冠状动脉CT血流储备分数在冠状动脉临界狭窄患者心肌缺血诊断中的应用

目的 评价冠状动脉无创血流储备分数（FFR-CT）对冠状动脉临界狭窄病变（冠状动脉狭窄50%～70%）心肌缺血的诊断效能,为FFR-CT在心肌缺血诊断中的临床应用提供参考。方法 67例冠状动脉临界狭窄病变患者,均行冠状动脉CT血管造影（CTA）及冠状动脉造影检查。患者均行冠状动脉血流储备分数（FFR）检查,根据FFR值评估心肌缺血情况。根据冠状动脉CTA影像数据算出FFR-CT值。采用Pearson相关分析FFR值和FFR-CT值之间的相关性。采用ROC评估FFR-CT对冠状动脉临界狭窄病变患者心肌缺血诊断的效能。结果 67例患者中FFR值≤0.8的有35例,FFR-CT值≤0.8的有26例。FFR值与FFR-CT值呈正相关（r=0.666 8,P<0.01）。共评估血管83支,FFR-CT用于心肌缺血诊断的ROC下面积为0.938(95%CI 0.890～0.985,P<0.01),诊断界值为0.8时,其对心肌缺血诊断的灵敏度87.5%、特异度95.24%、阳性预测值85.29%、阴性预测值79.63%。结论 FFR-CT值对冠状动脉临界狭窄病变患者心肌缺血具有较高的诊断...     

320排动态容积CT结合ECT预测老年前降支单支病变致血流储备分数<0.75的价值

目的以冠状动脉血流储备分数(FFR)为金标准,预测320排动态容积CT(320CT)结合ECT评价FFR0.75的准确性。方法连续入选临床诊断不稳定性心绞痛(UA)且冠脉320CT提示前降支(LAD)单支病变的老年患者72例,行ECT静息和运动负荷试验检查,二者结合与冠状动脉造影联合FFR比较,评价其预测FFR0.75的价值。结果 320CT示LAD狭窄超过50%联合ECT预测FFR0.75的敏感度为98%,特异度为86%,阳性预测值为94%,阴性预测值为95%;以320CT示LAD狭窄超过75%联合ECT预测FFR0.75的敏感度为96%,特异度为85%,阳性预测值为96%,阴性预测值为85%。结论当病变局限在LAD时,联合ECT和320排CT对预测LAD病变的功能学有较大价值,以320CT示狭窄超过50%为阳性标准时预测价值更高。     

静息全周期比值与冠脉血流储备分数的一致性

目的 评价静息全周期比值(resting full-cycle ratio,RFR)与金标准冠脉血管储备分数(fractional flow reserve,FFR)的一致性。方法 纳入2021年9月～2022年9月在沧州市中心医院接受侵入性生理学检查的冠心病患者。以RFR≤0.89作为参考值与FFR≤0.80作为参考值进行比较,评价RFR与FFR一致性,RFR的敏感性、特异性、阳性预测值、阴性预测值等指标。结果 本研究共纳入138例患者,共189支血管。以RFR≤0.89作为参考值与FFR≤0.80作为参考值比较,两种方法 一致性达81.5%,并具有统计学意义(R²=0.629,P<0.01),RFR≤0.89作为参考值其敏感度70.1%,特异度87.7%,阳性预测值75.8%,阴性预测值84.3%,准确率81.5%,ROC曲线下AUC面积为0.889(95%CI:0.842～0.937,P<0.01),RFR的cutoff值：0.915。约登指数为0.609。结论 RFR与金标准FFR具有良好的相关性,是冠脉生理学评估方法 的选择之一。     

