Meijboom W Bob, Van Mieghem Carlos A G, van Pelt Niels, Weustink Annick, Pugliese Francesca, Mollet Nico R, Boersma Eric, Regar Eveline, van Geuns Robert J, de Jaegere Peter J, Serruys Patrick W, Krestin Gabriel P, de Feyter Pim J
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Am Coll Cardiol. 2008 Aug 19;52(8):636-43. doi: 10.1016/j.jacc.2008.05.024.
We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard.
It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance.
We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as >/=50% diameter stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis.
A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001).
The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
我们试图确定无创视觉（计算机断层扫描冠状动脉造影[CTCA]）和定量计算机断层扫描冠状动脉造影（QCT）预测冠状动脉狭窄血流动力学意义的诊断准确性，以冠状动脉内血流储备分数（FFR）作为参考标准。
已证明CTCA在识别冠状动脉狭窄方面具有出色的诊断敏感性，但可能缺乏对血流动力学意义的准确描绘。
我们调查了79例稳定型心绞痛患者，这些患者同时接受了64层或双源CTCA以及离散冠状动脉狭窄的FFR测量。进行CTCA和传统冠状动脉造影（CCA），以及QCT和定量冠状动脉造影（QCA），以确定狭窄的严重程度，并与FFR测量结果进行比较。显著的解剖学或功能性狭窄定义为直径狭窄≥50%或FFR<0.75。分析不包括支架置入段和旁路移植血管。
共评估了89处狭窄，其中18%（89处中的16处）的FFR<0.75。CTCA、QCT、CCA和QCA检测血流动力学显著冠状动脉病变的诊断准确性分别为49%、71%、61%和67%。QCT和QCA与FFR测量之间的相关性较弱（R值分别为-0.32和-0.30）。QCT和QCA之间的相关性显著，但仅为中等程度（R = 0.53；p<0.0001）。
通过视觉CTCA、CCA或QCT或QCA对冠状动脉狭窄血流动力学意义的解剖学评估与FFR的功能评估相关性不佳。在转诊进行血运重建治疗之前，确定血管造影显示的中度狭窄的血流动力学意义仍然很重要。
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