CT-FFR参数联合斑块定量技术在心肌缺血再灌注损伤预测中的应用

Predictive value of CT-FFR combined with plaque quantification for reperfusion injury in patients with myocardial ischemia

目的:分析基于CT的血流储备分数(CT-FFR)联合斑块定量技术在心肌缺血患者再灌注损伤预测中的应用。方法:回顾性分析126例行择期经皮冠状动脉介入(PCI)治疗的冠心病(CHD)患者的临床资料,所有患者在PCI术前行冠状动脉CT血管成像检查,在PCI术后8 d内行心脏磁共振或光学相干断层成像判断再灌注损伤情况,将出现心肌微循环障碍(MVO)及(或)心肌内出血(IMH)者纳入再灌注损伤组,未出现MVO及IMH者纳入非再灌注损伤组。比较两组患者性别、年龄等基线资料及PCI术前CT-FFR值及斑块定量参数差异,利用受试者工作特征(ROC)曲线分析CT-FFR值及斑块定量参数对CHD患者再灌注损伤的预测价值。结果:再灌注损伤组多支血管病变率显著高于非再灌注损伤组(P<0.05),PCI后TIMI 3级率低于非再灌注损伤组(P<0.05)。两组最小管腔面积、钙化斑块体积、重构指数、偏心指数比较,差异无统计学意义(P>0.05);再灌注损伤组CT-FFR值低于非再灌注损伤组(P<0.05),狭窄程度、斑块长度、非钙化斑块体积及斑块总体积均高于非再灌注损伤组(P<0.05)。ROC曲线分析显示,CT-FFR值、狭窄程度、斑块长度、非钙化斑块体积、斑块总体积均对CHD患者再灌注损伤具有较高预测价值(AUC=0.758、0.943、0.865、0.928、0.891,P<0.05),其Cut-off值分别为0.671、75.44%、38.61 mm、186.08 mm3、305.04 mm3,且5项联合预测价值最高(AUC=0.999,P<0.05)。结论:CT-FFR及斑块定量参数对预测CHD患者再灌注损伤有积极作用,可为CHD临床诊疗提供参考。

Objective To analyze the value of CT-based fractional flow reserve(CT-FFR)combined with plaque quantification for predicting the reperfusion injury in patients with myocardial ischemia.Methods The clinical data of 126 patients with coronary heart disease(CHD)who were scheduled for percutaneous coronary intervention(PCI)were retrospectively analyzed.All patients underwent coronary CT angiography before PCI,and received cardiac magnetic resonance or optical coherence tomography within 8 d after PCI to assess the reperfusion injury.Those with myocardial microvascular obstruction(MVO)and/or intramyocardial hemorrhage(IMH)were included in reperfusion injury group,and those without MVO and IMH were enrolled as non-reperfusion injury group.The baseline data,such as gender,age,etc,and differences in CT-FFR and plaque quantitative parameters before PCI were compared between two groups.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CT-FFR and plaque quantitative parameters for reperfusion injury in CHD patients.Results The multivessel lesion rate in reperfusion injury group were significantly higher than that in non-reperfusion injury group(P<0.05),while the rate of TIMI grade 3 flow after PCI was lower than that in non-reperfusion injury group(P<0.05).The differences between two groups in the minimum lumen area,calcified plaque volume,remodeling index and eccentricity index were trivial(P>0.05).Compared with non-reperfusion injury group,reperfusion injury group had lower CT-FFR,but higher degree of stenosis,longer plaque length,larger non-calcified plaque volume and total plaque volume(P<0.05).ROC curve analysis showed that CT-FFR,stenosis degree,plaque length,non-calcified plaque volume and total plaque volume had high predictive value for reperfusion injury in CHD patients(AUC=0.758,0.943,0.865,0.928,0.891;P<0.05),with the Cut-off values of 0.671,75.44%,38.61 mm,186.08 mm3,and 305.04 mm3,respectively,and the predictive value of the combination of the 5 items was the highest(AUC=0.999,P<0.05).Conclusion CT-FFR and plaque quantitative parameters play a role in predicting reperfusion injury in CHD patients,and can provide a reference for the clinical diagnosis and treatment of CHD.