Gong Yanjun, Feng Yundi, Yi Tieci, Yang Fan, Li Yuxi, Zhang Long, Zheng Bo, Hong Tao, Liu Zhaoping, Huo Yunlong, Li Jianping, Huo Yong
Department of Cardiology, Peking University First Hospital, Beijing, China.
PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.
Front Bioeng Biotechnol. 2020 Oct 21;8:596401. doi: 10.3389/fbioe.2020.596401. eCollection 2020.
Based on the aortic pressure waveform, a specially designed computational fluid dynamic (CFD) method was proposed to determine coronary angiography-derived diastolic pressure ratio (caDPR) without using invasive pressure wire. The aim of the study is to retrospectively assess diagnostic performance of the caDPR in the catheterization laboratory, based on a previous multicenter trial for online assessment of coronary angiography-derived FFR (caFFR).
Patients with diagnosis of stable or unstable angina pectoris were enrolled in six centers. Wire-derived FFR was measured in coronary arteries with 30-90% diameter stenosis. Offline caDPR was assessed in blinded fashion against wire-derived FFR at an independent core laboratory. A total of 330 patients who met the inclusion/exclusion criteria were enrolled from June 26 to December 18, 2018. Offline computed caDPR and wire-derived FFR were compared in 328 interrogated vessels. The caDPR with a cutoff value of 0.89 shows diagnostic accuracy of 87.7%, sensitivity of 89.5%, specificity of 86.8%, and AUC of 0.940 against the wire-derived FFR with a cutoff value of 0.80.
Using wired-based FFR as the standard reference, there is good diagnostic performance of the novel-CFD-design caDPR. Hence, caDPR could enhance the hemodynamic assessment of coronary lesions.
基于主动脉压力波形，提出一种专门设计的计算流体动力学（CFD）方法，以在不使用有创压力导丝的情况下确定冠状动脉造影衍生的舒张压比值（caDPR）。本研究的目的是基于先前一项用于在线评估冠状动脉造影衍生的血流储备分数（caFFR）的多中心试验，回顾性评估导管室中caDPR的诊断性能。
诊断为稳定型或不稳定型心绞痛的患者在六个中心入组。在直径狭窄30%-90%的冠状动脉中测量导丝衍生的FFR。在独立的核心实验室以盲法根据导丝衍生的FFR评估离线caDPR。2018年6月26日至12月18日，共纳入330例符合纳入/排除标准的患者。在328条受检血管中比较离线计算的caDPR和导丝衍生的FFR。caDPR的截断值为0.89时，相对于截断值为0.80的导丝衍生的FFR，诊断准确性为87.7%，敏感性为89.5%，特异性为86.8%，曲线下面积（AUC）为0.940。
以基于导丝的FFR作为标准参考，新型CFD设计的caDPR具有良好的诊断性能。因此，caDPR可增强对冠状动脉病变的血流动力学评估。
