冠状动脉CT血管成像狭窄评分定量评估缺血相关病变的临床价值

目的:分析冠状动脉CT血管成像狭窄评分(CCTA-SS)在定量评估缺血相关病变中的临床价值。方法:回顾性分析经冠状动脉CT血管成像(CCTA)诊断为左前降支单支病变的冠状动脉粥样硬化性心脏病(冠心病)疑似患者的临床资料。患者入院1周内接受有创冠状动脉造影(ICA)及血流储备分数(FFR)检查,分析影像特征并计算CCTA-SS,以数值≥70%判断缺血相关病变。以FFR≤0.80评价CCTA、ICA、CCTA-SS诊断缺血相关冠心病的准确性,分析三者受试者工作特征(ROC)曲线。临床依据FFR≤0.80行经皮冠状动脉介入术(PCI)并随访。结果:共入选患者101例,左室前壁与侧壁心肌早期灌注及心肌功能的差异有统计学意义(P<0.001)。35例患者有高风险斑块,37例患者FFR≤0.80。以FFR≤0.80为标准,CCTA、ICA、CCTA-SS诊断准确率分别为46.53%、66.34%、89.11%,最佳截断值分别为60%、66%、38%,敏感度与特异度分别为82.98%与55.56%、91.04%与82.35%、80.00%与81.82%;CCTA-SS的ROC曲线下面积明显大于CCTA(P<0.05),CCTA-SS与ICA的ROC曲线下面积差异无统计学意义。37例患者接受PCI治疗,其中36例(97.30%)CCTA-SS≥70%,提示心肌缺血;64例接受药物治疗,其中56例(87.50%)CCTA-SS<70%,提示无心肌缺血。8例患者再次住院,其中2例接受PCI治疗,CCTA-SS再次评分>70%,6例接受药物治疗,CCTA-SS再次评分<70%。结论:CCTA-SS在判断冠状动脉解剖狭窄的同时,可反映供血区心肌功能,提高CCTA评价冠状动脉缺血相关病变的能力。

Clinical value of coronary CT angiography stenosis score in quantitative assessment of ischemic-related lesions

Objective:To analyze the clinical value of coronary CT angiography(CCTA)stenosis score(CCTA-SS)in quantitative assessment of ischemic-related lesions.Methods:Patients with suspected coronary artery disease(CAD)diagnosed by CCTA,who represented single vessel lesion in left anterior descending(LAD)coronary artery,were included.All the patients underwent invasive coronary angiography(ICA)and fractional flow reserve(FFR)within one week after admission.The image features were analyzed and the value of CCTA-SS was calculated.Ischemic-related lesion was defined as the value of CCTA-SS≥70%.The accuracy of CCTA,ICA and CCTA-SS was evaluated in receiver operating characteristic(ROC)analysis,using FFR≤0.80 as a reference standard for diagnosing CAD.Percutaneous coronary intervention(PCI)was performed in patients with FFR≤0.80.And the patients were followed-up.Results:A total of 101 patients were included.There were 35 cases with the high-risk plaque,and 37 cases with FFR≤0.80.There was statistically significant difference in the early myocardial perfusion and the myocardial function between the anterior and the lateral wall(P<0.001).The diagnostic accuracy of CCTA,ICA,and CCTA-SS was 46.53%,66.34%,89.11%,respectively.The cutoff value was 60%,66%and 38%,respectively.And the sensitivity was 82.98%,91.04%,and 80.00%,respectively with specificity of 55.56%,82.35%,and 81.82%.The area under the curve(AUC)of CCTA-SS was bigger than that of CCTA(P<0.05).There was not statistically significant difference between CCTA-SS and ICA(P>0.05).PCI was performed in 37 cases,and there were 36 cases(97.30%)with CCTA-SS≥70%,which indicated ischemic-related lesions.Sixty-four patients received drug treatment,and among them 56 cases(87.50%)presented with CCTA-SS<70%,indicating non-ischemic-related lesions.Eight patients were hospitalized again,among whom 2 cases underwent PCI with CCTA-SS>70%.Six patients accepted drug treatment with CCTA-SS<70%.Conclusions:CCTA-SS could reflect the myocardial function of the blood supply area while judging the coronary artery anatomical stenosis,and significantly improve the ability of CCTA to evaluate coronary artery ischemia related lesions.