瞬时无波形比值与血流储备分数在稳定性冠心病心肌缺血诊断的一致性分析

Consistency analysis of instantaneous wave-free ratio and flow reserve fraction in the diagnosis of myocardial ischemia in stable coronary heart disease

目的评估瞬时无波形比值(iFR)与血流储备分数(FFR)在稳定性冠心病心肌缺血诊断效能的相关性、一致性及影响诊断一致性的因素。方法回顾性分析浙江医院2015年7月至2020年9月期间同时接受FFR及iFR检测的稳定性冠心病患者。收集患者的一般临床资料以及入院时的实验室指标,进行诊断性冠状动脉造影,对造影图像进行冠状动脉定量分析,随后进行冠状动脉生理学测量。采用Spearman相关性检验分析iFR与FFR之间的相关性。采用Bland-Altman分析检验iFR和FFR的诊断一致性。采用受试者工作特征(ROC)曲线分析iFR对FFR≤0.80预测价值,采用多因素Logistic回归进行iFR与FFR诊断不一致的影响因素分析。结果本研究共纳入了符合入排标准的稳定性冠心病患者109例,共120根血管进行回顾性分析。iFR和FFR的中位数分别为0.92(0.89,0.96);0.84(0.78,0.88),二者呈明显线性相关(r=0.772,P <0.01)。Bland-Altman分析显示,i FR与FFR具有良好的一致性,两者差值的平均值为(0.093±0.097)。根据ROC曲线分析,iFR预测FFR≤0.80的曲线下面积为0.913(P <0.01),诊断准确度、敏感度、特异度、阳性预测值、阴性预测值分别为86.7%、81.8%、88.5%、73.0%、92.8%。iFR与FFR诊断一致率为86.7%。多因素Logistic回归分析显示临床及病变特征等因素不是影响i FR和FFR诊断不一致的影响因素(P> 0.05)。结论 iFR和FFR具有良好的一致性,患者的临床及病变特征等因素可能对两者的诊断一致性不产生影响。

Objective To evaluate the correlation and consistency between instantaneous wave-free ratio(iFR) and fractional flow reserve(FFR) in the diagnosis of myocardial ischemia in patients with stable coronary heart disease and their factors. Methods Retrospective analysis of patients with stable coronary heart disease who received FFR and iFR detection in Zhejiang Hospital from July 2015 to September 2020. General clinical data and laboratory indicators of patients on admission were collected. Diagnostic coronary angiography was performed and quantitative analysis of coronary arteries was performed on the angiographic images, then coronary physiological measurements were also performed. Spearman correlation test was used to analyze the correlation between iFR and FFR.Bland-altman analysis was used to test the diagnostic consistency of iFR and FFR.The predictive value of iFR to FFR ≤ 0.80 was analyzed by ROC curve. Multivariate logistic regression was used to analyze the influencing factors of iFR and FFR diagnosis inconsistency. Results A total of 120 pairs of FFR and iFR data from 109 patients were collected. The median of iFR and FFR were 0.92(0.89, 0.96)and 0.84(0.78, 0.88) respectively. There was a significant linear correlation between them(r=0.772,P < 0.01). Bland-Altman analysisi for the i FR and FFR showed a good relativity, and the mean difference between them was(0.093± 0.097). ROC curve analysis showed that i FR predicted the area under the curve(AUC) of FFR ≤ 0.80 was 0.913, and the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 86.7%, 81.8%, 88.5%, 73.0% and 92.8% respectively. The diagnostic consistency was 86.7%. Multivariate logistic regression analysis showed that clinical and lesions features were not influence factors of the discordance between i FR and FFR(P > 0.05). Conclusion i FR and FFR have a great diagnostic consistency in evaluating myocardial ischemia in stable coronary heart diseases. Patients’ clinical and lesions features may have no influence on the discordance between i FR and FFR in this retrospective study.