定量血流分数评价左心室舒张功能不全患者心肌缺血的价值

Quantitative flow ratio in the evaluation of myocardial ischemia in patients with left ventricular diastolic dysfunction

目的探讨定量血流分数(quantitative flow ratio,QFR)在诊断左心室舒张功能不全患者心肌缺血的价值。方法纳入2017年1月至2018年12月间广东省人民医院心脏超声诊断为左心室舒张功能不全但收缩功能正常,同时行冠状动脉造影及血流储备分数(fractional flow reserve,FFR)检查的患者110例。根据FFR测量值分为心肌缺血组(FFR≤0.80,n=52)和对照组(FFR>0.80,n=58)。比较两组患者的临床资料,并分别用QFR与定量冠状动脉造影(quantitative coronary angiography,QCA)两种工具分析造影图像,绘制受试者工作曲线(receiver operating characteristic curve,ROC)并评价QFR的诊断效能。结果两组患者的临床资料比较,差异无统计学意义(P>0.05)。以FFR作为参考标准,QFR的诊断效能均明显高于QCA,其中准确率[83.6%(95%CI:75.5~89.5)vs. 59.1%(95%CI:49.7~67.8)]、敏感度[75.0%(95%CI:61.7~84.9)vs. 46.2%(95%CI:33.3~59.5)]、特异度[91.4%(95%CI:81.0~96.7)vs. 70.7%(95%CI:57.9~80.9)]、阳性预测值[88.6%(95%CI:75.6~95.5)vs.58.5%(95%CI:43.4~72.3)]及阴性预测值[80.3%(95%CI:69.0~88.3)vs. 59.4%(95%CI:47.6~70.2)]比较,差异均有统计学意义(P<0.01)。QFR与QCA的阳性似然比分别为8.721 vs. 1.577,阴性似然比分别为0.274 vs.0.761。QFR与QCA诊断心肌缺血的ROC的曲线下面积分别为0.94(95%CI:0.88~0.98)和0.67(95%CI:0.58~0.76)(Z=5.167,P<0.0001)。结论 QFR比QCA能更灵敏、早期识别导致左心室舒张功能不全患者的心肌缺血情况,在指导治疗、改善患者预后方面具有重要临床意义。

Objectives To explore the value of quantitative flow ratio(QFR)in the diagnosis of myocardial ischemia in patients with left ventricular diastolic dysfunction.Methods Totally 110 patients with left ventricular diastolic dysfunction but normal systolic function diagnosed by echocardiography from January 2017 to December 2018 in Guangdong Provincial People′s Hospital were enrolled.All the patients received coronary angiography and fractional flow reserve(FFR)examination.According to the FFR measurement,the patients were divided into myocardial ischemia group(FFR≤0.80,n=52)and control group(FFR>0.80,n=58).The clinical data of the two groups were compared.The angiography images were analyzed by QFR and quantitative coronary angiography(QCA).The diagnostic efficacy of QFR was evaluated by receiver operating characteristic curve(ROC).Results There was no significant difference of the clinical data between the two groups(P>0.05).The QFR diagnostic accuracy[83.6%(95%CI:75.5-89.5)vs.59.1%(95%CI:49.7-67.8)],sensitivity[75.0%(95%CI:61.7-84.9)vs.46.2%(95%CI:33.3-59.5)],pecificity[91.4%(95%CI:81.0-96.7)vs.70.7%(95%CI:57.9-80.9)],positive predictive value[88.6%(95%CI:75.6-95.5)vs.58.5%(95%CI:43.4-72.3)]and negative predictive value[80.3%(95%CI:69.0-88.3)vs.59.4%(95%CI:47.6-70.2)]were significantly higher than QCA(P<0.01).Positive likelihood ratio of QFR and QCA was 8.721 vs.1.577,and negative likelihood ratio was 0.274 vs.0.761,respectively.The area under the ROC for QFR and QCA diagnozing myocardial ischemia was 0.94(95%CI:0.88-0.98)and 0.67(95%CI:0.58-0.76),respectively(Z=5.167,P<0.0001).Conclusions QFR is more sensitive than QCA to identify patients left ventricular diastolic dysfunction associated with myocardial ischemia at an early stage,which is of great significance in guiding the treatment and improving the prognosis of patients.