CT 血管造影预测中重度病变的血流动力学意义：与定量冠状动脉造影使用血流储备分数作为参考标准的头对头比较
CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard.
机构信息
Department of Medicine, Los Angeles Biomedical Research Center, Torrance, California.
Cedars-Sinai Heart Institute and Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
JACC Cardiovasc Imaging. 2016 May;9(5):559-64. doi: 10.1016/j.jcmg.2015.08.021. Epub 2016 Feb 17.
OBJECTIVES
The goal of this study was to compare the diagnostic performance of coronary computed tomography angiography (CTA) versus quantitative coronary angiography (QCA) for the detection of lesion-specific ischemia using fractional flow reserve (FFR) as the gold standard.
BACKGROUND
Coronary CTA has emerged as a noninvasive method for accurate detection and exclusion of high-grade coronary stenoses. FFR is the gold standard for determining lesion-specific ischemia and has been shown to improve clinical outcomes when guiding revascularization.
METHODS
A total of 252 patients from 5 countries were prospectively enrolled (mean age 63 years; 71% male). Patients underwent coronary CTA and invasive coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and FFR were interpreted by independent core laboratories. Stenosis severity according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%, 50% to 69%, and 70% to 100%; stenosis ≥50% was considered anatomically obstructive. Lesion-specific ischemia was defined according to FFR ≤0.8, whereas QCA and coronary CTA stenosis ≥50% were considered obstructive. Diagnostic accuracy and areas under the receiver-operating characteristics curve (AUC) for lesion-specific ischemia was assessed.
RESULTS
According to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for QCA (p = 0.6). No differences between CTA and QCA existed for discrimination of ischemia within the left anterior descending artery (AUC 0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p = 0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6).
CONCLUSIONS
CTA and ICA exhibited similar diagnostic performance for the detection and exclusion of lesion-specific ischemia. Using a true reference standard to determine appropriate revascularization targets, 3-dimensional coronary CTA performed as well as 2-dimensional ICA.
目的
本研究旨在比较冠状动脉计算机断层扫描血管造影（CTA）与定量冠状动脉造影（QCA）在检测以血流储备分数（FFR）为金标准的病变特异性缺血方面的诊断性能。
背景
冠状动脉 CTA 已成为一种准确检测和排除高等级冠状动脉狭窄的非侵入性方法。FFR 是确定病变特异性缺血的金标准，并且当指导血运重建时，已显示可改善临床结局。
方法
本研究前瞻性纳入了来自 5 个国家的 252 例患者（平均年龄 63 岁，71%为男性）。252 例患者共 407 处病变接受了冠状动脉 CTA 和有 FFR 的有创冠状动脉造影（ICA）检查。冠状动脉 CTA、QCA 和 FFR 由独立的核心实验室进行解读。根据冠状动脉 CTA 和 QCA 对狭窄程度进行分级，0%至 29%、30%至 49%、50%至 69%和 70%至 100%；狭窄程度≥50%被认为是解剖学上的阻塞。根据 FFR≤0.8 定义病变特异性缺血，而 QCA 和冠状动脉 CTA 狭窄程度≥50%被认为是阻塞性病变。评估了病变特异性缺血的诊断准确性和受试者工作特征曲线下面积（AUC）。
结果
根据 FFR，407 处病变中有 151 处（37%）存在缺血。冠状动脉 CTA 的诊断准确性、敏感度、特异度、阳性预测值和阴性预测值分别为 69%、79%、63%、55%和 83%；QCA 的分别为 71%、74%、70%、59%和 82%。用于识别缺血性病变的 AUC 相似：冠状动脉 CTA 为 0.75，QCA 为 0.77（p=0.6）。冠状动脉 CTA 和 QCA 之间在左前降支（AUC 0.71 与 0.73；p=0.6）、左旋支（AUC 0.78 与 0.85；p=0.4）和右冠状动脉（AUC 0.80 与 0.83；p=0.6）内区分缺血病变方面无差异。
结论
CTA 和 ICA 在检测和排除病变特异性缺血方面表现出相似的诊断性能。使用真正的参考标准来确定适当的血运重建目标，三维冠状动脉 CTA 的表现与二维 ICA 一样好。
Zotero 插件