压降系数相对于血流储备分数和冠状动脉血流储备的诊断性能。

Diagnostic performance of pressure drop coefficient in relation to fractional flow reserve and coronary flow reserve.

作者信息

Kolli Kranthi K, Arif Imran, Peelukhana Srikara V, Succop Paul, Back Lloyd H, Helmy Tarek A, Leesar Massoud A, Effat Mohamed A, Banerjee Rupak K

机构信息

Department of Mechanical and Materials Engineering, 598 Rhodes Hall, PO Box 210072, Cincinnati, OH 45221-0072 USA.

出版信息

J Invasive Cardiol. 2014 May;26(5):188-95.

PMID:24791716

Abstract

OBJECTIVES AND BACKGROUND

Functional assessment of coronary lesion severity during cardiac catheterization is conducted using diagnostic parameters like fractional flow reserve (FFR; pressure derived) and coronary flow reserve (CFR; flow derived). However, the complex hemodynamics of stenosis might not be sufficiently explained by either pressure or flow alone, particularly in the case of intermediate stenosis. CDP (ratio of pressure drop across a stenosis to distal dynamic pressure), a non-dimensional index derived from fundamental fluid dynamic principles based on a combination of intracoronary pressure and flow, may improve the functional assessment of coronary lesion severity.

METHODS

We performed a meta-analysis of seven studies, retrieved from MEDLINE and PubMed, comparing the results of FFR and CFR of the same lesions. Two studies reported functional measurements (pressure and flow) obtained in individual patients. Five studies reported two-dimensional plots of FFR vs. CFR. The FFR and CFR data were digitized and corresponding functional measurements were extracted using the reported mean values of hemodynamic data from each of the five studies. The receiver operating characteristic (ROC) curve was used to identify the optimal cut-off point of CDP, which corresponds to the clinically used cut-off values (FFR = 0.80, FFR = 0.75, and CFR = 2.0).

RESULTS

CDP correlated significantly with FFR (r = 0.78; P<.001) and had significant diagnostic efficiency (area under the ROC curve = 89%), specificity (83% and 85%), and sensitivity (81% and 76%) at FFR <0.8 and FFR <0.75, respectively. The corresponding cut-off value for CDP to detect FFR <0.80 and FFR <0.75 was at CDP >27.1 and CDP >27.9, respectively.

CONCLUSIONS

CDP, a functional parameter based on both intracoronary pressure and flow measurements, has close agreement (area under the ROC curve = 89%) with FFR, the most frequently used method for evaluation of coronary stenosis severity.

摘要

目的与背景

在心脏导管插入术中，使用诸如血流储备分数（FFR；基于压力得出）和冠状动脉血流储备（CFR；基于血流得出）等诊断参数对冠状动脉病变严重程度进行功能评估。然而，狭窄的复杂血流动力学可能无法仅通过压力或血流充分解释，尤其是在中度狭窄的情况下。CDP（狭窄两端压力降与远端动态压力之比）是一种无量纲指数，基于冠状动脉内压力和血流的组合，从基本流体动力学原理推导得出，可能会改善冠状动脉病变严重程度的功能评估。

方法

我们对从MEDLINE和PubMed检索到的七项研究进行了荟萃分析，比较同一病变的FFR和CFR结果。两项研究报告了个体患者获得的功能测量值（压力和血流）。五项研究报告了FFR与CFR的二维图。将FFR和CFR数据数字化，并使用五项研究中每项报告的血流动力学数据平均值提取相应的功能测量值。采用受试者工作特征（ROC）曲线确定CDP的最佳截断点，该截断点对应于临床使用的截断值（FFR = 0.80、FFR = 0.75和CFR = 2.0）。

结果

CDP与FFR显著相关（r = 0.78；P <.001），在FFR <0.8和FFR <0.75时，分别具有显著的诊断效率（ROC曲线下面积 = 89%）、特异性（83%和85%）和敏感性（81%和76%）。检测FFR <0.80和FFR <0.75时，CDP的相应截断值分别为CDP >27.1和CDP >27.9。