深脉分数在冠状动脉临界病变中的诊断价值

目的 以血流储备分数（FFR）为金标准,探讨基于国产软件DEEPVESSEL-FFR的冠状动脉CT血流储备分数（CT-FFR,即深脉分数）,对冠状动脉（冠脉）临界病变的诊断价值。方法 回顾性纳入2019年1月至2020年12月于河南省人民医院阜外华中心血管病医院行侵入性FFR检查的冠状动脉粥样硬化性心脏病（冠心病）患者17例（25支血管,血管直径均超过2.0 mm）,入选患者冠脉狭窄程度为50%～80%。采用DEEPVESSEL-FFR软件计算CT-FFR值,当CT-FFR≤0.8时认为狭窄具有血流动力学意义。计算并分析DEEPVESSEL-FFR在患者及血管水平诊断冠脉临界狭窄的准确度、敏感度、特异度、阳性预测值及阴性预测值,同时绘制受试者工作特征曲线（ROC）。结果 共纳入17例患者,25支病变血管。以FFR为金标准,DEEPVESSEL-FFR在患者水平的准确度、敏感度、特异度、阳性预测值及阴性预测值分别为84.0%、88.9%、87.5%、88.9%、87.5%。在血管水平的准确度、敏感度、特异度、阳性预测值及阴性预测值分别为88.2%、81.8%、85.7%、81.8%、85...     

冠脉血流储备和平板运动试验在评估冠脉狭窄病变功能的价值

目的分析冠脉血流储备功能测定和平板运动试验用于评估冠脉狭窄病变功能学影响严重性的价值。方法选择性入选2011年3月-2012年3月52例冠心病住院患者,进行运动平板试验、冠脉造影和冠脉血流储备分数(Coronary Fractional Flow Reserve简称FFR)测定。根据FFR值分为2组:A组24例FFR<0.75和B组28例FFR≥0.75,收集两组资料,随访约12个月。结果 A组24例运动平板试验均为阳性,予以植入支架治疗。在支架植入术后15分钟重复测定FFR值均高于0.75;并在介入术后第5天,A组患者重复运动平板试验结果均恢复正常。B组有25例患者运动平板试验阴性,有3例患者运动试验阳性,FFR方法可产生假阴性。所有B组患者均未进行PCI干预,而以最佳的药物治疗。28例患者临床平均随访12个月,无缺血性冠脉事件及紧急血运重建事件发生。FFR对冠脉狭窄病变功能学诊断的敏感性为88.9%,特异性为100%;阳性预测值和阴性预测值分别为100%和89.3%;其准确性为94.2%。结论 FFR是一个评估冠脉狭窄病变功能严重性值得信赖的指标。     

冠状动脉内心电图对分叉病变中分支心肌缺血的判断价值

目的:研究冠状动脉(冠脉)内心电图对分叉病变中分支心肌缺血的判断价值。方法:对65例冠脉分叉病变患者,采用Cross-over治疗策略。主支支架植入前后,进行冠脉造影和分支血管冠脉内心电图检查,并对分支血管进行心肌血流储备分数(FFR)检测。结果:主支支架植入后,分支血管明显狭窄,狭窄率达(65.1±21.4)%,较主支支架植入前(30.1±23.1)%差异有统计学意义(P<0.05)。冠脉内心电图ST段变化≥0.1mV的20例患者中,17例FFR≤0.80;冠脉内心电图ST段变化<0.1mV的45例患者中,4例FFR≤0.80。以FFR≤0.80作为判断分支狭窄病变引起心肌缺血的标准,冠脉内心电图变化对分支心肌缺血预测的敏感性为81%,特异性为93%;阳性预测值为85%,阴性预测值为91%。结论:冠脉内心电图能有效判断分支狭窄病变是否引起心肌缺血,具有即刻、便捷、不增加患者费用等优点,值得临床推广应用。     

