FFRCT联合斑块特征与心肌灌注显像对冠心病患者主要不良心脏事件预测效能的比较

Myocardial perfusion imaging versus FFRCTand atherosclerosis plaque characteristics in predicting major adverse cardiac events in patients with coronary artery disease

目的:比较冠脉CT血流储备分数(CT-fractional flow reserve,FFRCT)联合斑块特征与心肌灌注显像(myocardial perfusion imaging,MPI)对冠心病(coronary artery disease,CAD)患者主要不良心脏事件(major adverse cardiovascular events,MACE)的预测效能。方法:回顾性分析南京医科大学第一附属医院80例在3个月内完成CT血管成像(coronary computed tomography angiography,CCTA)及MPI并有完整随访资料的患者,测量FFRCT值及斑块定量特征值、总负荷积分、总积分差、相位标准差(standard deviation,SD)及相位直方图带宽(band width,BW)等影像参数,比较无事件组与事件组之间影像参数的差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线比较两种方法对MACE的预测效能。结果:11例发生MACE。与无事件组相比,事件组的FFRCT更低(P=0.009)、斑块更长(P=0.007)、非钙化斑块体积更大(P=0.026)、静息状态下舒张期SD及BW更低(P<0.05)。ROC曲线分析示,FFRCT及斑块长度对MACE的曲线下面积为0.80、0.81,SD及BW的曲线下面积为0.62、0.56。结论:FFRCT联合斑块特征对CAD患者发生MACE的预测效能优于MPI。

Objective:This study aims to analyze the predictive value of fractional flow reserve derived from coronary CTA(FFRCT) and plaque characteristics for major adverse cardiac events(MACE)in patients with coronary artery disease(CAD),and compare with myocardial perfusion imaging(MPI).Methods:Eighty patients with suspected CAD patients who underwent coronary CTA(CCTA)and MPI within 3 months were retrospectively enrolled and followed up.Measurement parameters included FFRCT,atherosclerosis plaque characteristics,summed stress score,summed difference score,phase standard deviation(SD),phase histogram bandwidth(BW).The differences of indicators were compared between positive MACE group and negative MACE groups.ROC curve analysis was performed to evaluate the predictive value of FFRCTcombined with plaque characteristics and MPI for MACE.Results:MACE occurred in 11 patients.FFRCT,rest diastole SD(RDSD)and rest diastole BW(RDBW)in positive MACE group were significantly lower than that in negative MACE group(all P<0.05).Plaque length and non-calcified volume in patients with MACE were significantly higher(all P<0.05).The AUC of FFRCTand plaque length for prediction of MACE was 0.80 and 0.81,while the predictive value of RDSD and RDBW was 0.62 and 0.56,respectively.Conclusion:FFRCT and plaque characteristics demonstrated a higher predictive value for MACE than phase analysis of MPI in CAD patients.