Eberhard Matthias, Nadarevic Tin, Cousin Andrej, von Spiczak Jochen, Hinzpeter Ricarda, Euler Andre, Morsbach Fabian, Manka Robert, Keller Dagmar I, Alkadhi Hatem
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Radiology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
Cardiovasc Diagn Ther. 2020 Aug;10(4):820-830. doi: 10.21037/cdt-20-381.
Computed tomography (CT)-derived fractional flow reserve (FFR) enables the non-invasive functional assessment of coronary artery stenosis. We evaluated the feasibility and potential clinical role of FFR in patients presenting to the emergency department with acute chest pain who underwent chest-pain CT (CPCT).
For this retrospective IRB-approved study, we included 56 patients (median age: 62 years, 14 females) with acute chest pain who underwent CPCT and who had at least a mild (≥25% diameter) coronary artery stenosis. CPCT was evaluated for the presence of acute plaque rupture and vulnerable plaque features. FFR measurements were performed using a machine learning-based software. We assessed the agreement between the results from FFR and patient outcome (including results from invasive catheter angiography and from any non-invasive cardiac imaging test, final clinical diagnosis and revascularization) for a follow-up of 3 months.
FFR was technically feasible in 38/56 patients (68%). Eleven of the 38 patients (29%) showed acute plaque rupture in CPCT; all of them underwent immediate coronary revascularization. Of the remaining 27 patients (71%), 16 patients showed vulnerable plaque features (59%), of whom 11 (69%) were diagnosed with acute coronary syndrome (ACS) and 10 (63%) underwent coronary revascularization. In patients with vulnerable plaque features in CPCT, FFRCT had an agreement with outcome in 12/16 patients (75%). In patients without vulnerable plaque features (n=11), one patient showed myocardial ischemia (9%). In these patients, FFR and patient outcome showed an agreement in 10/11 patients (91%).
Our preliminary data show that FFR is feasible in patients with acute chest pain who undergo CPCT provided that image quality is sufficient. FFR has the potential to improve patient triage by reducing further downstream testing but appears of limited value in patients with CT signs of acute plaque rupture.
计算机断层扫描（CT）衍生的血流储备分数（FFR）能够对冠状动脉狭窄进行无创功能评估。我们评估了FFR在因急性胸痛到急诊科就诊并接受胸痛CT（CPCT）检查的患者中的可行性及潜在临床作用。
对于这项经机构审查委员会批准的回顾性研究，我们纳入了56例因急性胸痛接受CPCT检查且至少有轻度（直径≥25%）冠状动脉狭窄的患者（中位年龄：62岁，14例女性）。评估CPCT是否存在急性斑块破裂和易损斑块特征。使用基于机器学习的软件进行FFR测量。我们评估了FFR结果与患者结局（包括有创导管血管造影和任何无创心脏成像检查结果、最终临床诊断和血运重建）在3个月随访期内的一致性。
FFR在38/56例患者（68%）中技术上可行。38例患者中有11例（29%）在CPCT中显示急性斑块破裂；他们均接受了即刻冠状动脉血运重建。其余27例患者（71%）中，16例患者显示易损斑块特征（59%），其中11例（69%）被诊断为急性冠状动脉综合征（ACS），10例（63%）接受了冠状动脉血运重建。在CPCT中有易损斑块特征的患者中，FFRCT与12/16例患者（75%）的结局一致。在无易损斑块特征的患者（n = 11）中，1例患者出现心肌缺血（9%）。在这些患者中，FFR与患者结局在10/11例患者（91%）中一致。
我们的初步数据表明，对于接受CPCT检查的急性胸痛患者，只要图像质量足够，FFR是可行的。FFR有可能通过减少进一步的下游检查来改善患者分诊，但在有急性斑块破裂CT征象的患者中似乎价值有限。
