基于冠状动脉CT血流储备分数预测冠心病价值的研究

Predictive value of coronary computed tomography-derived fractional flow reserve for coronary artery disease

目的 探究冠状动脉CT血流储备分数(fractional flow reserve derived from coronary computed tomography, FFR_(CT))对冠心病的预测价值。方法 回顾性连续收集2020年1月至2022年2月于苏北人民医院就诊的疑似冠心病患者136例共309支主要冠状动脉血管。患者已完成冠状动脉CT血管造影(coronary computed tomography angiography, CCTA)、FFR_(CT)和冠状动脉造影术(coronary angiography, CAG)检查。比较CCTA和FFR_(CT)对309支冠状动脉主要血管狭窄诊断的准确性、阳性预测值、阴性预测值、敏感性、特异性;采用一致性检验分析FFR_(CT)与CAG的相关性;影像科医师对其中156支血管测量影像学参数,记录并分析最窄管腔直径、狭窄斑块长度、直径狭窄率、面积狭窄率、狭窄管腔面积与斑块性质。将冠状动脉血管狭窄≥50%的98支血管列入冠心病组,<50%排除缺血性狭窄的58支血管列入非冠心病组。用logistic回归分析156支血管的相关参数与冠心病的关系;用ROC曲线分析各参数的单独及联合诊断冠心病的价值。结果 FFR_(CT)诊断冠心病的准确性高于CCTA(P<0.01)。Kappa一致性分析显示,FFR_(CT)诊断结果与CAG诊断结果的Kappa值为0.620,具有较高的一致性(P<0.01)。冠心病组管腔最窄直径、FFR_(CT)明显小于非冠心病组,狭窄斑块长度、直径狭窄率、面积狭窄率明显大于非冠心病组(P<0.01)。多因素logistic回归分析显示,管腔最窄直径(OR=0.536,95%CI:0.335~0.858)、狭窄斑块长度(OR=1.109,95%CI:1.054~1.166)、FFR_(CT)≤0.80(OR=0.204,95%CI:0.078~0.532)是预测冠心病的独立影响因素(P<0.01)。ROC曲线显示,管腔最窄直径、狭窄斑块长度、FFR_(CT)≤0.80三者联合诊断冠心病的曲线下面积为0.853(0.795~0.918)。结论 FFR_(CT)相较CCTA诊断冠心病具有较高的价值,FFR_(CT)≤0.8、管腔最窄直径、狭窄斑块长度三者联合诊断能进一步提高诊断冠心病的准确性。

Objective To explore the predictive value of the fractional flow reserve derived from coronary computed tomography(FFR_(CT)) in CAD.Methods Clinical data of 136 patients(309 major coronary vessels) with suspected CAD consecutively attending to Northern Jiangsu People's Hospital from January 2020 to February 2022 were collected and retrospectively analyzed.Coronary computed tomography angiography(CCTA) and coronary angiography(CAG) data and FFR_(CT) were collected.The accuracy, positive predictive value, negative predictive value, sensitivity and specificity of CCTA and FFR_(CT) for the diagnosis of stenosis in 309 major coronary arteries were compared;the correlation between FFR_(CT) and CAG was analyzed using the consistency test.Imaging parameters of 156 vessels were analyzed by senior radiologists for smallest luminal diameter, stenotic plaque length, stenotic diameter rate, stenotic area rate, stenotic lumen area and plaque properties.The 98 vessels with ≥50% coronary stenosis were assigned into the coronary group, and the 58 vessels with <50% ischaemic stenosis were into the non-coronary group.Logistic regression was used to analyze the relationship between the vessel parameters of 156 vessels and coronary heart disease(CHD);ROC curve was plotted to analyze the value of each parameter and their combination for the diagnosis of CHD.Results The diagnostic efficacy of FFR_(CT) was more accurate than that of CCTA for CAD(P<0.01),and the Kappa agreement analysis showed that the Kappa value of the diagnostic results of FFR_(CT) and CAG was 0.620,indicating high agreement(P<0.01).Lower smallest luminal diameter, lower FFR_(CT),longer stenotic plaque length, and higher diameter stenosis rate and area stenosis rate were observed in the coronary group than the non-coronary group(P<0.01).Multivariate logistic regression analysis showed that smallest luminal diameter(OR=0.536,95%CI:0.335-0.858),stenotic plaque length(OR=1.109,95%CI:1.054-1.166),and FFR_(CT) ≤0.80(OR=0.204,95%CI:0.078-0.532) were independent influencing factors in predicting CAD(P<0.01).ROC curve analysis revealed that the AUC value of combined smallest luminal diameter, stenotic plaque length, and FFR_(CT) ≤0.80 together in diagnosis of CAD was 0.853(0.795-0.918).Conclusion FFR_(CT) has a higher diagnostic value for CAD than CCTA,and the combined diagnosis of FFR_(CT) ≤0.80,smallest luminal diameter, and stenotic plaque length can further improve the accuracy of the diagnosis of CAD.