冠脉腔内心电图评估急性心肌梗死短期预后的价值

目的 研究冠状动脉腔内心电图在急性心肌梗死短期预后评估中的意义。方法 选取2021年2月至2023年2月本院收治的患者68例,根据冠状动脉腔心电图（IC-ECG）显示ST段发生有意义改变与否分为A组（有变化）和B组（无变化）。比较两组患者血清标志物水平、冠脉血流储备分数（FFR）的差异性。结果 共选入病例68例,通过FFR测量系统测定,FFR≤0.80组39例,FFR>0.80组29例;ST段表现为有意义变化有47例,无意义变化有21例;以FFR≤0.8为冠脉狭窄阳性病变参考标准,IC-ECG预测FFR异常的敏感性为89.74%,特异性为58.62%,阳性预测值为74.47%,阴性预测值为80.95%;A组血清中脑钠肽（BNP）、肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I(c TnI)水平和FFR值均高于B组（P<0.05）;随访30天,A组发生不良心血管事件高于B组（P<0.05）。结论 IC-ECG显示ST段发生有意义变化患者血清标志物水平与FFR值明显高于无变化患者,且不良心血管事件发生率差异显著,IC-ECG对于患者短期预后评估有一定参考价值。     

冠状动脉狭窄病变功能学评估新进展

正血流储备分数(fractional flow reserve, FFR)是目前国际公认的评价冠状动脉狭窄病变的功能学指标,即有狭窄病变的冠状动脉支配区域心肌最大血流量与同一冠状动脉无狭窄病变时心肌所能获得的最大血流量的比值,可简化为冠状动脉狭窄病变远端平均压力(Pd)和病变近端平均压力(Pa)的比值,即FFR值,其判断引起心肌缺血的界限值为0.80[1-3]。有临床研究证实,FFR值0.80提示该病变需要血运重建,FFR值0.80提示该病变引起心肌缺血的可能性很     

静息全周期比值和定量血流分数评价冠状动脉临界病变准确性的对比研究

目的 以血流储备分数（FFR）为金标准，比较定量血流分数（QFR）与静息全周期比值（RFR）评估冠状动脉临界病变的准确性及临床应用价值。方法 回顾性纳入2020年9月至2022年1月，在北京大学第三医院因冠状动脉性心脏病行冠状动脉造影并同时接受FFR和RFR检测的142例患者142支血管病变，分析RFR、QFR与FFR的线性相关性和诊断一致率，并进行受试者工作特征（ROC）曲线分析。根据性别及靶血管进行亚组分析。结果 142例患者年龄66(58,71)岁，87例（61.3%）为男性，110支（77.5%）靶病变位于左前降支，RFR与FFR相关性r=0.814(95%CI 0.748～0.864,P<0.0001)、QFR与FFR相关性r=0.617(95%CI0.503～0.709,P<0.0001)，均存在显著线性相关关系。RFR对应FFR≤0.80的AUC0.786(95%CI0.715～0.857)，而QFR对应FFR≤0.80的AUC 0.707(95%CI0.633～0.782)，两者之间的AUC差异无统计学意义（P=0.056）。在不同性别及靶病变的亚组分析中，...     

冠状动脉介入治疗血流储备分数测定的护理配合

目的总结了46例冠状动脉（冠脉）介入治疗血流储备分数（fractional flow reserve,FFR）测定的护理配合。方法冠脉造影显示冠脉血管处于临界病变时,通过压力导丝对冠脉FFR的测定,根据测定的结果决定是否行介入治疗。结果46例患者共59处病变行FFR测定,测出其中19处病变的FFR值〉0．75,给予药物保守治疗：其余40处病变FFR值≤0．75,行冠脉介入（PCI）治疗,术后复测FFR均〉0．91。结论在整个术程中,除要求护士熟练掌握FFR的操作程序以及严密观察药物不良反应外,正确把握腺苷药物使用的时机是整个术程的关键。     

Incremental Prognostic Value of Post-Intervention Pd/Pa in Patients Undergoing Ischemia-Driven Percutaneous Coronary Intervention

