冠状动脉CT血流储备分数对血管内超声指导下冠状动脉临界病变预后的预测价值  

Predictive value of coronary CT fractional flow reserve for prognosis ofcoronary artery borderline lesions guided by intravascular ultrasound

作　　者：贾成高 谷凌云 徐卓文[2] 李伟章[2] 张华 JIA Chenggao;GU Lingyun;XU Zhuowen;LI Weizhang;ZHANG Hua(Jiangyin Clinical College of Xuzhou Medical University,Jiangyin,Jiangsu 214400,China;Department of Cardiology,Jiangyin People′s Hospital,Jiangyin,Jiangsu 214400)

机构地区：[1]徐州医科大学附属江阴临床学院,江苏江阴214400 [2]江阴市人民医院心内科,江苏江阴214400

出　　处：《徐州医科大学学报》2024年第12期905-911,共7页Journal of Xuzhou Medical University

基　　金：无锡市卫生健康委科研项目(Z202120)。

摘　　要：目的基于冠状动脉CT血流储备分数(CT-FFR),应用列线图构建用于评估血管内超声(IVUS)指导下冠状动脉临界病变患者预后的模型。方法纳入2017年12月—2023年1月在江阴市人民医院行冠状动脉CT血管成像检查和IVUS检查(检查相差时间不超过2周)的264例冠状动脉临界病变患者,收集临床资料进行单中心回顾性分析。按照7∶3的比例将患者随机分为训练集和验证集。采用Lasso回归分析及多因素logistic回归分析确定独立危险因素,并以此构建列线图预后模型,通过受试者工作特征(ROC)曲线下面积(AUC)、校准曲线和Hosmer-Lemeshow拟合优度检验、决策曲线分析(DCA)对列线图预后模型进行综合评估。结果经皮冠状动脉介入治疗、Gensini评分、CT-FFR、丙氨酸氨基转移酶、载脂蛋白A1是冠状动脉临界病变患者发生主要心血管不良事件(MACE)的独立危险因素(P<0.05)。训练集的AUC值为0.795(95%CI:0.728~0.863),验证集的AUC值为0.697(95%CI:0.579~0.815)。Hosmer-Lemeshow拟合优度检验结果显示该模型χ2=6.400,P=0.603,提示拟合良好。训练集、验证集的DCA曲线显示该列线图预后模型具有良好的临床实用性。结论基于CT-FFR的列线图预后模型为临床医生提供了个性化评估IVUS指导下冠状动脉临界病变患者预后的工具。Objective To develop a nomogram for evaluating the prognosis of patients with coronary artery borderline lesions guided by intravascular ultrasound(IVUS),based on coronary CT fractional flow reserve(CT-FFR).Methods A total of 264 patients with coronary artery borderline lesions,who underwent coronary CT angiography and IVUS(with an interval of less than two weeks)in Jiangyin People′s Hospital were enrolled and their clinical data were collected for retrospective analysis.The patients were randomly divided into a training set and a validation set at a ratio of 7∶3.Independent risk factors were screened through Lasso regression and multivariate logistic regression analysis,which were then used to construct a prognostic nomogram.The nomogram was comprehensively evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),calibration curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA).Results Percutaneous coronary intervention,Gensini score,CT-FFR,alanine aminotransferase,and apolipoprotein A1 were independent risk factors for major adverse cardiovascular events(MACE)in patients with coronary artery borderline lesions(P<0.05).The AUC value for the training set was 0.795(95%CI:0.728-0.863),while the AUC value for the validation set was 0.697(95%CI:0.579-0.815).The Hosmer-Lemeshow goodness-of-fit test showedχ2=6.400,P=0.603,indicating good calibration.The DCA curves for both the training and validation sets demonstrated good clinical utility of the nomogram. Conclusions The CT-FFR-basedprognostic nomogram provides clinicians with a personalized tool for evaluating the prognosis of patients with coronaryartery borderline lesions guided by IVUS.

关 键 词：冠状动脉临界病变 冠状动脉CT血流储备分数 预后模型 列线图 主要心血管不良事件 冠状动脉粥样硬化性心脏病 

分 类 号：R543.3[医药卫生—心血管疾病]