基于冠状动脉CT血管造影的血流储备分数对高原高海拔环境下冠心病的诊断价值

Diagnostic Value of Fractional Flow Reserve Based on Coronary CT Angiography for Coronary Heart Disease in High Altitude Environment of Plateau

目的:探讨冠状动脉CT血管造影(CCTA)的血流储备分数(FFR)对高原高海拔环境下冠心病的诊断价值。方法:选择2022年1月至2023年5月期间在青海省心脑血管病专科医院接受CCTA检查并行导丝测量FFR的患者54例为研究对象。采用Flash双源螺旋CT采集数据,基于CCTA图像通过流体力学原理模拟计算基于CCTA的FFR(CT-FFR)。以FFR为金标准,分析CT-FFR诊断冠心病和冠脉血管病变的阳性预测值和阴性预测值、敏感度、准确性、特异度,采用受试者工作特征(ROC)曲线分析CT-FFR对冠心病和冠脉血管病变的诊断效能;采用Bland-Altman图分析CT-FFR与FFR的一致性。结果:CT-FFR诊断冠心病的阳性预测值为73.08%,阴性预测值为89.29%,敏感度为86.36%,准确性为81.48%,特异度为78.13%;CT-FFR诊断冠心病的曲线下面积(AUC)为0.854,95%CI为0.747~0.962;CT-FFR诊断冠状动脉血管病变的阳性预测值为71.05%,阴性预测值为91.84%,敏感度为87.10%,准确性为82.76%,特异度为80.36%;CT-FFR诊断冠脉血管病变的AUC为0.921,95%CI为0.865~0.978。无论是诊断冠心病还是诊断冠状动脉血管病变,CT-FFR与FFR具有良好的一致性。结论:CT-FFR诊断高原海拔环境下的冠心病具有较高的准确性和敏感度,检测效能较理想,与FFR具有良好的一致性。

Objective:To investigate the diagnostic value of fractional flow reserve(FFR)of coronary CT angiography(CCTA)in coronary heart disease(CHD)in high altitude environment of plateau.Methods:54 patients who underwent CCTA examination and guidewire measurement of FFR in Qinghai Provincial Cardiovascular and Cerebrovascular Disease Specialized Hospital from January 2022 to May 2023 were selected as the research objects.The data were collected by Flash dual-source spiral CT,CCTA-based FFR(CT-FFR)was simulated calculation by fluid mechanics principle based on CCTA images.FFR as the gold standard,positive predictive value,negative predictive value,sensitivity,accuracy and specificity of CT-FFR in the diagnosis of coronary heart disease and coronary artery lesions were analyzed,the diagnostic efficacy of CT-FFR in coronary heart disease and coronary artery lesions were analyzed by receiver operating characteristic(ROC)curve.The consistency between CT-FFR and FFR were analyzed by Bland-Altman plot.Results:The positive predictive value of CT-FFR in the diagnosis of coronary heart disease was 73.08%,negative predictive value was 89.29%,sensitivity was 86.36%,accuracy was 81.48%,sensitivity was 78.13%.The area under the curve(AUC)of CT-FFR in the diagnosis of coronary heart disease was 0.854,and 95%CI was 0.747~0.962.The positive predictive value of CT-FFR in the diagnosis of coronary artery lesions was 71.05%,negative predictive value was 91.84%,sensitivity was 87.10%,accuracy was 82.76%,sensitivity was 80.36%.The AUC of CT-FFR in the diagnosis of coronary artery lesions was 0.921,and 95%CI was 0.865~0.978.Whether the diagnosis of coronary heart disease or diagnosis of coronary artery lesions,CT-FFR and FFR had good consistency.Conclusion:CT-FFR has high accuracy and sensitivity in the diagnosis of coronary heart disease in high altitude environment,and the detection efficiency is ideal,which has good consistency with FFR.