基于三维定量分析对可获得分叉最佳投照角度和分叉介入角度的研究

Assessment of obtainable bifurcation optimal viewing angles and intervention viewing angles by three-dimensional quantitative coronary angiography

目的评估可获得最佳投照角度的临床价值,用三维定量分析的方法评估可获得分叉最佳投照角度和临床分叉介入角度的差异性。方法该回顾性研究共纳入76例患者85个分叉病变,其中53例接受了介入治疗。采用新型经验证的三维定量分析软件计算可获得分叉最佳投照角度,计算可获得分叉最佳投照角度和介入角度靶血管主支、边支短缩率,2位经验丰富的心脏介入医生以实际介入角度为参照对可获得投照角度的优越性予以评价,评价结果量化为-2~2共5个等级,同时对最常见的分叉病变的可获得最佳投照角度和介入角度的分布特征给予分析。结果可获得分叉最佳投照角度与介入分叉角度相比,无论主支还是边支均有更少的短缩率[分别为(4.84±3.08)%比(12.55±7.00)%,(5.80±3.10)%比(12.59±7.04)%,均P<0.001]。可获得分叉病变最佳投照角度优于实际介入投照角度。可获得分叉最佳投照角度相对分散,而实际分叉介入角度相对集中,47.2%可获得分叉最佳投照角度不同于解剖意义分叉最佳投照角度。结论可获得分叉最佳投照角度主支、边支短缩率均小于实际介入角度,约一半的可获得分叉最佳投照角度不同于解剖意义上最佳投照角度,当解剖意义上最佳投照角度无法达到时,可获得最佳投照角度可作为第2最佳选择。

Objective To assess clinical approval of obtainable bifurcation optimal viewing angles（OBOVA）and the difference between OBOVA and bifurcation intervention viewing angles（BIVA）in real world by three-dimensional quantitative coronary angiography（3DQCA）. Methods A total of 85 bifurcations in this retrospective study were evaluated,in which 53 bifurcations underwent interventional therapy. A validated 3D QCA software package was applied to calculate OBOVA. The percentages of foreshortening for OBOVA and BIVA were calculated respectively. Two experienced interventional cardiologists evaluated the success of OBOVA with respect to BIVA using grade. Distribution characteristics of OBOVA and BIVA for main bifurcations were analyzed respectively. Results The percentage of foreshortening for OBOVA was less than BIVA：（4.84±3.08）% vs（12.55±7.00）%（P〈0.001）in main branch,（5.80±3.10）% vs（12.59±7.04）%（P〈0.001）in side branch. The average score for evaluating the success of OBOVA with respect to BIVA was 1.46±0.54（P〈0.001）. OBOVA distributed sparsely with large ranges of variance while BIVA distributed with relatively concentration. OBVOA in 47.2% of the cases was different from anatomy-defined bifurcation optimal viewing angle（ABOVA）. Conclusion Interventional cardiologist preferred OBOVA over BIVA. The percentage of foreshortening for OBOVA was less than BIVA in main branches as well as side branches.Nearly half of OBVOA was different from ABVOA and had to consider another obtainable optimal viewing angle as an alternative option.