钙化对FFR CT诊断冠状动脉疾病准确性影响的研究

目的研究钙化对冠状动脉CT血管成像(CCTA)测定的血流储备分数(FFR_(CT))诊断冠状动脉疾病准确性的影响。方法回顾性分析行CCTA检查和有创FFR检查的38例病人共50支血管的资料。用Agatston积分法测量50支血管的钙化积分值,以钙化积分值100为阈值,分为A1组(≤100)和A2组(100)。利用c FFR软件进行FFR_(CT)值测定,FFR及FFR_(CT)0.8定义为病变特异性心肌缺血。采用组内相关系数(ICC)计算总体及A1、A2组FFR_(CT)与FFR的一致性。以有创FFR作为参考标准,以血管为分析单位,分别计算总体及A1、A2两组FFR_(CT)的诊断准确度、敏感度、特异度、阳性预测值及阴性预测值,并采用Fisher确切概率法比较2组间的差异。结果总体FFR_(CT)和FFR的ICC系数为0.771(95%CI:0.597~0.870),A1组FFR_(CT)和FFR的ICC为0.819(95%CI:0.633~0.910),A2组FFR_(CT)和FFR的ICC为0.649(95%CI:0.032~0.873)。总体FFR_(CT)诊断敏感度、特异度、准确度、阳性预测值及阴性预测值分别为90.9%、97.4%、96.0%、90.9%、97.4%;A1组和A2组FFR_(CT)诊断敏感度、特异度、准确度、阳性预测值及阴性预测值分别为85.7%、100%、96.9%、100%、96.0%和100%、92.3%、94.1%、80.0%、100%;A1和A2组间诊断效能各指标的差异均无统计学意义(均P0.05)。结论 FFR_(CT)与FFR在冠状动脉狭窄血流评估方面有较好的一致性,研究未显示钙化影响FFR_(CT)的诊断效能。

Influence of coronary calcification on the diagnostic accuracy of FFR CT in coronary artery disease

Objective?To?study?the?influence?of?coronary?calcification?on?the?diagnostic?performance?of?fractional?flow?reserve?(FFR)?derived?from?coronary?computed?tomography?angiography?(CCTA)?(FFR_CT)?in?coronary?artery?disease.?Methods?CCTA?and?invasive?coronary?angiography?data?from?38?patients,?including?50?target?vessels,?were?retrospectively?studied.?The?calcium?scores?of?the?50?coronary?arteries?were?measured?by?Agatston?integral?method,?and?patients?were?divided?into?two?groups:?A1?group?(≤100)?and?A2?group?(>100)?.?The?FFR_CT?values?were?measured?by?cFFR?software.?FFR?derived?from?invasive?coronary?angiography?and?FFR_CT?values?<0.8?were?defined?as?lesion?specific?ischemia.?The?consistencies?between?FFR_CT?and?FFR?of?the?total,?and?A1?and?A2?groups?were?calculated?by?using?the?correlation?coefficient?(ICC).?With?invasive?FFR?as?reference?standard,?in?a?per-vessel?basis,?the?accuracy,?sensitivity,?specificity,?positive?predictive?value,?and?negative?predictive?value?of?the?total,?and?A1?and?A2?groups?were?calculated?and?Fisher’s?exact?probability?method?was?used?to?compare?the?differences?between?the?two?groups.?Results?ICC?coefficient?of?FFR_CT?and?FFR?in?the?whole?cohort?was?0.771?(95%CI:?0.597~0.870),?in?A1?group?was?0.819?(95%CI:?0.633~0.910),?and?in?A2?group?was?0.649?(95%CI:?0.032~0.873).?The?diagnostic?sensitivity,?specificity,?accuracy,?positive?predictive?value,?and?negative?predictive?value?of?FFR_CT?were?90.9%,?97.4%,?96.0%,?90.9%,?and?97.4%,?respectively?for?the?whole?cohort;?85.7%,?100%,?96.9%,100%,?and?96%,?repectively,?for?the?A1?group;?and?100%,?92.3%,?94.1%,?80%,?and?100%,?respectively,?for?the?A2?group.?There?was?no?statistically?significant?difference?in?the?diagnostic?efficacy?between?the?A1?and?A2?groups?(P>0.05).?Conclusion?FFR_CT?has?good?consistency?with?FFR?in?the?evaluation?of?coronary?artery?stenosis.?Calcification?does?not?affect?the?diagnostic?accuracy?of?FFR_CT.?