Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden, ZA, 2333, The Netherlands.
Medis medical imaging systems B.V., Leiden, The Netherlands.
Eur J Nucl Med Mol Imaging. 2017 Oct;44(11):1888-1896. doi: 10.1007/s00259-017-3769-2. Epub 2017 Jul 6.
A new method has been developed to calculate fractional flow reserve (FFR) from invasive coronary angiography, the so-called "contrast-flow quantitative flow ratio (cQFR)". Recently, cQFR was compared to invasive FFR in intermediate coronary lesions showing an overall diagnostic accuracy of 85%. The purpose of this study was to investigate the relationship between cQFR and myocardial ischemia assessed by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI).
Patients who underwent SPECT MPI and coronary angiography within 3 months were included. The cQFR computation was performed offline, using dedicated software. The cQFR computation was based on 3-dimensional quantitative coronary angiography (QCA) and computational fluid dynamics. The standard 17-segment model was used to determine the vascular territories. Myocardial ischemia was defined as a summed difference score ≥2 in a vascular territory. A cQFR of ≤0.80 was considered abnormal.
Two hundred and twenty-four coronary arteries were analysed in 85 patients. Overall accuracy of cQFR to detect ischemia on SPECT MPI was 90%. In multivariable analysis, cQFR was independently associated with ischemia on SPECT MPI (OR per 0.01 decrease of cQFR: 1.10; 95% CI 1.04-1.18, p = 0.002), whereas clinical and QCA parameters were not. Furthermore, cQFR showed incremental value for the detection of ischemia compared to clinical and QCA parameters (global chi square 48.7 to 62.6; p <0.001).
A good relationship between cQFR and SPECT MPI was found. cQFR was independently associated with ischemia on SPECT MPI and showed incremental value to detect ischemia compared to clinical and QCA parameters.
一种新的方法已经被开发出来，用于从侵入性冠状动脉造影中计算血流储备分数（FFR），即所谓的“对比血流定量流量比（cQFR）”。最近，cQFR 与中间冠状动脉病变的侵入性 FFR 进行了比较，总体诊断准确性为 85%。本研究的目的是探讨 cQFR 与单光子发射计算机断层心肌灌注成像（SPECT MPI）评估的心肌缺血之间的关系。
纳入在 3 个月内接受 SPECT MPI 和冠状动脉造影的患者。cQFR 计算是在离线状态下使用专用软件进行的。cQFR 计算基于三维定量冠状动脉造影（QCA）和计算流体动力学。标准的 17 节段模型用于确定血管区域。心肌缺血定义为血管区域的总和差异评分≥2。cQFR≤0.80 被认为是异常的。
在 85 例患者的 224 条冠状动脉中进行了分析。cQFR 检测 SPECT MPI 上缺血的总体准确性为 90%。多变量分析显示，cQFR 与 SPECT MPI 上的缺血独立相关（cQFR 每降低 0.01 的比值比：1.10；95%置信区间 1.04-1.18，p=0.002），而临床和 QCA 参数则不然。此外，cQFR 在检测缺血方面比临床和 QCA 参数具有更大的增值作用（总体卡方值 48.7 至 62.6；p<0.001）。
发现 cQFR 与 SPECT MPI 之间存在良好的关系。cQFR 与 SPECT MPI 上的缺血独立相关，与临床和 QCA 参数相比，在检测缺血方面具有更大的增值作用。
