7页Chinese Journal of Interventional Cardiology

基　　金：北京大学第三医院创新转化基金项目(BYSYZHKC 2022106)。

摘　　要：目的以血流储备分数(FFR)为金标准,比较定量血流分数(QFR)与静息全周期比值(RFR)评估冠状动脉临界病变的准确性及临床应用价值。方法回顾性纳入2020年9月至2022年1月,在北京大学第三医院因冠状动脉性心脏病行冠状动脉造影并同时接受FFR和RFR检测的142例患者142支血管病变,分析RFR、QFR与FFR的线性相关性和诊断一致率,并进行受试者工作特征(ROC)曲线分析。根据性别及靶血管进行亚组分析。结果142例患者年龄66(58,71)岁,87例(61.3%)为男性,110支(77.5%)靶病变位于左前降支,RFR与FFR相关性r=0.814(95%CI 0.748~0.864,P<0.0001)、QFR与FFR相关性r=0.617(95%CI0.503~0.709,P<0.0001),均存在显著线性相关关系。RFR对应FFR≤0.80的AUC 0.786(95%CI0.715~0.857),而QFR对应FFR≤0.80的AUC 0.707(95%CI 0.633~0.782),两者之间的AUC差异无统计学意义(P=0.056)。在不同性别及靶病变的亚组分析中,RFR和QFR的AUC差异均无统计学意义(均P>0.05)。结论RFR、QFR与FFR有较高的一致性,二者与FFR诊断一致率较高,性别和靶病变对二者诊断准确性影响较小。Objective Using fractional flow reserve(FFR)as the gold standard,this study aims to compare the accuracy and clinical application value of quantitative flow ratio(QFR)and resting full-cycle ratio(RFR)in evaluating intermediate coronary lesions.Methods A retrospective selection was made of 142 vessels from 142 patients who underwent coronary angiography for coronary artery disease and simultaneous FFR and RFR at Peking University Third Hospital from September 2020 to January 2022.The linear correlations and diagnostic concordance rates of RFR,QFR,and FFR were analyzed,followed by receiver operating characteristic(ROC)curve analysis.Subgroup analysis was performed based on gender and target vessels.Results The age of the 142 patients was 66(58,71)years,with 87(61.3%)being male and 110(77.5%)target lesions located in the left anterior descending branch.Significant linear correlations were found between RFR and FFR(r=0.814,95%CI 0.748-0.864,P<0.0001)and between QFR and FFR(r=0.617,95%CI 0.503-0.709,P<0.0001).The area under the curve(AUC)of RFR for FFR≤0.80 was 0.786(95%CI 0.715-0.857),while the AUC of QFR for FFR≤0.80 was 0.707(95%CI 0.633-0.782),with no statistically significant difference between the two AUCs(P=0.056).In the subgroup analysis based on different genders and target lesions,there were no statistically significant differences in the AUCs between RFR and QFR.Conclusions RFR and QFR demonstrate substantial consistency with FFR,displaying essentially equivalent diagnostic concordance rates with FFR.The impact of gender and target lesions on the diagnostic accuracy of the two methods is minimal.

关 键 词：静息全周期比值 血流储备分数 定量血流分数 

分 类 号：R541[医药卫生—心血管疾病]