基于Revolution CT的冠状动脉血管成像联合血流储备分数评估冠心病并发心力衰竭患者NYHA心功能分级及预后的效果  

Evaluation of NYHA Heart Function Classification and Prognosis in Patients with Coronary Heart Disease and Heart Failure Based on Revolution CT Coronary Angiography Combined with Fractional Flow Reserve

作　　者：张维明 顾立君 张晗 陈玮刚 徐依强 ZHANG Weiming;GU Lijun;ZHANG Han;CHEN Weigang;XU Yiqiang(Department of Radiology,Qingdao Fuwai Cardiovascular Hospital,Qingdao,Shandong 266034,China)

机构地区：[1]青岛阜外心血管病医院放射科,山东青岛266034

出　　处：《岭南心血管病杂志》2023年第4期395-399,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探究基于Revolution计算机断层扫描(computed tomography,CT)的冠状动脉血管成像(coronary CT angiography,CCTA)联合血流储备分数(fractional flow reserve,FFR)对冠状动脉粥样硬化性心脏病(冠心病)并发心力衰竭患者纽约心脏协会(New York Heart Association,NYHA)心功能分级及预后的评估效果。方法采取回顾性分析方法,收集青岛阜外心血管病医院2021年4月至2022年4月收治的64例冠心病并发心力衰竭患者的病历资料,统计患者基于Revolution CT技术的CCTA联合FFR的检查结果,比较不同NYHA心功能分级患者CCTA定量系数和CT-FFR指标,并进行CCTA定量系数联合CT-FFR与NYHA心功能分级的相关性分析。随访发生主要心血管不良事件(major adverse cardiovascular events,MACE)的患者例数,对发生MACE的危险因素进行Cox多因素回归分析。得出单独FFR和单独CCTA检查以及联合检查的受试者工作特征曲线(receiver operating characteristic curve,ROC)-曲线下面积(area under the curve,AUC)。结果NYHA心功能分级Ⅲ级患者斑块数、血管体积、斑块体积、血管狭窄程度、斑块负荷、重建指数、CT-FFR值大于Ⅰ级患者,差异有统计学意义(P<0.05)。斑块数、血管体积、斑块体积、血管狭窄程度、斑块负荷、重建指数以及CT-FFR与NYHA心功能分级呈正相关(P<0.05)。MACE组患者CT-FFR≤0.80、重度狭窄的比例高于非MACE组,差异有统计学意义(P<0.05)。左心室射血分数、冠状动脉狭小程度及CT-FFR是发生MACE的独立危险因素;基于Revolution CT技术的CCTA联合FFR检查的ACU大于单独CCTA检查和FFR检查(P<0.05)。结论针对冠心病并发心力衰竭患者,基于Revolution CT技术的CCTA联合FFR对判断冠心病并发心力衰竭患者NYHA心功能分级和预后有较高价值。Objectives To explore the application effect of coronary computed tomography(CT)angiography(CCTA)combined with fractional flow reserve(FFR)based on Revolution CT technology in evaluating the New York Heart Association(NYHA)heart function classification and prognosis of patients with coronary heart disease complicated with heart failure.Methods A retrospective analysis was used to collect the medical records of 64 patients with coronary heart disease and heart failure who were admitted to Qingdao Fuwai Cardiovascular Hospital from April 2021 to April 2022,and the results of coronary angiography combined with FFR detection based on Revolution CT technology were collected.The CCTA quantitative coefficient and CT-FFR index of patients with different New York Heart Association(NYHA)heart function classification were compared,and the correlation analysis of CCTA quantitative coefficient com⁃bined with CT-FFR and NYHA heart function classification were conducted.The number of major adverse cardiovascular events(MACE)cases during follow-up was recorded,and Cox multivariate regression analysis was performed on the risk factors for the occurrence of MACE.The area under the curve(AUC)of receiver operating characteristic curve(ROC)for the FFR alone and CCTA alone and combined assays was derived.Results The plaque number,vessel volume,plaque volume,degree of stenosis,plaque load,reconstruction index and CT-FFR value of patients with NYHA heart function classification gradeⅢwere higher than those of patients with heart function classification gradeⅠ(P<0.05)Plaque volume,vascular stenosis degree,plaque load,reconstruction index and CT-FFR positively correlated with NYHA heart function classification(P<0.05).The proportions of CT-FFR≤0.80 and severe stenosis in MACE group were higher than those in non-MACE group(P<0.05).Left ventricular ejection fraction(LVEF),coronary stenosis and CT-FFR were independent risk factors for MACE.The ACU of CCTA combined with FFR based on Revolution CT technology was greater than that of CC

关 键 词：冠状动脉疾病 冠状动脉血管成像 血流储备分数 心力衰竭 

分 类 号：R541.4[医药卫生—心血管疾病] R445.3[医药卫生—内科学]