ObjectivesThis study sought to evaluate the prognostic value of post–percutaneous coronary intervention (PCI) distal coronary pressure to aortic pressure ratio (Pd/Pa) in predicting long-term clinical outcomes and to determine whether Pd/Pa combined with fractional flow reserve (FFR) post-intervention provides additional prognostic information superior to either marker alone.BackgroundPost-PCI FFR has been shown to be a predictor of long-term outcomes in numerous studies. The role of post-PCI resting Pd/Pa has not been previously studied in this setting.MethodsConsecutive patients undergoing PCI who had pre- and post-PCI Pd/Pa and FFR were followed for major adverse cardiovascular events (MACE) including death, myocardial infarction, and target vessel revascularization.ResultsA total of 574 patients were followed for 30 months (25th to 75th percentile 18 to 46 months). Using receiver-operating characteristic curve analysis post-stenting FFR cutoff of ≤0.86 had the best predictive accuracy of MACE (17% vs. 23%; log-rank p = 0.02), whereas post-stenting Pd/Pa ≤0.96 was the best predictor of MACE (15% vs. 24%; log rank p = 0.0006). There was a significant interaction between post-PCI Pd/Pa and FFR on MACE risk such that patients with Pd/Pa ≤0.96 and FFR ≤0.86 had the highest event rate (25%), whereas those with Pd/Pa >0.96 and FFR >0.86 had the lowest event rate (15%), which was not different from patients with Pd/Pa >0.96 and FFR ≤0.86 (17%). In a fully adjusted Cox regression analysis, Pd/Pa was an independent predictor of MACE (hazard ratio: 2.07; 95% confidence interval: 1.3 to 3.3; p = 0.002).ConclusionsPost-PCI resting Pd/Pa is a powerful prognostic tool for MACE prediction. It adds complementary and incremental risk stratification over established factors including post-PCI FFR.     

Pooled diagnostic accuracy of resting distal to aortic coronary pressure referenced to fractional flow reserve: The importance of resting coronary physiology

Introduction

Both resting and hyperemic physiologic methods to guide coronary revascularization improve cardiovascular outcomes compared with angiographic guidance alone. Fractional flow reserve (FFR) remains underutilized due to concerns regarding hyperemia, prompting study of resting distal to aortic coronary pressure (Pd/Pa). Pd/Pa is a vasodilator‐free resting index unlike FFR. While Pd/Pa is similar to another resting index, instantaneous wave‐free ratio (iFR), it is a whole‐cycle measurement not limited to the wave‐free diastolic period. Pd/Pa is not validated clinically although multiple accuracy studies have been performed. Our meta‐analysis examines the overall diagnostic accuracy of Pd/Pa referenced to FFR, the accepted invasive standard of ischemia.

Methods

We searched PubMed, EMBASE, Central, ProQuest, and Web of Science databases for full text articles published through August 9, 2017 addressing the diagnostic accuracy of Pd/Pa referenced to FFR < 0.80. The following keywords were used: “distal coronary artery pressure ” OR “Pd/Pa ” AND “fractional flow reserve ” OR “FFR .”

Results

In total, 14 studies comprising 7004 lesions were identified. Pooled diagnostic accuracy estimates of Pd/Pa versus FFR < 0.80 were: sensitivity, 0.77 (95% CI, 0.75‐0.78); specificity, 0.82 (0.81‐0.83); positive likelihood ratio, 4.7 (3.3‐6.6); negative likelihood ratio, 0.29 (0.24‐0.34); diagnostic odds ratio, 18.1 (14.4‐22.6); area under the summary receiver‐operating characteristic curve of 0.88; and diagnostic accuracy of 0.80 (0.76‐0.83).

Conclusions

Pd/Pa shows adequate agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. Pd/Pa has the potential to guide coronary revascularization with easier application and availability compared with iFR and FFR.

