心脏超声与心肌血流储备分数诊断冠心病心肌缺血的价值

The value of echocardiography and FFR in diagnosing myocardial ischemia in coronary heart disease

目的探讨心脏超声节段性室壁运动异常与心肌血流储备分数(fraction flow reserve,FFR)诊断冠心病心肌缺血的临床应用价值。方法回顾性选取95例疑似冠心病心肌缺血患者的临床资料进行研究,经冠状动脉造影确诊为冠心病心肌缺血共52例;均予以心脏超声检查与FFR的检测,进一步分析对比两种检测指标的阳性预测值、阴性预测值、准确率、特异度、敏感度,分析其ROC曲线。结果95例疑似冠心病心肌缺血患者经心脏超声检查后其阳性预测值为81.63%,阴性预测值为73.91%;低于金标准(P<0.05);经FFR检测后其阳性预测值为96.15%,阴性预测值为95.35%;与金标准相比差异无统计学意义(P>0.05)。FFR法的敏感度、特异度、准确度均高于心脏超声(P<0.05)。心脏超声检出前降支病变共15例(71.43%)、回旋支病变共12例(75.00%)、右冠状动脉病变共13例(86.67%);FFR检出前降支病变共20例(95.24%)、回旋支病变共15例(93.75%)、右冠状动脉病变共15例(100.00%);两种方法的总检出率比较,差异有统计学意义(P<0.05)。心脏超声节段性室壁运动异常的曲线下面积AUC值为(0.780,P<0.05);FFR的曲线下面积AUC值为(0.958,P<0.05)。结论心脏超声节段性室壁运动异常与FFR相比,后者预测价值更高,能为冠心病心肌缺血的诊断提供客观依据。

Objective To explore the clinical application value of segmental wall motion abnormalities and myocardial fraction flow reserve(FFR)in the diagnosis of myocardial ischemia in coronary heart disease(CHD).Methods The clinical data of 95 patients with suspected myocardial ischemia in CHD were retrospectively selected for study.A total of 52 patients were diagnosed with myocardial ischemia in CHD by coronary angiography;all received echocardiography and FFR was detected.The positive predictive value,negative predictive value,accuracy,specificity,and sensitivity of the two indicators were further analyzed and compared,and the receiver operating characteristic(ROC)curve was analyzed.Results The positive predictive value of 95 patients with suspected myocardial ischemia in CHD after echocardiography was 81.63%,and the negative predictive value was 73.91%,which was lower than the gold standard(P<0.05).The positive predictive value was 96.15%after FFR detection,and the negative predictive value was 95.35%,which was not significantly different,as compared with the gold standard(P>0.05).The sensitivity,specificity,and accuracy of FFR were higher than those of echocardiography(P<0.05).A total of 15 cases(71.43%)of anterior descending artery disease,12 cases(75.00%)of circumflex artery disease,and 13 cases(86.67%)of right coronary disease were detected by echocardiography.FFR detected a total of 20 cases of anterior descending artery disease(95.24%),15 cases of circumflex artery disease(93.75%),and 15 cases of right coronary disease(100.00%).The total detection rate of the two methods showed a significant difference(P<0.05).The area under the ROC curve(AUC)of segmental wall motion abnormalities by echocardiography was 0.780(P<0.05),and the AUC of FFR was 0.958(P<0.05).Conclusion Compared with FFR,segmental wall motion abnormalities by echocardiography have higher predictive value and can provide objective evidence for the diagnosis of myocardial ischemia in CHD.