通过定量冠状动脉造影得出的狭窄血流储备在预测经血流储备分数评估的具有功能意义的冠状动脉狭窄方面具有适度但递增的价值。
Stenotic flow reserve derived from quantitative coronary angiography has modest but incremental value in predicting functionally significant coronary stenosis as evaluated by fractional flow reserve.
作者信息
Potter Elizabeth L, Machado Colin, Malaiapan Yuvaraj, Narayan Om, Ko Brian S H, Psaltis Peter J, Munnur Kiran, Cameron James D, Meredith Ian T, Wong Dennis Thiam Leong
机构信息
Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia.
Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia;; Department of Medicine, University of Adelaide & Heart Health Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia.
出版信息
Cardiovasc Diagn Ther. 2017 Feb;7(1):52-59. doi: 10.21037/cdt.2016.12.01.
BACKGROUND
Stenotic flow reserve (SFR) derived from quantitative coronary angiography (QCA) has been correlated with myocardial ischaemia as determined by pharmacological stress echocardiography. However, the diagnostic accuracy of SFR in predicting functionally significant coronary stenosis as assessed by the gold standard, fractional flow reserve (FFR), has not been previously characterised.
METHODS
Patients who underwent coronary angiography and FFR assessment between January 2010 and February 2012 in a single tertiary centre were retrospectively assessed. QCA parameters such as minimal lumen diameter (MLD), lesion length, diameter stenosis (DS), SFR, turbulent resistance (TR) and Poiseuille resistance (PR) were assessed. Significant FFR was defined as FFR ≤0.8. The diagnostic accuracy of QCA parameters to predict significant FFR was assessed by independent t-test and receiver operator characteristic (ROC) curve. Statistical significance was defined as P value of <0.05.
RESULTS
The study included 272 patients (age: 64±11, 70% males) and 415 vessels. There were 180 (43%) vessels which were FFR significant. The mean FFR value for all vessels was 0.81±0.11. On comparison of AUC for predicting significant FFR, SFR (AUC =0.76) had the highest diagnostic accuracy compared to PR (AUC =0.75), % DS (AUC =0.73), TR (AUC =0.69), MLD (AUC =0.71) and DS >50% (AUC =0.64). Using a retrospectively determined optimal cut-off value of 3.51, the sensitivity of stenotic-flow-reserve was modest at 56% with good specificity of 81%. DS >50% had a sensitivity of 47% and specificity of 82% in predicting significant FFR. There was incremental predictive value when SFR was added to DS >50% on integrated discrimination improvement index (IDI =0.103, P<0.001) and net reclassification index (NRI =0.72, P<0.001).
CONCLUSIONS
SFR has modest diagnostic accuracy for predicting significant FFR but adds incremental predictive value to DS >50% for predicting significant FFR.
背景
源自定量冠状动脉造影（QCA）的狭窄血流储备（SFR）已与通过药物负荷超声心动图确定的心肌缺血相关。然而，SFR在预测经金标准——血流储备分数（FFR）评估的具有功能意义的冠状动脉狭窄方面的诊断准确性此前尚未得到描述。
方法
对2010年1月至2012年2月在单个三级中心接受冠状动脉造影和FFR评估的患者进行回顾性评估。评估QCA参数，如最小管腔直径（MLD）、病变长度、直径狭窄（DS）、SFR、湍流阻力（TR）和泊肃叶阻力（PR）。将显著FFR定义为FFR≤0.8。通过独立t检验和受试者操作特征（ROC）曲线评估QCA参数预测显著FFR的诊断准确性。统计学显著性定义为P值<0.05。
结果
该研究纳入了272例患者（年龄：64±11岁，70%为男性）和415支血管。有180支（43%）血管的FFR显著。所有血管的平均FFR值为0.81±0.11。在比较预测显著FFR的AUC时，SFR（AUC =0.76）与PR（AUC =0.75）、%DS（AUC =0.73）、TR（AUC =0.69）、MLD（AUC =0.71）和DS>50%（AUC =0.64）相比，具有最高的诊断准确性。使用回顾性确定的最佳截断值3.51，狭窄血流储备的敏感性为56%，特异性良好，为81%。DS>50%在预测显著FFR时的敏感性为47%，特异性为82%。当将SFR添加到DS>50%时，综合判别改善指数（IDI =0.103，P<0.001）和净重新分类指数（NRI =0.72，P<0.001）有增加的预测价值。
结论
SFR在预测显著FFR方面具有中等诊断准确性，但在预测显著FFR方面比DS>50%增加了预测价值。
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