基于心肌缺血危险因素的冠状动脉CTA和CT-FFR诊断价值的探讨

Diagnostic value of coronary artery CTA and CT-FFR based on risk factors of myocardial ischemia

目的:探讨基于心肌缺血危险因素的冠状动脉CT血管造影(CT angiography,CTA)和CT-FFR诊断价值。方法:选取2021年5月—9月在苏州大学附属第三医院接受冠状动脉CT血管造影检查的患者126例,并进行CT-FFR测量。测量病变血管的斑块总体积、钙化斑块体积、非钙化斑块体积、斑块长度、钙化积分、最小管腔直径、最小管腔面积和管腔狭窄特征,并将患者按CT-FFR值分为心肌非缺血组(CT-FFR> 0.8)和缺血组(CT-FFR≤0.8)。比较两组的斑块特征,并采用Logistic回归分析探讨斑块特征与心肌缺血性病变之间的关系。结果:126例患者中有220支冠脉血流储备分数>0.8,176支冠脉血流储备分数≤0.8。两组间斑块总体积、钙化斑块体积、斑块长度、钙化积分、最小管腔直径、最小管腔面积、管腔狭窄差异均有统计学意义(Z=9.802、2.521、5.893、2.749、7.837、6.858,x2=13.87,P<0.05)。Logistic回归分析显示斑块总体积、钙化斑块体积、斑块长度、钙化积分、最小管腔直径和管腔狭窄是心肌缺血的危险因素(OR=2.421、1.022、2.148、1.001、0.556、0.179,P<0.05)。结论:斑块总体积、钙化斑块体积、斑块长度、钙化积分、最小管腔直径和管腔狭窄是心肌缺血的预测因子。冠状动脉CTA结合CT-FFR能进一步提高心肌缺血的诊断。

Objective To explore the diagnostic value of coronary artery computed tomography angiography(CTA) and CT fractional flow reserve(CT-FFR) based on the risk factors of myocardial ischemia.Methods From May to September 2021,126patients who underwent coronary CT angiography in the Third Affiliated Hospital of Soochow University were selected,and measure the CT-FFR.The total plaque volume,calcified plaque volume,non calcified plaque volume,plaque length,calcification score,minimum lumen diameter,minimum lumen area and lumen stenosis characteristics of diseased vessels were measured,and patients were divided into myocardial non ischemic group(CT-FFR>0.8) and ischemic group(CT-FTR ≤0.8) according to CT-FFR value.The plaque characteristics of the two groups were compared,and the relationship between plaque characteristics and myocardial ischemic lesions was discussed by logistic regression analysis.Results 220 coronary blood flow reserve fractions>0.8 in 226 patients,176 coronary flow reserve scores ≤8.The total plaque volume,calcified plaque volume,plaque length,calcification score,minimum lumen diameter,minimum lumen area,and lumen stenosis between the two groups were statistically significant(Z=9.802,2.521,5.893,2.749,7.837,6.858,χ~2=13.87,P <0.05).Logistic regression analysis showed that total plaque volume,calcified plaque volume,plaque length,calcification score,minimum lumen diameter and lumen stenosis were risk factors for myocardial ischemia(OR=2.421,1.022,2.148,1.001,0.556,0.179,P <0.05).Conclusion Total plaque volume,calcified plaque volume,plaque length,calcification score,minimum lumen diameter and lumen stenosis were predictive factors of myocardial ischemia.Coronary CTA combined with CT-FFR can further improve the diagnosis of myocardial ischemia.