     

Combining Baseline Distal-to-Aortic Pressure Ratio and Fractional Flow Reserve in the Assessment of Coronary Stenosis Severity

ObjectivesThis study sought to understand the physiological basis of baseline distal-to-aortic pressure ratio (Pd/Pa) and fractional flow reserve (FFR) agreement and discordance, using coronary flow reserve (CFR), stenosis resistance, and microcirculatory resistance measurements, and form there, to investigate the potential value of combining Pd/Pa with FFR in the diagnostic rationale.BackgroundPd/Pa is always available before FFR assessment, and emerging data supports the notion that baseline indices can determine the ischemic potential of coronary stenosis in selected subsets.MethodsA total of 467 stenosed vessels from 363 patients were investigated with pressure and flow sensors during baseline and hyperemia: 168 vessels (135 patients) with thermodilution-derived flow, and 299 vessels (228 patients) with Doppler-derived flow.ResultsPd/Pa correlated more strongly with CFR than FFR (ρ difference = 0.129; p for ρ comparison <0.001). Although Pd/Pa and FFR were closely correlated (ρ = 0.798; 95% confidence interval: 0.767 to 0.828), categorical discordance was observed in 19.3% of total vessels. Such discordance was associated with the patients’ clinical profile and was characterized by contrastive changes in stenosis resistance, microcirculatory resistance, and the underlying CFR. Notably, all stenosis with Pd/Pa ≤0.83 (n = 74, 15.8%) progressed to FFR ≤0.80, and although no Pd/Pa cutoff was able to exclude the development of FFR ≤0.80 in the high end of values, only 15 (10.1%) vessels with Pd/Pa ≥0.96 (n = 149, 31.9%) developed FFR ≤0.80, from which none had definite ischemia, as defined by CFR ≤1.74.ConclusionsCombining baseline Pd/Pa with FFR seems to provide a more comprehensive physiological examination of stenosed coronary arteries and a closer pressure-based appraisal of the flow reserve of the downstream myocardial bed.     

Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions

Objective

Fractional flow reserve (FFR) using adenosine has been the gold standard in the functional assessment of intermediate coronary stenoses in the catheterization laboratory. We aim to study the correlation of adenosine-free indices such as whole cycle Pd/Pa [the ratio of mean distal coronary pressure (Pd) to the mean pressure observed in the aorta (Pa)], instantaneous wave-free ratio (iFR), and contrast-induced submaximal hyperemia (cFFR) with FFR.

N-端心房利钠肽与N-端脑利钠肽对预测左室收缩功能障碍的价值

目的比较N-端心房利钠肽(心钠素NT-proANP)和N-端脑钠肽(NT-proBNP)对左室收缩功能障碍(LVSD)预测效率,依据二者特性确定适用范围并界定最佳下限(cut-off)值。方法入选心血管病患者380例(病例组),依据左室射血分数(LVEF)将患者划分为LVSD组(LVEF≤40%,n=90)及非LVSD组(LVEF40%,n=290)。另选136名健康体检者作为对照组。超声心动图测定LVEF;ELISA法测定血浆NT-proANP和NT-proB-NP浓度。描记NT-proANP和NT-proBNP预测左室收缩功能障碍受试者工作特征(ROC)曲线。依据年龄(以65岁为分界)、性别及原发心血管疾病种类划分亚组,分别描记各组患者NT-proANP和NT-proBNP预测左室收缩功能障碍ROC曲线;确定最佳cut-off值。结果病例组血浆NT-proANP和NT-proBNP浓度均显著高于对照组log(NT-proANP):(3.30±0.41)vs(2.98±0.16),P0.01;log(NT-proBNP):(2.71±0.30)vs(2.49±0.13),P0.01。NT-proANP和NT-proBNP对不同程度LVSD(LVEF≤40%或LVEF≤30%)患者诊断ROC曲线下面积(AUC)均大于0.73(P0.01);对LVEF≤40%的患者,NT-proANPAUC大于NT-proBNP(0.820vs0.738);对LVEF≤30%的患者,NT-proANPAUC明显小于NT-proBNP(0.853vs0.877)。根据各亚组ROC曲线确定cut-off值,NT-proANP为1676.92pmol/L时对各组LVSD预测敏感度88.9%～100%;特异度14.0%～58.7%;阳性预测值9.04%～30.04%;阴性预测值96.96%～98.77%。NT-proBNP为417.37pmol/L时,敏感度77.8%～94.4%;特异度10.0%～55.8%;阳性预测值7.07%～48.88%;阴性预测值94.46%～98.87%。结论 NT-proBNP与NT-proANP均能够反映心力衰竭高危人群心脏功能状态,可作为LVSD的诊断指标,对于LVEF≤40%的预测,NT-proANP效果优于NT-proBNP,有助于早期发现LVSD患者。     

