Osawa Kazuhiro, Miyoshi Toru, Miki Takashi, Koide Yuji, Kawai Yusuke, Ejiri Kentaro, Yoshida Masatoki, Sato Shuhei, Kanazawa Susumu, Ito Hiroshi
Department of Cardiovascular Medicine, Okayama University Hospital, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Department of Radiology, Okayama University Hospital, Okayama, Japan.
Heart Vessels. 2017 Apr;32(4):390-398. doi: 10.1007/s00380-016-0892-0. Epub 2016 Sep 13.
High diagnostic performance of noninvasive fractional flow reserve computed from CT (FFR-CT) was recently reported in prospective multicenter trials. The aims of this study were to evaluate the diagnostic accuracy of FFR-CT in clinical practice and to examine the lesion characteristics showing a mismatch between FFR-CT and invasive FFR. A total of 20 patients (29 vessels) with suspected coronary artery disease were included. All patients underwent invasive coronary angiography and invasive FFR according to coronary artery CT angiography (CCTA) findings. The same raw data used for CCTA were used to evaluate FFR-CT. Results from FFR-CT were compared with invasively measured FFR. A positive ischemia was defined as FFR <0.80. Analyses from three vessels in two patients were not evaluated because of severe calcification or motion artifacts. The diagnostic accuracy, sensitivity, and specificity of FFR-CT per-vessel basis were 81, 100, and 69 %, respectively. To find the reason for mismatch in positive ischemia, lesion characteristics determined with CCTA were compared between the matched group and the mismatched group. A significant difference in bifurcation lesions with positive remodeling was observed between the matched group and the mismatched group (p < 0.01). The high sensitivity of FFR-CT may provide an additional support to the use of CCTA, although particular attention should be paid when using FFR-CT in bifurcation lesions with positive remodeling.
最近在前瞻性多中心试验中报告了基于CT计算的无创血流储备分数（FFR-CT）具有较高的诊断性能。本研究的目的是评估FFR-CT在临床实践中的诊断准确性，并检查显示FFR-CT与有创FFR不匹配的病变特征。共纳入20例疑似冠心病患者（29支血管）。所有患者均根据冠状动脉CT血管造影（CCTA）结果接受了有创冠状动脉造影和有创FFR检查。用于CCTA的相同原始数据被用于评估FFR-CT。将FFR-CT的结果与有创测量的FFR进行比较。将FFR<0.80定义为阳性缺血。由于严重钙化或运动伪影，两名患者的三支血管分析未纳入评估。FFR-CT单支血管的诊断准确性、敏感性和特异性分别为81%、100%和69%。为了找出阳性缺血不匹配的原因，比较了匹配组和不匹配组通过CCTA确定的病变特征。匹配组和不匹配组之间在有正向重构的分叉病变方面观察到显著差异（p<0.01）。FFR-CT的高敏感性可能为CCTA的使用提供额外支持，尽管在有正向重构的分叉病变中使用FFR-CT时应特别注意。
