Xia Guozhi, Fan Di, Yao Xiaowei, Guan Gongchang, Wang Junkui
a Department of Cardiovascular , First Affiliated Hospital of Medical College, Xi'an Jiaotong University , Xi'an , Shaanxi , China.
b Department of Radiology , Tangdu Hospital, Fourth Military Medical University , Xi'an , Shaanxi , China.
Acta Cardiol. 2018 Feb;73(1):76-83. doi: 10.1080/00015385.2017.1335037. Epub 2017 Aug 22.
The management of patients with intermediate coronary lesions is a major clinical issue. Fractional flow reserve (FFR) is considered the gold criterion for the assessment of ischaemic stenosis, but it requires an invasive procedure. Coronary computed tomography angiography (CTA) for fractional flow reserve (FFR) is a novel noninvasive alternative for the diagnosis of ischaemic lesions. The aim was to determine the diagnostic efficacy of FFR for ischaemic coronary artery stenosis lesions of intermediate severity.
A total of 129 patients underwent 64-row dual-source CTA and invasive coronary angiography (ICA). In all, 156 vessels were identified as intermediate-grade coronary artery stenosis by subsequent ICA, defined as a maximum diameter reduction of 50%-70%. The FFR was also measured during ICA. FFR was computed from the three-dimensional dual-source CTA model and coronary flow dynamics data.
Per-patient diagnostic sensitivity, specificity, positive predictive values, negative predictive values and accuracy of FFR amounted to 89.2%, 81.5%, 66.0%, 94.9% and 83.7%, respectively; and 86.9%, 73.6%, 58.0%, 93.1% and 77.6% on the per-vessel basis, respectively. FFR and FFR showed a good positive correlation. Bland-Altman analysis displayed good concordance between FFR and FFR. The receiver operating characteristic curve revealed that the area under the curve of FFR was 0.918 (95% confidence interval 0.849-0.986) on the per-patient analysis and 0.916 (95% confidence interval 0.863-0.969) on per-vessel analysis, respectively.
FFR is featured by moderate accuracy in discriminating lesions of intermediate coronary artery stenosis that cause myocardial ischaemia. Impact statement How to treat intermediate coronary stenosis represents a major clinical issue. FFR has recently emerged as a novel noninvasive method evaluating ischemic lesions. In this study, we defined such lesion as 50-70% diameter stenosis. We designed the study to assess the diagnostic efficacy of FFR both at per-vessel level and at per-vessel levels for ischemic lesions.
中度冠状动脉病变患者的管理是一个主要的临床问题。血流储备分数（FFR）被认为是评估缺血性狭窄的金标准，但它需要进行侵入性操作。用于血流储备分数（FFR）的冠状动脉计算机断层扫描血管造影（CTA）是诊断缺血性病变的一种新型非侵入性替代方法。目的是确定FFR对中度严重程度的缺血性冠状动脉狭窄病变的诊断效能。
共有129例患者接受了64排双源CTA和侵入性冠状动脉造影（ICA）检查。通过后续的ICA，共识别出156支血管为中度冠状动脉狭窄，定义为最大直径减少50%-70%。在ICA检查期间也测量了FFR。FFR是根据三维双源CTA模型和冠状动脉血流动力学数据计算得出的。
FFR的患者诊断敏感性、特异性、阳性预测值、阴性预测值和准确性分别为89.2%、81.5%、66.0%、94.9%和83.7%；在每支血管基础上分别为86.9%、73.6%、58.0%、93.1%和77.6%。FFR与FFR显示出良好的正相关。Bland-Altman分析显示FFR与FFR之间具有良好的一致性。受试者工作特征曲线显示，在患者分析中FFR的曲线下面积为0.918（95%置信区间0.849-0.986），在每支血管分析中为0.916（95%置信区间0.863-0.969）。
FFR在鉴别导致心肌缺血的中度冠状动脉狭窄病变方面具有中等准确性。影响声明如何治疗中度冠状动脉狭窄是一个主要的临床问题。FFR最近已成为一种评估缺血性病变的新型非侵入性方法。在本研究中，我们将此类病变定义为直径狭窄50%-70%。我们设计该研究以评估FFR在每支血管水平和每支血管水平上对缺血性病变的诊断效能。
