基于冠状动脉CT造影的无创血流储备分数在冠心病诊断中应用的初探

Noninvasive fractional flow reserve from coronary computed tomography angiography in coronary disease:a preliminary clinical study

目的:以有创血流储备分数(FFR)为金标准,初步探讨我国自主研发的无创血流储备分数(FFRct)检测技术在冠心病诊断中应用的价值。方法:入选于我院行冠状动脉CT造影(CCTA)及有创FFR检查的已知或疑似冠心病患者9例。通过传统CCTA图像,应用计算机流体力学获得FFRct值后,进一步分析该检测技术的敏感性、特异性、准确性和κ值,并检验FFRct与有创FFR测定值的相关性。结果:纳入9例患者,共计12支病变血管。以患者数目和血管支数为单位,FFRct的敏感性、特异性、准确性及κ值分别为87.5%、100.0%、88.9%、0.61和66.7%、100.0%、75.0%、0.50。FFRct与有创FFR测定值的相关系数分别为患者(r=0.671,P<0.05)和血管(r=0.734,P<0.05),经FFRct技术计算的血流压力值稍高于FFR实测值的平均差值[(0.04±0.06),P<0.05],二者间具有较好的相关性和一致性。结论:本研究以我国自主研发的FFRct检测平台为基础,初步证实了FFRct作为一种新的无创诊疗技术,能够识别冠状动脉缺血病变,具有良好的临床应用前景。

Objective： To preliminarily evaluate the China＇s domestically developed noninvasive fractional flow reserve（ FFRct） from coronary computed tomography angiography（ CCTA） in patients with coronary artery disease（ CAD）. Methods： Nine patients with known or suspected CAD were enrolled in our study. Invasive coronary angiography with fractional flow reserve（ FFR） and CCTA were performed in these patients.Computation of FFRct was derived from CCTA data,using computational fluid dynamics algorithm by our local workstation. Sensitivity,specificity accuracy and κ value of FFRct was calculated with invasive FFR as the reference standard. Results： FFR and FFRct were applied for targeted lesion,including 7 cases of left anterior descending,2 cases of left circumflex and 3 cases of right coronary artery. Of the 9 patients and 12 vessels,the sensitivity,specificity,accuracy,and κ value of FFRct were 87. 5% 、100. 0% 、88. 9% 、0. 61,respectively,on a per-vessel basis and were 66. 7% 、100. 0% 、75. 0% 、0. 50,respectively,on a per-patient basis. There was a good correlation of patient-and vessel-based FFRct values with FFR values（ r = 0. 671,P〈0. 05; r = 0. 734,P〈0. 001）,with a slight overestimation of FFRct as compared with measured FFR（ mean difference 0. 04 ±0. 06,P〈0. 05）. Conclusion： With the use of domestically developed software platform,FFRct was proved to be a novel method for evaluating functional severity of coronary stenosis. Future large-scale studies focusing on the diagnostic accuracy of local FFRct is warranted.