血管内超声测定定量血流分数对临界病变冠状动脉介入手术策略的价值

The value of quantitative flow ratio determined by intravascular ultrasound for critical lesions coronary intervention strategy

目的结合血管内超声结果分析定量血流分数在评估冠状动脉中重度狭窄及介入手术策略的指导价值。方法回顾性收集2022年2—10月在北京安贞医院住院行冠状动脉造影(CA)和/或经皮冠状动脉介入治疗(PCI)并接受靶血管血管内超声检查(IVUS)的患者110例,基于IVUS结果定量测定靶血管最小管腔面积(MLA)和斑块负荷(PB)等参数。利用患者的冠状动脉造影图像数据,对接受治疗的靶病变血管计算定量血流分数(QFR)。以IVUS结果为依据,评价QFR对血管病变程度的诊断及对行介入手术策略的价值。结果筛选临界病变并行IVUS检查110例,其中IVUS图像伪影严重13例,血管严重迂曲18例,造影显示全程病变或图像质量不佳24例,最终共计入组患者55例、靶血管55支。以IVUS管腔面积≤3 mm^(2)或IVUS管腔面积≤4 mm^(2)并且IVUS斑块负荷≥70%,作为血管显著狭窄引起心肌缺血的诊断标准。患者QFR值为0.75±0.12,MLA为(3.32±0.74)mm^(2),PB为(70±9)%。QFR值≤0.800时与IVUS评价冠状动脉狭窄缺血的一致性良好(Kappa=0.656,P<0.01,95%CI 0.452~0.860)。QFR的敏感度为0.853,特异度为0.810,阳性预测值为87.9%,阴性预测值为77.3%;MLA和QFR值之间存在中度正相关关系(r=0.566,P<0.01)。PB和QFR值之间存在轻度负相关关系(r=-0.371,P<0.01)。结论QFR对冠脉临界病变狭窄治疗决策的指导具有良好的诊断意义。

Objective To analyze the value of quantitative flow ratio in the evaluation of moderate-to-severe coronary artery stenosis and the interventional strategy in conjunction with the results of intravascular ultrasound.Methods A total of 55 patients admitted to Beijing Anzhen Hospital for coronary angiography or percutaneous coronary intervention and intravascular ultrasound guidance were retrospectively collected.The minimum lumen area(MLA)and plaque burden(PB)measured by intravascular ultrasound were collected.The data of coronary angiography were used to calculate the quantitative flow Ratio of the treated target vessels.Based on intravascular ultrasound,to evaluate the value of quantitative flow ratio in the diagnosis of vascular disease and the guidance of interventional surgery strategy.Results 110 cases of critical lesions were screened and examined by IVUS,of which 13 cases had serious artifacts in IVUS images,18 cases had serious tortuous vessels,and 24 cases had full lesions or poor image quality,and 55 patients and 55 target vessels were enrolled in the final study.The diagnostic criteria for myocardial ischemia due to significant stenosis were IVUS lumen area≤3 mm^(2) or IVUS lumen area≤4 mm^(2) and IVUS plaque load≥70%.The QFR value of 0.75±0.12,MLA(3.32±0.74)mm^(2),and PB(70±9)%.QFR values≤0.80 were in good agreement with IVUS for evaluating coronary artery stenosis ischemia(Kappa=0.656,P<0.01,95%CI 0.452-0.860).The sensitivity of QFR was 0.853,specificity was 0.810,positive predictive value was 87.9%,negative predictive value was 77.3%;there was a moderate positive correlation between MLA and QFR values(r=0.566,P<0.01).There was a slight negative correlation between PB and QFR values(r=-0.371,P<0.01).Conclusions QFR has good diagnostic significance in guiding the treatment decision of coronary critical lesion stenosis.