Zafar Haroon, Ullah Ihsan, Dinneen Kate, Matiullah Sajjad, Hanley Alan, Leahy Martin J, Sharif Faisal
Tissue Optics & Microcirculation Imaging Facility, National University of Ireland, Galway, Ireland; National Biophotonics & Imaging Platform, Dublin, Ireland.
Department of Cardiology, University Hospital Galway, Ireland.
J Cardiol. 2014 Jul;64(1):19-24. doi: 10.1016/j.jjcc.2013.11.009. Epub 2013 Dec 22.
The main objective of this study is to determine the correlation between fractional flow reserve (FFR)- and frequency domain optical coherence tomography (FD-OCT)-measured lumen parameters, and to determine the diagnostic competence of FD-OCT concerning the identification of severe coronary stenosis.
A total of 41 coronary stenoses in 30 patients were assessed consecutively by quantitative coronary angiography (QCA), FFR, and FD-OCT. Stenoses were labeled severe if FFR ≤ 0.80. The minimal lumen area (MLA), minimal lumen diameter (MLD), and percent lumen area stenosis (%AS) were measured using FD-OCT.
FFR was ≤ 0.80 in 10 stenoses (24.4%). A poor but significant correlation between FFR and FD-OCT-measured MLA (r(2) = 0.4, p < 0.001), MLD (r(2) = 0.28, p < 0.001), and %AS (r(2) = 0.13, p = 0.02) was found. In the overall group, the diagnostic efficiency of MLA and MLD in identifying significant stenosis was moderate. The area under the curve (AUC) was 0.80 [95% confidence interval (CI): 0.64-0.91] for MLA and 0.76 (95% CI: 0.60-0.88) for MLD. The best cut-off values of FD-OCT-measured lumen parameters to identify stenosis with FFR ≤ 0.80 were 1.62 mm(2) [specificity 97%, sensitivity 70%, positive predictive value (PPV) 89% and negative predictive value (NPV) 91%] for MLA and 1.23 mm (specificity 87%, sensitivity 70%, PPV 64% and NPV 90%) for MLD. The diagnostic efficiency of MLA in identifying significant stenosis in vessels having reference diameter < 3 mm was high. The AUC was 0.96 (95% CI: 0.83-1.0).
The FFR values and FD-OCT anatomical parameters MLA, MLD were found to be significantly correlated. In the overall group, the FD-OCT-measured MLA and MLD have shown moderate diagnostic efficiency in the functional evaluation of significant stenosis. FD-OCT-measured MLA has high diagnostic efficiency in identifying severe coronary stenosis in vessels having reference diameter < 3 mm.
本研究的主要目的是确定血流储备分数（FFR）与频域光学相干断层扫描（FD - OCT）测量的管腔参数之间的相关性，并确定FD - OCT在识别严重冠状动脉狭窄方面的诊断能力。
连续对30例患者的41处冠状动脉狭窄进行定量冠状动脉造影（QCA）、FFR和FD - OCT评估。若FFR≤0.80，则将狭窄标记为严重狭窄。使用FD - OCT测量最小管腔面积（MLA）、最小管腔直径（MLD）和管腔面积狭窄百分比（%AS）。
10处狭窄（24.4%）的FFR≤0.80。发现FFR与FD - OCT测量的MLA（r² = 0.4，p < 0.001）、MLD（r² = 0.28，p < 0.001）和%AS（r² = 0.13，p = 0.02）之间存在较弱但显著的相关性。在整个研究组中，MLA和MLD在识别显著狭窄方面的诊断效率中等。MLA的曲线下面积（AUC）为0.80 [95%置信区间（CI）：0.64 - 0.91]，MLD的AUC为0.76（95% CI：0.60 - 0.88）。FD - OCT测量的管腔参数用于识别FFR≤0.80的狭窄的最佳截断值，MLA为1.62 mm² [特异性97%，敏感性70%，阳性预测值（PPV）89%，阴性预测值（NPV）91%]，MLD为1.23 mm（特异性87%，敏感性70%，PPV 64%，NPV 90%）。MLA在识别参考直径<3 mm的血管中的显著狭窄方面诊断效率较高。AUC为0.96（95% CI：0.83 - 1.0）。
发现FFR值与FD - OCT解剖参数MLA、MLD显著相关。在整个研究组中，FD - OCT测量的MLA和MLD在显著狭窄的功能评估中显示出中等诊断效率。FD - OCT测量的MLA在识别参考直径<3 mm的血管中的严重冠状动脉狭窄方面具有较高诊断效率。
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