Prognostic Implications of Post-Intervention Resting Pd/Pa and Fractional Flow Reserve in Patients With Stent Implantation

ObjectivesThis study sought to investigate the prognostic implications of post–percutaneous coronary intervention (PCI) nonhyperemic pressure ratios compared with that of post-PCI fractional flow reserve (FFR).BackgroundFFR measured after PCI has been shown to possess prognostic implications. However, the prognostic value of post-PCI nonhyperemic pressure ratios has not yet been clarified.MethodsA total of 588 patients who underwent PCI with available both post-PCI FFR and resting distal coronary pressure-to-aortic pressure ratio (Pd/Pa) were analyzed. Post-PCI FFR and Pd/Pa were measured after successful angiographic stent implantation. The primary outcome was target vessel failure (TVF) up to 2 years, defined as a composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization. Prognosis of patients according to post-PCI Pd/Pa was compared with that of post-PCI FFR.ResultsDespite angiographically successful PCI, 18.5% had post-PCI FFR ≤0.80 and 36.9% showed post-PCI Pd/Pa ≤0.92. In post-PCI Pd/Pa >0.92 group, 93.8% of patients showed post-PCI FFR >0.80. Conversely, 60.4% of patients showed post-PCI FFR >0.80 in post-PCI Pd/Pa ≤0.92 group. Although there was significant difference in TVF according to post-PCI FFR (≤0.80 vs. >0.80: 10.3% vs. 2.5%; p < 0.001) and Pd/Pa (≤0.92 vs. >0.92: 6.2% vs. 2.5%; p = 0.029), the reclassification ability of model for TVF was increased only with post-PCI FFR (net reclassification index 0.627; p = 0.003; integrated discrimination index 0.019; p = 0.015), but not with post-PCI Pd/Pa, compared with model including clinical factors. Compared with patients with post-PCI Pd/Pa >0.92, patients with post-PCI Pd/Pa ≤0.92 and FFR ≤0.80 had significantly higher risk of TVF (10.4% vs. 2.5%; adjusted hazard ratio: 4.204; 95% confidence interval: 1.521 to 11.618; p = 0.006); however, those with post-PCI Pd/Pa ≤0.92 but FFR >0.80 showed similar risk of TVF (3.5% vs. 2.5%; adjusted hazard ratio: 1.327; 95% confidence interval: 0.398 to 4.428; p = 0.645).ConclusionsOver one-half of the patients with abnormal post-PCI Pd/Pa ≤0.92 showed post-PCI FFR >0.80. Compared with post-PCI FFR, post-PCI Pd/Pa showed limited reclassification ability for the occurrence of TVF. Among patients with abnormal post-PCI Pd/Pa, only patients with positive post-PCI FFR showed significantly higher risk of TVF than did those with post-PCI Pd/Pa >0.92. (Prognostic Perspective of Invasive Hyperemic and Non-Hyperemic Physiologic Indices Measured After Percutaneous Coronary Intervention [PERSPECTIVEPCI]; NCT04265443)     

