基于冠状动脉CT的血流储备分数在心肌缺血中的诊断应用价值:一项单中心前瞻性研究

目的探讨国产自主研发的基于冠状动脉CT的血流储备分数(CT-FFR)对心肌缺血的诊断价值。方法前瞻性入选2019年11月至2020年5月复旦大学附属中山医院完成冠状动脉CT血管造影检查的心绞痛住院患者。基于冠状动脉CT图像,利用CT-FFR软件来建模计算CT-FFR值。以冠状动脉造影术中导管测定的FFR值为诊断金标准,计算CT-FFR的诊断效能,包括敏感度、特异度、预测值、曲线下面积(AUC)等。采用Pearson相关分析和Bland-Altman图分析两者的相关性和一致性。并且针对临界病变人群和钙化病变人群进行亚组分析。结果入选患者77例。CT-FFR的诊断敏感度为91.4%,特异度为94.7%,阳性预测值为98.1%,阴性预测值为78.2%,准确性为92.2%。CT-FFR用于诊断心肌缺血的AUC为0.96(95%CI 0.91~0.99,P=0.024),最佳诊断界值为0.795。Pearson相关分析显示CT-FFR和FFR的相关性良好(r=0.767,P<0.001),Bland-Altman图显示CT-FFR与FFR具有良好的一致性。在临界病变和钙化病变亚组分析中,CT-FFR也有着类似的诊断效能。结论CT-FFR对心肌缺血疾病的诊断效能接近导管测定的FFR,是一种行之有效的无创检测心肌缺血的手段。

The diagnostic value of fractional fl ow reserve derived from coronary computed tomographic angiography in myocardial ischemia:a single-center prospective study

Objective To explore the diagnostic value of fractional flow reserve derived from coronary computed tomographic angiography(CT-FFR)in myocardial ischemia.Methods Patients with angina pectoris from November 2019 to May 2020 who completed coronary angiography and coronary CTA were prospectively selected.The CT-FFR was calculated by software based on coronary CTA images.We used FFR values measured during coronary angiography as the diagnostic gold standard and calculated the diagnostic effi cacy of CT-FFR,including sensitivity,specifi city,predictive value,area under the curve(AUC).Pearson correlation analysis and Bland-Altman plot were used to analyze the correlation and consistency of CTFFR and FFR values.Subgroup analyses were conducted during the patients with borderline and calcifi cation lesions.Results A total of 77 patients were included in the analysis.The sensitivity,specifi city,positive predictive value,negative predictive value and accuracy of CT-FFR were 91.4%,94.7%,98.1%,78.2%and 92.2%,respectively.The AUC of CT-FFR for diagnosing myocardial ischemia was 0.96(95%CI 0.91–0.99,P=0.024),and the optimal diagnostic threshold was 0.795.Pearson correlation analysis showed the CTFFR value was highly correlated with the FFR value(r=0.767,P<0.001).Bland-Altman plot suggested the good consistency between CT-FFR and FFR values.CT-FFR showed similar performance in subgroup analysis for borderline and calcification lesions.Conclusions The diagnostic efficacy of CT-FFR for myocardial ischemia is comparable to FFR,and it is an eff ective non-invasive method for detecting myocardial ischemia.