Christou Maria A C, Siontis George C M, Katritsis Demosthenes G, Ioannidis John P A
Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Am J Cardiol. 2007 Feb 15;99(4):450-6. doi: 10.1016/j.amjcard.2006.09.092. Epub 2006 Dec 20.
We performed a meta-analysis of 31 studies comparing the results of fractional flow reserve (FFR) against quantitative coronary angiography (QCA) and/or noninvasive imaging of the same lesions. Studies were retrieved from PubMed (last search February 2006). Across 18 studies (1,522 lesions), QCA had a random effects sensitivity of 78% (95% confidence interval [CI] 67 to 86) and specificity of 51% (95% CI 40 to 61) against FFR (0.75 cutoff). Overall concordances were 61% for lesions with diameter stenosis 30% to 70%, 67% for stenoses >70%, and 95% for stenoses <30%. Compared with noninvasive imaging (21 studies, 1,249 lesions), FFR had a sensitivity of 76% (95% CI 69 to 82) and specificity of 76% (95% CI 71 to 81) by random effects. Summary receiver-operator characteristic estimates were similar. Most data addressed comparisons with perfusion scintigraphy (976 lesions, sensitivity 75%, specificity 77%), and some data were also available for dobutamine stress echocardiography (273 lesions, sensitivity 82%, specificity 74%). In conclusion, QCA does not predict the functional significance of coronary lesions. FFR shows modest concordance with noninvasive imaging tests. The prognostic implications of discordant FFR and imaging results need further study.
我们对31项研究进行了荟萃分析，这些研究比较了血流储备分数（FFR）与定量冠状动脉造影（QCA）和/或对相同病变的无创成像结果。研究从PubMed数据库检索（最后一次检索时间为2006年2月）。在18项研究（1522个病变）中，与FFR（截断值为0.75）相比，QCA的随机效应敏感度为78%（95%置信区间[CI]为67%至86%），特异度为51%（95%CI为40%至61%）。直径狭窄30%至70%的病变总体一致性为61%，狭窄>70%的病变为67%，狭窄<30%的病变为95%。与无创成像（21项研究，1249个病变）相比，FFR的随机效应敏感度为76%（95%CI为69%至82%），特异度为76%（95%CI为71%至81%）。汇总的受试者工作特征估计值相似。大多数数据涉及与灌注闪烁显像的比较（976个病变，敏感度75%，特异度77%），也有一些数据可用于多巴酚丁胺负荷超声心动图（273个病变，敏感度82%，特异度74%）。总之，QCA不能预测冠状动脉病变的功能意义。FFR与无创成像检查的一致性一般。FFR与成像结果不一致的预后意义需要进一步研究。
