定量血流分数对冠状动脉血流动力学的评估价值

Evaluation value of quantitative flow ratio on coronary hemodynamics

目的探讨在血流储备分数(fractional flow reserve,FFR)≤0.80时定量血流分数(quantitative flow ratio,QFR)评估冠状动脉血流动力学的准确性。方法回顾性分析2017年1月12日至2018年3月7日期间在广东省人民医院因怀疑冠状动脉粥样硬化性心脏病(冠心病)而进行冠状动脉造影检查的患者的临床资料,调取出已经进行FFR检查的患者52例,分析人员在盲法下分析血管的QFR与定量冠状动脉造影(quantitative coro⁃nary angiography,QCA)的数值。采用Clopper-Pearson计算QFR与FFR的相关性;以FFR为“金标准”,计算QFR与QCA的诊断准确率、敏感性、特异性、阳性预测值、阴性预测值。使用SPSS软件,绘制受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积,探讨QFR在冠状动脉血流动力学方面的临床价值。结果共有52例患者(52条血管)入选了本研究,以FFR的数据为“金标准”,QFR的同阴性和同阳性诊断准确率明显高于QCA,差异有统计学意义[83.3%(95%CI:72.2~92.6)vs.61.1%(95%CI:48.1~74.1),P=0.005]。QFR的敏感性和特异性均高于QCA,差异有统计学意义(敏感性:85.7%vs.57.1%,P<0.05;特异性:87.5%vs.67.7%,P<0.05)。QFR的阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为81.8%、90.0%、6.86和0.16;QCA的阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为54.5%、70.0%、1.77和0.63。QFR的ROC曲线下面积大于QCA(66.8 vs.47.2),提示QFR的诊断效能比QCA更高。Clopper-Pearson计算QFR与FFR之间的相关系数是0.79(P<0.01)。结论QFR和FFR在诊断冠状动脉血流动力学之间有很好的相关性,QFR对冠状动脉狭窄的诊断准确性高于QCA,在冠状动脉血流动力学诊断方面具有临床应用价值。

Objectives To evaluated the accuracy of quantitative flow ratio(QFR)in diagnosing coronary hemodynamics when fractional flow reserve(FFR)is less than 0.80.Methods The clinical data of patients who received coronary angiography for suspected coronary atherosclerotic heart disease from 12th January 2017 to 7th March 2018 in Guangdong Provincial People′s Hospital were retrospectively analyzed.Among them,52 patients who underwent FFR were retrospectively analyzed in this study.The QFR and QCA values of vessels were analyzed blindly.Clopper-Pearson was used to analyze the correlation between QFR and FFR.With FFR as the gold standard,we analyzed the diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value of QFR and QCA.SPSS software was used in this research.Receiver operating characteristic(ROC)curve was drawn and the area under the ROC curve was used to evaluate the QFR in diagnosing coronary hemodynamics.Results Fifty-two patients(52 vessels)were enrolled in this study.With FFR as the gold standard,the diagnostic accuracy of QFR was significantly higher than QCA[83.3%(95%CI:72.2-92.6)vs.61.1%(95%CI:48.1-74.1),P=0.005].The sensitivity and specificity of QFR were also higher than QCA(sensitivity:85.7%vs.57.1%,specificity:87.5%vs.67.7%).The positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of QFR were 81.8%,90.0%,6.86 and 0.16,respectively.The positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of QCA were 54.5%,70.0%,1.77 and 0.63,respectively.Clopper-Pearson showed that the correlation coefficient between QFR and FFR was 0.79(P<0.0001).The area under the ROC curve of QFR was larger than that of QCA(66.8 vs.47.2).Conclusions QFR is closer to the accuracy of FFR in diagnosis of coronary hemodynamics.The diagnostic accuracy of QFR in coronary stenosis is higher than that of QCA,which has clinical diagnostic value.