瞬时无波形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)为标准,比较定量血流分数(QFR)和瞬时无波形比值(iFR)评估冠状动脉临界病变的准确性,并分析QFR与iFR的相关性及诊断一致率。方法回顾性纳入北京大学第三医院2015年5月至2020年6月因冠心病进行冠状动脉造影(CAG)并接受FFR和iFR检测的62例患者,收集患者的临床和CAG病变解剖学资料、靶血管iFR和FFR值,并测量同一靶血管的QFR值。以FFR≤0.80为判断心肌缺血的临界值,比较QFR和iFR与FFR评估冠状动脉临界病变的准确性,并分析QFR与iFR的相关性及诊断一致率。结果62例患者中,有53例(85.5%)靶血管为左前降支,基线直径狭窄率为48.0%(41.1%,55.7%)。iFR、QFR与FFR均具有较好的相关性r=0.773(95%CI 0.649~0.857)、r=0.626(95%CI 0.445~0.757),均P<0.001]。QFR、iFR预测FFR≤0.80的受试者工作特征曲线下面积(AUC)比较,差异无统计学意义0.859(95%CI 0.748~0.935)比0.875(95%CI 0.766~0.945),P=0.801];二者与FFR诊断一致率的差异无统计学意义(74.2%比79.0%,P=0.615)。QFR与iFR的相关性较弱(r=0.396,95%CI 0.162~0.587,P=0.0015)。QFR对应iFR≤0.89的AUC为0.663(95%CI 0.524~0.801,P=0.028)。QFR、iFR联合诊断策略可以与FFR达到88.7%的诊断一致率,同时减少58.1%的压力导丝使用。结论iFR与QFR评估冠状动脉临界病变具有相似的诊断准确率,但二者相关性较弱。二者联合诊断策略可进一步提高诊断准确率。

Comparison of instantaneous wave-free ratio and quantitative fl ow ratio for evaluating physiological function of intermediate coronary lesions

Objective To compare the accuracy of instantaneous wave-free ratio(iFR)and quantitative fl ow ratio(QFR)for evaluating physiological function of coronary borderline lesions by taking fractional fl ow reserve(FFR)as the criterion,and to analyze the correlation and diagnostic consistency between QFR and iFR.Methods A total of 62 patients underwent coronary arteriography(CAG)and FFR,iFR examination in Peking University Third Hospital from May 2015 to June 2020 were included.The patients’clinical anatomy and the CAG lesions,iFR and FFR values of target blood vessels were collected,and the QFR value of the same target vessel was measured.FFR≤0.80 was used to determine the threshold of myocardial ischemia.The accuracy of QFR,IFR and FFR in evaluating coronary borderline lesions was compared,and the correlation and diagnostic consistency between QFR and iFR were analyzed.Results Among 62 lesions,53(85.5%)target vessels were left anterior descending artery.The percent diameter stenosis of target vessels was 48.0%(41.1%,55.7%).Both iFR and QFR were significantly correlated with FFRr=0.773(95%CI 0.649–0.857)and 0.626(95%CI 0.445–0.757),both P<0.001].AUC of QFR and iFR in detecting FFR≤0.80 were similar0.875(95%CI 0.766–0.945)vs.0.859(95%CI 0.748–0.935),P=0.801],and there was no statistically significance of the overall diagnostic accuracy of QFR and iFR(74.2%vs.79.0%,P=0.615).A poor agreement between QFR and iFR was revealed(r=0.396,95%CI 0.162–0.587,P=0.0015).Regarding iFR≤0.89,AUC of QFR was 0.663(95%CI 0.524–0.801,P=0.028).Consequential procedure of QFR and iFR could increase the diagnostic accuracy to 88.7%and decrease the use of pressure wire by 58.1%.Conclusions Both QFR and iFR have similar diagnostic accuracy for detecting coronary borderline lesions.However,QFR has poor agreement with iFR.Consequential procedure of QFR and iFR could increase diagnostic accuracy.