基于工作站的CT-FFR对评估冠状动脉功能性狭窄的临床初步探究

目的 以负荷核素心肌灌注显像(single photon emission computedtomography/myocardial perfusion imaging,SPECT/MPI)为标准,探讨基于工作站的CT-冠状动脉血流储备分数(CT-fractional flow reserve,CT-FFR)对于诊断...

Diagnostic performance of workstation-based CT-FFR for detection of functionally significant stenosis in coronary artery disease

Objective To investigate the diagnostic performance of workstation-based CT-fractional flow reserve (CT-FFR) for identifying functionally significant stenosis in patients with coronary artery disease (CAD) with single angiopathy,with reference to single photon emission computed tomography/myocardial perfusion imaging (SPECT/MPI). Methods Single-center prospective study underwent coronary CT angiography (CCTA) with stenosis of 40% to 90%.CCTA data was collected by Canon 320-detector CT scanner.Prospective electrocardiogram gating was used,covering 70% to 99% of the R-R interval.Invasive coronary angiography (ICA) was performed to accurately assess coronary stenosis.A workstation-based CT-FFR software version was used for CT-FFR analysis.Any lesion vessel showing a CT-FFR value ≤ 0.80 at the site of diameter of 2.0 mm was defined as having hemodynamically significant stenosis. SPECT/MPI was used as standard for detection of stenosis-induced myocardial ischemia,ROC curve of CCTA,ICA and CT-FFR was performed to calculate the AUC.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy were recorded. Results Forty-one patients (41 vessels) were included in the study.Sensitivity,specificity and accuracy of functional assessment of coronary stenosis were 87.5%,96.0% and 92.7% for CT-FFR,100%,32.0% and 58.5% for CCTA,and 93.8%,32.0% and 56.1% for ICA,respectively. The AUC value of CT-FFR was 0.93 (95%CI:0.81-0.99),which was significantly higher than that of CCTA (0.76,95%CI:0.60-0.88) and ICA (0.80,95%CI:0.64-0.91) (both P<0.05). Conclusion SPECT/MPI was used as the diagnostic criteria for detection of myocardial ischemia in patients with CAD with single angiopathy.The workstation-based CT-FFR showed significantly better diagnostic accuracy than CCTA in the diagnosis of functional coronary stenosis,and had good applying prospect.