无创CT血流储备分数对冠状动脉中度狭窄患者预后预测作用及相关因素分析

Predictive effect of CT derived fractional flow reserve on prognosis of patients with moderate coronary artery stenosis and analysis of related factors

目的:利用CT血流储备分数(CT-FFR)分析冠状动脉功能性缺血的相关因素,并分析相关因素对冠状动脉功能性缺血的诊断价值,探究CT-FFR <0.8对冠状动脉中度狭窄患者预后的预测作用。方法:纳入在保定市第一中心医院,行冠状动脉CT血管成像(CCTA)提示冠状动脉中度狭窄并行冠状动脉造影(ICA)的冠心病患者356例,计算其冠状动脉CT-FFR值。以CT-FFR <0.8视为冠状动脉存在功能性缺血界值分为两组。比较两组患者临床资料,通过多因素Logistic回归筛选CT-FFR <0.8的相关因素,利用受试者工作特征(ROC)曲线评价多个相关因素联合对冠状动脉功能性缺血的诊断价值。进行随访,采用多因素Logistic回归分析CT-FFR <0.8与患者发生主要不良心血管事件(MACE)的相关性。结果:多因素Logistic回归分析表明,RDW升高、LAD病变、高同型半胱氨酸血症是冠状动脉功能性缺血的危险因素,HDL-C升高是冠状动脉功能性缺血的保护因素。利用ROC曲线分析联合多个相关因素对冠状动脉功能性缺血具有一定诊断价值。多因素Logistic回归分析表明,CT-FFR <0.8与患者发生MACE呈显著相关性,为MACE发生的危险因素。结论:对于CCTA中度狭窄患者,HDL-C降低、RDW升高、LAD病变、高同型半胱氨酸血症对冠状动脉功能性缺血有预测作用,且CT-FFR <0.8对冠状动脉中度狭窄患者MACE事件有重要预测作用。

Objective: To analyze the related factors of coronary artery functional ischemia by computed tomography fractional flow reserve(CT-FFR),and to analyze the diagnostic value of related factors for coronary artery functional ischemia, and explore the predictive effect of CT-FFR < 0.8 on the prognosis of patients with moderate coronary stenosis. Methods: 356 patients with coronary heart disease who underwent coronary CT angiography(CCTA) showed moderate coronary stenosis and underwent invasive coronary angiography(ICA) in Baoding NO.1 Central Hospital were included,calculate the CT-FFR value of coronary artery. CT-FFR < 0.8 was regarded as the functional ischemia threshold of coronary artery, which was divided into two groups.The clinical data of the two groups were compared,the related factors with CT-FFR < 0.8 were screened by multivariate logistic regression,using the receiver operating characteristic(ROC) curve to evaluate the diagnostic value of the combination of multiple related factors for coronary functional ischemia.follow up,multivariate logistic regression was used to analyze the correlation between CT-FFR<0.8 and major adverse cardiovascular events(MACE). Results: Multivariate logistic regression analysis showed that,elevated RDW,LAD lesions and Hyperhomocysteinemia are independent risk factors for coronary functional ischemia,HDL-C elevation is an independent protective factor of coronary functional ischemia.ROC curve analysis combined with multiple related factors has certain diagnostic value for coronary functional ischemia.Multivariate logistic regression analysis showed that CT-FFR < 0.8 was significantly correlated with MACE, which was an independent risk factor for MACE. Conclusions: For patients with moderate stenosis in CCTA,the decrease of HDL-C, the increase of RDW, LAD lesion and Hyperhomocysteinemia can independently predict the functional ischemia of coronary artery,CT-FFR < 0.8 has an important predictive effect on MACE events in patients with moderate coronary stenosis.