计算机断层摄影术冠状动脉造影对血流储备的评价

Evaluation of Fractional Flow Reserve Determined by CT Coronary Angiography in Relevant Patients

目的：计算机断层摄影术冠状动脉（冠脉）造影（CTA）评价血流储备的准确性及临床应用价值。方法：回顾性分析2013-10至2015-10于第四军医大学唐都医院、陕西省人民医院住院患者43例,男29例（67.4%）,平均年龄（60.2±10.1）岁。入选患者均在冠脉造影术前1周内行CTA检查,两项检查的间隔时间均为（5.4±1.6）d。选择冠脉临界病变（狭窄50%～70%）为靶血管,经导管压力导丝测定血流储备分数（FFR）,记录相关影像数据,计算CTA测定的血流储备分数（FFRCT）。结果：入选43例患者中共计48段冠脉为靶血管,以FFR为金标准,FFRCT诊断准确性83.3%,敏感性75.0%,特异性89.3%,阳性预测值83.3%,阴性预测值83.3%;与FFR呈显著相关（r=0.704,P〈0.001）;Bland-Altman分析显示95%一致界限为（-0.12～0.16）,95.8%（46/48）点落在一致性界限内,4.2%（2/48）点在95%一致性界限外,两者具有良好一致性;受试者工作特征曲线下面积0.871（95%可信区间：0.770～0.973）。结论：CTA能够准确评价血流储备,有望成为指导冠脉临界病变治疗策略选择的检查方法。

Objective： To evaluate the accuracy and clinical value of fractional lfow reserve （FFR） determined by CT coronary angiography （CTA） in relevant patients. Methods： A total of 43 patients treated in our hospitals from 2013-10 to 2015-10 were retrospectively studied. There were 29 （67.40%） with male gender, the average age was （60.2±10.1） years. The patients received CTA at 1 week prior coronary angiography （CAG）, the interval between CTA and CAG was （5.4±1.6） days. FFR was measured by both CAG and CTA （FFRCT） in selected target vessel which was deifned as maximal diameter reduction 50% to 70%. The imaging data were recorded and compared, FFRCT was calculated. Results： 48 vessels from 43 patients were eligible for analysis as target vessels. FFRCT vas evaluated based on the gold criteria of FFR. FFRCT had the diagnostic accuracy at 83.3%, sensitivity 75.0%, speciifcity 89.3% and positive predictive value was 83.3%, negative predictive value was 83.3% respectively. FFR and FFRCT showed obvious correlation （r=0.704,P〈0.001）; Bland-Altman analysis presented good concordance with 95% limits of agreement for FFRCTand FFR value ranged from -0.12 to 0.16, and 95.8% of the points （46/48） fell in the 95% limit of agreement, Receiver operating characteristic curve indicated that AUC of FFRCT was 0.871 （95% CI 0.770-0.973）. Conclusion： CTA could accurately assess FFR, and FFRCT might be used in guiding the treatment for patients with intermediate coronary stenosis in clinical practice.