肝脏硬度检测对乙型肝炎肝硬化食管静脉曲张的预测

目的遴选乙型肝炎（乙肝）肝硬化食管静脉曲张（esophagealvarices,Ev）的无创性诊断指标,并建立相应诊断模型。方法回顾性分析280例乙肝肝硬化患者资料,统计分析血常规、生化指标、超声指标及肝脏硬度,建立诊断模型。结果20例（7．1％）肝脏硬度检测失败。肝脏硬度、肝脏超声指标、清蛋白、血小板与EV具有相关性（Kendallb〉0．20无EV患者的年龄、肝脏硬度、肝脏超声评分、脾厚度、清蛋白、球蛋白、白细胞、血小板等指标与Ev患者相比,差异有统计学意义。肝脏超声评分联合肝脏硬度预测Ev的受试者工作特征曲线下面积（area under receiver operating characteristic curve, AUROC ）为0．83,以食管静脉曲张指数（esophagealvaricesindex,EVI）：4．254为诊断界值,预测患者无Ev的可能性为92．6％,阴性似然比为0．11;以EVI=6．853为诊断界值,预测患者存在EV的可能性为81．8％。在ALT〉5×ULN者中,肝脏硬度与EV相关性有所提高（Kendallb：0．421）,肝脏硬度检测预测Ev的AUROC为0．90。应用肝脏硬度预测Ev,80％患者可免除胃镜检查。肝脏硬度〈32．7kPa,排除EV的可能性为96．3％;肝脏硬度〉46．0kPa,确定EV存在的可能性为83．3％,阳性似然比为17．8。结论肝脏超声评分联合肝脏硬度可有效筛选、预测EV状态;在ALT〉5×ULN者中,肝脏硬度检测可独立准确预测EV状态。     

双源计算机断层扫描成像在冠状动脉小血管支架内再狭窄的应用价值

目的探讨双源计算机断层扫描冠状动脉造影术(dual source computed tomography coronary angiography,DSCT-CA)在冠状动脉小血管支架内再狭窄的应用价值。方法对76例(男59例,女17例)有胸闷、胸痛的患者在术后6～12个月行经皮冠状动脉造影后行DSCT-CA检查。根据心率及造影结果将患者分成不同的组别:心率≤70次/min组[n=48,扫描时心率(58±5)次/min]与心率﹥70次/min组[n=41,扫描时心率(78±9)次/min];简单病变组(单个支架,n=54)与复杂病变组(重叠支架及分叉支架,n=35);右冠状动脉组(n=33)、左回旋支组(n=43)和左前降支组(n=13),并比较分析DSCT-CA对各组诊断的敏感性、特异性及阳性预测值、阴性预测值。结果76例患者共植入89个支架,其中31.4%(28/89)的支架经血管造影证实有再狭窄。DSCT-CA对支架内再狭窄的敏感性、特异性及阳性预测值、阴性预测值分别为89%、87%、76%和95%。DSCT-CA对心率≤70次/min组与心率﹥70次/min组的诊断价值比较,差异无统计学意义(P>0.05)。DSCT-CA对冠状动脉三主支的诊断价值比较,差异也无统计学意义(P>0.05)。DSCT-CA诊断复杂病变组的敏感性、阳性预测值、特异性,阴性预测值均低于简单病变组,差异有统计学意义(83%vs.94%,P<0.05;63%vs.88%,P<0.05;74%vs.95%,P<0.05;89%vs.97%,P<0.05)。简单病变组组内分析结果显示,其敏感性和特异性比较,差异无统计学意义(94%vs.95%,P>0.05);阳性预测值低于阴性预测值,差异有统计学意义(88%vs.97%,P<0.05)。4年的质控分析结果显示,DSCT-CA检测小血管支架内再狭窄率呈逐年上升趋势,2006年及2007年再狭窄率均在平均水平以下,2009年超出了平均水平的一倍。结论DSCT-CA可作为小血管支架术后再狭窄的筛选手段,阴性者可排外支架内再狭窄,阳性者需进一步行冠状动脉造影以明确诊断。     

