冠状动脉 CT 血管成像血流储备分数分析的排斥率的决定因素。
Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis.
机构信息
From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.).
出版信息
Radiology. 2019 Sep;292(3):597-605. doi: 10.1148/radiol.2019182673. Epub 2019 Jul 23.
Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFR Purpose To determine the rejection rate of FFR analysis and to determine factors associated with technically unsuccessful calculation of FFR Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFR in Coronary Care (ADVANCE) registry (: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFR rejection rate (defined as an inability to perform quantitative analysis with FFR). Factors that were associated with FFR rejection rate were assessed with multiple linear regression. Results In the ADVANCE registry, FFR rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFR rejection rate was 8.4% ( = 892; 95% CI: 6.2%, 7.2%; < .001 vs the ADVANCE cohort). The main reason for the inability to perform FFR analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; < .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; < .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; < .001) cohorts were independent predictors of rejection. Conclusion The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Thinner CT section thickness and lower patient heart rate may increase rates of completion of CT fractional flow reserve analysis. Published under a CC BY 4.0 license. See also the editorial by Sakuma in this issue.
背景
从 CT 血管造影（FFT）得出的冠状动脉分流量储备（FFR）可实现冠状动脉狭窄的功能评估。先前的临床试验表明，有 13%-33%的冠状动脉 CT 血管造影研究因定量分析 FFR 而质量不足。目的：确定 FFR 分析的拒绝率，并确定与 FFR 计算技术不成功相关的因素。材料与方法：前瞻性采集冠状动脉 CT 血管造影扫描，作为评估非侵入性 FFR 在冠状动脉护理中的诊断价值（ADVANCE）注册研究（NCT02499679）的一部分，以及用于临床分析的冠状动脉 CT 血管造影系列，均包括在内。主要结果是 FFR 拒绝率（定义为无法进行 FFR 定量分析）。使用多元线性回归评估与 FFR 拒绝率相关的因素。结果：在 ADVANCE 注册研究中，由于图像质量不足导致的 FFR 拒绝率为 2.9%（2778 例患者中有 80 例；95%置信区间[CI]：2.1%，3.2%）。在接受临床分析的 10621 例连续患者中，FFR 拒绝率为 8.4%（=892；95%CI：6.2%，7.2%；<.001 与 ADVANCE 队列相比）。无法进行 FFR 分析的主要原因是存在运动伪影（ADVANCE 队列中有 63 例[78%]，临床队列中有 729 例[64%]）。多变量分析显示，ADVANCE（比值比[OR]，1.04；95%CI：1.001，1.09；=0.045）和临床（OR，1.03；95%CI：1.02，1.04；<.001）队列中的节段厚度和 ADVANCE（OR，1.05；95%CI：1.02，1.08；<.001）和临床（OR，1.06；95%CI：1.05，1.07；<.001）队列中的心率是拒绝的独立预测因素。结论：ADVANCE 注册研究和大型临床队列中，技术上不成功的 CT 衍生分流量储备的比率分别为 2.9%和 8.4%。更薄的 CT 节段厚度和更低的患者心率可能会增加 CT 分流量储备分析的完成率。在 CC BY 4.0 许可下发布。也可参见本期 Sakuma 的社论。
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