一项关于基于冠状动脉计算机断层扫描血管造影的简化方法得出的无创血流储备分数在疑似冠状动脉疾病中的研究。

A study of noninvasive fractional flow reserve derived from a simplified method based on coronary computed tomography angiography in suspected coronary artery disease.

作者信息

Shi Changzheng, Zhang Dong, Cao Kunlin, Zhang Tao, Luo Liangping, Liu Xin, Zhang Heye

机构信息

Medical Imaging Center, The First Affiliated Hospital, Jinan University, 613 Huangpu W Ave, Tianhe District, Guangzhou, 510630, Guangdong Province, China.

Research and Development Department, Shenzhen Keya Medical Technology, Co., Ltd., Longgang District, Shenzhen, 518116, Guangdong Province, China.

出版信息

Biomed Eng Online. 2017 Apr 14;16(1):43. doi: 10.1186/s12938-017-0330-2.

BACKGROUND

The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. Determining non-invasive FFR based on coronary computed tomographic angiography datasets using computational fluid dynamics tends to be a demanding process. Therefore, the diagnostic performance of a simplified method for the calculation of FFR requires further evaluation.

OBJECTIVES

The aim of this study was to investigate the diagnostic performance of FFR calculated based on a simplified method by referring to the invasive FFR in patient-specific coronary arteries and clinical decision-making.

METHODS

Twenty-nine subjects included in this study underwent CCTA before undergoing clinically indicated invasive coronary angiography for suspected coronary artery disease. Pulsatile flow simulation and a novel boundary condition were used to obtain FFR based on the CCTA datasets. The Pearson correlation, Bland-Altman plots and the diagnostic performance of FFR and CCTA stenosis were analyzed by comparison to the invasive FFR reference standard. Ischaemia was defined as an FFR or FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA stenosis >50%.

RESULTS

FFR and invasive FFR were well correlated (r = 0.742, P = 0.001). Slight systematic underestimation was found in FFR (mean difference 0.03, standard deviation 0.05, P = 0.001). The area under the receiver-operating characteristic curve was 0.93 for FFR and 0.75 for CCTA on a per-vessel basis. Per-patient accuracy, sensitivity and specificity were 79.3, 93.7 and 61.5%, respectively, for FFR and 62.1, 87.5 and 30.7%, respectively, for CCTA. Per-vessel accuracy, sensitivity and specificity were 80.6, 94.1 and 68.4%, respectively, for FFR and 61.6, 88.2 and 36.8%, respectively, for CCTA.

CONCLUSIONS

FFR derived from pulsatile simulation with a simplified novel boundary condition was in good agreement with invasive FFR and showed better diagnostic performance compared to CCTA, suggesting that the simplified method has the potential to be an alternative and accurate way to assess the haemodynamic characteristics for coronary stenosis.

背景

有创血流储备分数一直被认为是识别疑似冠心病患者缺血相关狭窄的金标准。基于冠状动脉计算机断层血管造影（CCTA）数据集，使用计算流体动力学来确定无创血流储备分数往往是一个复杂的过程。因此，一种简化的血流储备分数计算方法的诊断性能需要进一步评估。

目的

本研究旨在通过参考特定患者冠状动脉的有创血流储备分数及临床决策，探讨基于简化方法计算的血流储备分数的诊断性能。

方法

本研究纳入的29名受试者在因疑似冠心病接受临床指征的有创冠状动脉造影之前接受了CCTA检查。基于CCTA数据集，采用脉动流模拟和一种新的边界条件来获取血流储备分数。通过与有创血流储备分数参考标准进行比较，分析血流储备分数与CCTA狭窄的Pearson相关性、Bland-Altman图及诊断性能。缺血定义为血流储备分数≤0.80，解剖学上有阻塞性冠心病定义为CCTA狭窄>50%。

结果

血流储备分数与有创血流储备分数相关性良好（r = 0.742，P = 0.001）。发现血流储备分数存在轻微的系统性低估（平均差异0.03，标准差0.05，P = 0.001）。在单支血管基础上，血流储备分数的受试者工作特征曲线下面积为0.93，CCTA为0.75。血流储备分数的患者准确率、敏感性和特异性分别为79.3%、93.7%和61.5%，CCTA分别为62.1%、87.5%和30.7%。血流储备分数的单支血管准确率、敏感性和特异性分别为80.6%、94.1%和68.4%，CCTA分别为61.6%、88.2%和36.8%。