基于冠状动脉CT血流储备分数探讨其诊断性能一阶交互作用的研究

A study on the first-order interaction of diagnostic performance of coronary CT angiography-derived fractional flow reserve

目的探讨图像质量、狭窄程度、钙化及其一阶交互作用对冠状动脉CT血流储备分数(CT-FFR)诊断性能的影响。方法对中国多中心回顾性CT-FFR横断面研究数据的再次分析。搜集了2015年5月至2019年10月东部战区总医院等11个医疗中心522名疑似或已知冠心病且行冠状动脉CT血管成像(CCTA)和有创性血流储备分数(FFR)检查的患者。平均年龄61.6(34.0~83.0)岁,71.8%(354/493)为男性。在CCTA图像上记录目标血管的主观图像质量评分,在病变水平对狭窄程度进行目测评估,记录每个病变的钙化弧度和钙化重塑指数(CRI)。计算并比较组内敏感度、特异度、准确度、阳性预测值(PPV)和阴性预测值(NPV)。采用方差分析对图像质量、狭窄程度与钙化情况的一阶交互效应进行分析。结果共纳入493例患者629个有FFR作为金标准的病变。CT-FFR总体的敏感度、特异度和准确度分别为80.4%、93.8%和88.6%。图像质量≥3分组的特异度(95.0% 比 87.3%,χ^(2)=4.11,P=0.043)、准确度(90.1% 比 81.9%,χ^(2)=6.22,P=0.013)和NPV(89.7% 比 80.9%,χ^(2)=4.25,P=0.039)均高于图像质量<3分组。病变的狭窄程度影响CT-FFR的敏感度、PPV和NPV;病变的钙化弧度影响CT-FFR的特异度(均P<0.05)。CRI<1组的特异度(95.8% 比 90.5%,χ^(2)=4.23,P=0.040)、准确度(91.0% 比 86.1%,χ^(2)=4.01,P=0.045)、NPV(91.1% 比 83.8%,χ^(2)=5.10,P=0.024)均高于CRI≥1组。在轻、重度狭窄程度、无钙化和CRI<1组,图像质量≥3分组的CT-FFR准确度均高于图像质量<3分组;中度狭窄程度组的CT-FFR准确度主要受CRI的影响,CRI<1组的CT-FFR准确度高于CRI≥1组(经过Bonferroni校正,组间均P<0.05)。结论图像质量、狭窄程度、钙化及其一阶交互作用均会对CT-FFR的诊断性能产生负性影响。

Objective To investigate the effect of image quality,degree of stenosis,calcification,and their first-order interactions on diagnostic performance of coronary computed tomography(CT)angiography-derived fractional flow reserve(CT-FFR).Methods This is a reanalysis of data from a multi-center retrospective cross-sectional study of CT-FFR in China.A total of 522 patients with suspected or known coronary heart disease[mean age:61.6(34.0-83.0)years,71.8%(354/493)were male]from 11 medical centers including the General Hospital of Eastern Theater Command from May 2015 to October 2019 were enrolled.All patients underwent coronary CT angiography(CCTA),CT-FFR,and invasive FFR examination.Subjective image quality scores of target vessels were recorded on CCTA images,and stenosis was visually assessed at the lesion level.Calcification arc and calcification remodeling index(CRI)were recorded for each lesion.Sensitivity,specificity,accuracy,positive predictive value(PPV),and negative predictive value(NPV)were compared.Two-way analysis of variance was used to analyze the first-order interaction effects of image quality,degree of stenosis,and calcification.Results A total of 493 patients with 629 lesions with invasive FFR as a reference were included in the study.The overall sensitivity,specificity,and accuracy of CT-FFR were 80.4%,93.8%,and 88.6%,respectively.The specificity(95.0%vs.87.3%,χ^(2)=4.11,P=0.043);accuracy(90.1%vs.81.9%,χ^(2)=6.22,P=0.013);and NPV(89.7%vs.80.9%,χ^(2)=4.25,P=0.039)of the group with image quality≥3 was higher than the group with image quality<3.The degree of stenosis affected the sensitivity,PPV,and NPV of CT-FFR and the calcification arc affected the specificity of CT-FFR(all P>0.05).The specificity(95.8%vs.90.5%,χ^(2)=4.23,P=0.040);accuracy(91.0%vs.86.1%,χ^(2)=4.01,P=0.045);and NPV(91.1%vs.83.8%,χ^(2)=5.10,P=0.024)of the group with CRI<1 were higher than that of the group with CRI≥1.In the subgroup of mild and severe stenosis,no calcification,and CRI<1,the accuracy of CT-FFR with image quality≥3 points were higher than that with image quality<3 points.The accuracy of CT-FFR in the moderate stenosis group was mainly affected by CRI;the accuracy of CT-FFR in the group with CRI<1 was higher than that in the group with CRI≥1(after Bonferroni correction,P values between groups were statistically significant).Conclusion Subjective image quality,degree of stenosis,calcification of lesions,and their first-order interactions can all negatively affect the diagnostic performance of CT-FFR.