FFR_(CT)诊断冠心病的初步应用体会

Preliminary experience of applying FFR_(CT) derived from coronary computed tomography angiography in coronary artery disease

目的初步探究基于CT血管成像的无创血流储备分数(FFR_(CT))与传统有创血流储备分数(FFR)相比在冠心病病人心肌缺血诊断方面的应用价值。方法纳入2017年2月—12月于我院接受冠状动脉CT血管成像(CCTA)检查且后续1周内完成冠状动脉造影(ICA)及FFR检查的可疑或确诊冠心病的病人20例,其中男13例,女7例,平均年龄(64.72±8.01)岁。对病人CCTA影像采用简化一维c FFR软件进行FFR_(CT)值测定,以有创性FFR结果作为金标准,分析比较FFR_(CT)对冠心病病人心肌缺血诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度。绘制受试者操作特征(ROC)曲线,比较FFR_(CT)与CCTA的诊断准确性。采用Pearson相关性检验及BlandAltman方法比较FFR_(CT)与FFR的诊断相关性及一致性。结果以病变为分析单位,FFR_(CT)与CCTA诊断敏感度、特异度、阳性预测值、阴性预测值、准确度分别为93.5%、86.2%、87.9%、92.6%、90.0%及83.9%、79.3%、82.1%、81.2%、81.7%。FFR_(CT)和CCTA的ROC曲线下面积分别为0.960及0.892。FFR_(CT)与FFR诊断一致性及相关性良好(r=0.973,P<0.001)。结论 FFR_(CT)对于冠心病病人心肌缺血诊断具有良好的临床应用价值。

Objective To preliminarily investigate the diagnostic performance of computed tomography angiography derived noninvasive fractional flow reserve（FFRCT） for myocardial ischemia in patients with coronary artery disease（CAD） by comparing to that of invasive fractional flow reserve（FFR）. Methods Twenty patients（13 male, 7 female; mean age 64.72±8.01 years） with suspected or known CAD underwent coronary CT angiography（CCTA） and invasive FFR within one week after CCTA during February 2017 to December 2017 in our hospital.Using invasive FFR as the golden standard, the FFRCT values were measured by 1 D c FFR software, and FFRCTdiagnostic performance（sensitivity, specificity, positive predictive value, negative predictive value, and accuracy） was assessed for CAD patients with myocardial ischemia. The receiver operating characteristic（ROC） curves of FFRCTand CCTA were compared for the diagnostic accuracy. Pearson correlation and Bland-Altman consistency were used for comparing the diagnostic correlation and consistency between FFRCTand FFR.Results On a per-lesion basis, for the FFRCT, the sensitivity, specificity, positive predictive value, negative predictive value,and accuracy were 93.5%, 86.2%, 87.9%, 92.6%, and 90.0%, respectively; and for the CCTA, were 83.9%, 79.3%, 82.1%,81.2%, and 81.7%, respectively. The areas under the ROC curve of FFRCTand CCTA were 0.960 and 0.892, respectively. The FFRCTand FFR had a high consistency and correlation in the ischemia diagnosis（r=0.973,P〈0.001）. Conclusion FFRCThas promising diagnostic value for CAD patients with myocardial ischemia.