FFR CT诊断冠心病的初步应用体会

目的初步探究基于CT血管成像的无创血流储备分数（FFR_CT）与传统有创血流储备分数（FFR）相比在冠心病病人心肌缺血诊断方面的应用价值。方法纳入2017年2月-12月于我院接受冠状动脉CT血管成像（CCTA）检查且后续1周内完成冠状动脉造影（ICA）及FFR检查的可疑或确诊冠心病的病人20例，其中男13例，女7例，平均年龄（64.72±8.01）岁。对病人CCTA影像采用简化一维cFFR软件进行FFR_CT值测定，以有创性FFR结果作为金标准，分析比较FFR_CT对冠心病病人心肌缺血诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度。绘制受试者操作特征（ROC）曲线，比较FFR_CT与CCTA的诊断准确性。采用Pearson相关性检验及Bland-Altman方法比较FFR_CT与FFR的诊断相关性及一致性。结果以病变为分析单位，FFR_CT与CCTA诊断敏感度、特异度、阳性预测值、阴性预测值、准确度分别为93.5%、86.2%、87.9%、92.6%、90.0%及83.9%、79.3%、82.1%、81.2%、81.7%。FFR_CT和CCTA的ROC曲线下面积分别为0.960及0.892。FFR_CT与FFR诊断一致性及相关性良好（r=0.973，P<0.001）。结论FFR_CT对于冠心病病人心肌缺血诊断具有良好的临床应用价值。

Preliminary experience of applying FFR CT derived from coronary computed tomography angiography in coronary artery disease

ObjectiveTopreliminarilyinvestigatethediagnosticperformanceofcomputedtomographyangiographyderivednoninvasivefractionalflowreserve(FFR_CT)formyocardialischemiainpatientswithcoronaryarterydisease(CAD)bycomparingtothatofinvasivefractionalflowreserve(FFR).MethodsTwentypatients(13male,7female;meanage64.72±8.01years)withsuspectedorknownCADunderwentcoronaryCTangiography(CCTA)andinvasiveFFRwithinoneweekafterCCTAduringFebruary2017toDecember2017inourhospital.UsinginvasiveFFRasthegoldenstandard,theFFR_CTvaluesweremeasuredby1DcFFRsoftware,andFFR_CTdiagnosticperformance(sensitivity,specificity,positivepredictivevalue,negativepredictivevalue,andaccuracy)wasassessedforCADpatientswithmyocardialischemia.Thereceiveroperatingcharacteristic(ROC)curvesofFFR_CTandCCTAwerecomparedforthediagnosticaccuracy.PearsoncorrelationandBland-AltmanconsistencywereusedforcomparingthediagnosticcorrelationandconsistencybetweenFFR_CTandFFR.ResultsOnaper-lesionbasis,fortheFFR_CT,thesensitivity,specificity,positivepredictivevalue,negativepredictivevalue,andaccuracywere93.5%,86.2%,87.9%,92.6%,and90.0%,respectively;andfortheCCTA,were83.9%,79.3%,82.1%,81.2%,and81.7%,respectively.TheareasundertheROCcurveofFFRCTandCCTAwere0.960and0.892,respectively.TheFFR_CTandFFRhadahighconsistencyandcorrelationintheischemiadiagnosis(r=0.973，P<0.001).ConclusionFFR_CThaspromisingdiagnosticvalueforCADpatientswithmyocardialischemia.