光学相干断层扫描定量血流分数预测冠状动脉支架植入后靶血管功能学的可行性

Feasibility of Residual Optical Coherence Tomography Quantitative Flow Frac⁃tion in Predicting Target Vessel Function after Stent Implantation

目的探讨基于光学相干断层扫描(optical coherence tomography,OCT)定量血流分数(quantitative flow ratio,QFR)——光学血流分数(optical flow ratio,OFR)中的虚拟支架植入技术预估经皮冠状动脉支架植入后血管功能学的可行性。方法本研究纳入广东省人民医院2019年6月至2022年2月期间因疑似冠状动脉粥样硬化性心脏病(冠心病)行冠状动脉造影术与OCT探查术且成功植入支架的患者,应用OFR系统衍生的虚拟支架仿真植入技术计算其血管残余OFR值,后与支架植入术后基于Murray定律的QFR(Murray law based quantitative flow ratio,μQFR)进行比较,通过Spearman相关系数反映相关性。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under curve,AUC),同时可得出残余OFR预测经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后μQFR≤0.89的准确度、敏感度、特异度、阳性预测值、阴性预测值。结果共有139例患者(141支血管)入选本研究。所有血管行PCI治疗前采用虚拟支架技术计算的残余OFR为0.96±0.37,支架术后血管的μQFR为0.97±0.36,两者比较差异无统计学意义(P=0.235),残余OFR与PCI治疗后的μQFR具有高度相关性(r=0.82,95%CI:0.74~0.88,P<0.001)和良好的一致性(平均差异=0.00;P=0.236);残余OFR预测PCI治疗后的次优结果(μQFR≤0.89)的准确度、敏感度、特异度、阳性预测值和阴性预测值分别为96.45%、66.67%、98.49%、75.00%、97.74%,AUC为0.96(95%CI:0.92~1.0)。结论残余OFR与术后μQFR高度相关,OFR虚拟支架植入技术及其衍生的残余OFR可有效预测PCI治疗后血管的功能学水平,有助于术者科学地选择血管兴趣段植入支架,进而优化手术策略、改善患者预后。

Objectives To explore the feasibility of predicting the functional status of coronary arteries after percutaneous coronary intervention(PCI)using virtual stent implantation technology from optical flow ratio(OFR),which based on optical coherence tomography(OCT).Methods The study enrolled patients who underwent coronary angiography and OCT examination in Guangdong Provincial People's Hospital between June 2019 and February 2022,and all the patients successfully underwent stent implantation.The virtual stent simulation implantation technology derived from the OFR system was used to calculate the residual OFR of vessels,which was then compared with the quantitative flow ratio(QFR)based on Murray's law after stent implantation.The Spearman correlation coefficient was used to reflect the correlations.The receiver operating characteristic curve(ROC)was plotted,and the area under the curve(AUC)was calculated.At the same time,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of residual OFR in predicting PCI postoperative OFR≤0.89 were obtained.Results A total of 139 patients(141 vessels)were enrolled in this study.Before all vessels underwent PCI,virtual stent technology was used to calculate the residual OFR,with an average value of 0.96±0.37.The average OFR value of vessels after stent placement was 0.97±0.36,which was not significantly different from that before stent placement(P=0.235).The residual OFR was highly correlated with the OFR after PCI(r=0.82,95%CI:0.74-0.88,P<0.001)and showed good consistency(mean difference=0.00;P=0.236).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of residual OFR in predicting the suboptimal result(OFR≤0.89)after PCI were 96.45%,66.67%,98.49%,75.00%,and 97.74%,respectively,and the AUC was 0.96(95%CI:0.92-1.0).Conclusions The residual OFR was highly correlated with the postoperative OFR,and the OFR virtual stent implantation technology and its derived residual OFR can effectively predict the functional status of coronary arteries after PCI,which helps surgeons scientifically select vascular segments for stent implantation and optimize PCI strategies to improve the outcomes.