内镜超声引导下细针穿刺细胞学及囊液癌胚抗原分析诊断胰腺囊性病变的价值

目的探讨内镜超声引导下细针穿刺（EUS-FNA）细胞学检查、囊液癌胚抗原（cEA）分析对区分胰腺囊性病变良恶性的诊断价值。方法对27例胰腺囊性病变患者行EUS-FNA细胞学检查和囊液CEA分析,绘制囊液CEA受试者工作特征曲线并通过Youden指数确定诊断临界值,以手术病理诊断为金标准,统计分析EUS、EUS-FNA细胞学及囊液CEA分析鉴别诊断胰腺囊性病变良恶性的敏感度、特异度、阳性预测值、阴性预测值和准确率。结果手术病理确诊良性病变14例、潜在恶性／恶性病变13例。EUS鉴别诊断胰腺囊性病变良恶性的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为77．8％（21／27）、69．2％（9／13）、85．7％（12／14）、81．8％（9／11）、75．0％（12／16）;EUS-FNA细胞学上述指标分别为85．2％（23／27）、76．9％（10／13）、92．9％（13／14）、90．9％（10／11）、81．3％（13／16）;以囊液CEA值22．24ng／ml为诊断临界值,上述指标分别为74．1％（20／27）、84．6％（11／13）、64．3％（9／14）、68．8％（11／16）、81．8％（9／11）。结论EUS-FNA细胞学鉴别诊断胰腺囊性病变良恶性具有较高的准确率和特异度,而囊液CEA分析（诊断临界值22．24ng／m1）鉴别诊断胰腺囊性病变良恶性的敏感度较高,选择合适的胰腺囊液CEA分析诊断临界值结合EUS-FNA细胞学检查可以基本满足临床鉴别胰腺囊性病变良恶性的需要。     

Agreement Between iFR and Other Non-Hyperaemic Pressure Ratios in Severe Aortic Stenosis

BackgroundInstantaneous wave-free ratio (iFR) can reliably assess the physiological significance of coronary artery disease (CAD). Previous studies have demonstrated its interchangeability with other non-hyperaemic pressure ratios (NHPR), but there is no data exploring whether this association is maintained in patients with severe aortic stenosis (AS).MethodsForty-two patients (67 lesions) with severe AS were recruited and underwent invasive pressure-wire assessment. Data were extracted to calculate iFR, resting Pd/Pa, diastolic pressure ratios (DPR and dPR), and Diastolic Hyperaemia-Free Ratio (DFR). iFR was then compared with other NHPR to determine agreement and accuracy.ResultsMean aortic gradient and dimensionless index were 44.3 ± 11.6 mmHg and 0.23 ± 0.04, respectively. Of the 67 vessels, 57% were LAD, 15% LCx, 13% RCA and 12% other. There was strong positive correlation between iFR and all other NHPR, including Pd/Pa (r = 0.91, p < 0.001), DPR (r = 0.99, p < 0.001), dPR (r = 0.97, p < 0.001) and DFR (r = 0.98, p < 0.001). While Bald-Altman analysis demonstrated that Pd/Pa and DFR were numerically different from iFR, ROC analyses demonstrated iFR ≤0.89 was accurately identified by all NHPRs; Pd/Pa (AUC = 0.965, 95% CI [0.928–0.994]), DPR (AUC = 1.000, 95% CI [1.000–1.000]), dPR (AUC = 0.974, 95% CI [0.937–1.000]), DFR (AUC = 0.989, 95% CI [0.968–1.000]).ConclusionIn patients with severe AS, all the included NHPR in this analysis accurately predicted iFR < 0.89. These data should reassure clinicians that use of alternative NHPR to iFR is reasonable when assessing the physiological significance of CAD in patients with severe AS.