定量血流分数与血流储备分数诊断错配的影响因素研究

Research on influencing factors of diagnostic mismatch between quantitative flow ratio and fractional flowreserve

目的探讨定量血流分数(QFR)与血流储备分数(FFR)检查诊断错配的预测因素。方法回顾性选取2018年6月1日至2023年2月1日就诊于阜外华中心血管病医院行FFR检查的患者进行离线QFR分析,分别以0.80为临界值将符合纳入标准的337例患者分为四组:FFR(+)QFR(+)、FFR(+)QFR(-)、FFR(-)QFR(+)、FFR(-)QFR(-)。比较四组间基线数据、实验室及影像学检查,多因素logistic回归分析探究QFR和FFR诊断错配的预测因素。结果离线QFR和FFR功能分类的一致率为81.01%,273例病变分类一致,64例病变分类不一致。多因素logistic回归分析显示,FFR≤0.80时QFR错配预测因素为较小的直径狭窄百分比(DS%)(OR=0.837,95%CI 0.774~0.904,P<0.01)和较短的病变长度(LL)(OR=0.931,95%CI 0.893~0.971,P=0.001);FFR>0.80时QFR错配预测因素为较大的年龄(OR=1.055,95%CI 1.003~1.111,P=0.039)、较大的DS%(OR=1.240,95%CI 1.131~1.360,P<0.01)及较长的LL(OR=1.057,95%CI 1.025~1.090,P<0.01)。结论病变的DS%和LL是QFR与FFR诊断错配的重要预测因素。

Objective To explore the predictors of mismatch between quantitative flow ratio(QFR)and fractional flow reserve(FFR).Methods Patients admitted to Fuwai Central China Cardiovascular Hospital who underwent fractional flow reserve from June 1,2018 to February,2023 were retrospectively selected for off-line QFR analysis.With 0.80 as the cut-off value for myocardial ischemia,the lesions were divided into four groups:FFR(+)QFR(+)、FFR(+)QFR(-)、FFR(-)QFR(+)and FFR(-)QFR(-).The baseline data,laboratory and imaging examinations were compared among the four groups.Multivariate logistic regression was used to analyze the predictors of diagnosis mismatch between QFR and FFR.Results The concordance rate of functional classification between off-line QFR and FFR was 81.01%.273 lesions were concordant in lesion classification,while 64 lesions were discordant.Multivariate logistic regression analysis showed that the predictors of mismatch when FFR≤0.80 were a smaller percentage of diameter stenosis(DS%)(OR=0.837,95%CI 0.774-0.904,P<0.01)and shorter lesion length(LL)(OR=0.931,95%CI 0.893-0.971,P=0.001),whereas the predictors of mismatch when FFR>0.80 were the older age(OR=1.055,95%CI 1.003-1.111,P=0.039),larger DS%(OR=1.240,95%CI 1.131-1.360,P<0.01),and longer LL(OR=1.057,95%CI 1.025-1.090,P<0.01).Conclusion The DS%and LL are the important predictors of the mismatch between QFR and FFR.