McNabney Charis G, Sellers Stephanie L, Wilson Ryan J A, Hart Shmuel, Rosenblatt Samuel A, Murphy Darra T, Blanke Philipp, Ahmadi Amir A, Halankar Jaydeep, Attinger-Toller Adrian, Godoy Zamorano Marcelo, Li Yu Janice Wong, Nørgaard Bjarne L, Leipsic Jonathon A, Weir-McCall Jonathan R
Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.).
Radiol Cardiothorac Imaging. 2019 Jun 27;1(2):e190021. doi: 10.1148/ryct.2019190021. eCollection 2019 Jun.
To examine the prognostic implication of fractional flow reserve (FFR) derived from coronary CT (FFR) in routine clinical practice.
Patients referred for FFR analysis at a single center between October 2015 and June 2017 were retrospectively included and followed up for rates of invasive angiography and clinical events. Two hundred seven patients underwent successful FFR analysis with seven lost to follow-up, leaving 200 (mean age ± standard deviation, 62.4 years ± 10.0; 49 [24.5%] women) patients for analysis. At coronary CT angiography, patients were categorized as having significant stenosis (SS) in the presence of a diameter stenosis greater than or equal to 50% (hereafter, SS positive) and flow limitation in the presence of a postlesion (that is, FFR measured 2 cm to the distal aspect of the lesion) FFR less than 0.80 (hereafter, FFR positive). Vessel-oriented clinical events (VOCEs) were defined as vessel-related late revascularization (>90 days), myocardial infarction, and cardiac mortality.
At CT angiography, 130 (65%) studies were SS positive and 63 (31.5%) were FFR positive. At median follow-up of 477 days (range, 252-859 days), there were 26 VOCE end points in 22 patients: 22 revascularizations and four nonfatal myocardial infarctions. VOCE end points occurred in zero of 58 (0%) of SS-negative and FFR negative patients, in eight of 79 (10.1%) of SS-positive and FFR-negative patients, in zero of 12 (0%) of SS-negative and FFR-positive patients, and in 18 of 51 (35.3%) of SS-positive and FFR-positive patients (log-rank χ = 30.1; < .001). At multivariable Cox regression, both FFR (hazard ratio per 0.1 decrease, 1.54 [95% confidence interval: 1.1, 2.2] = .013) and stenosis (hazard ratio per unit increase, 2.16 [95% confidence interval: 1.25, 3.72] = .006) were independently associated with VOCE.
Stenosis and FFR are independent predictors of intermediate-term outcomes. In the absence of a stenosis greater than 50%, a positive FFR result is not associated with an increased intermediate risk.© RSNA, 2019See also commentary by Fairbairn and Bull in this issue.
探讨冠状动脉CT衍生的血流储备分数（FFRCT）在常规临床实践中的预后意义。
回顾性纳入2015年10月至2017年6月在单一中心接受FFR分析的患者，并随访其有创血管造影率和临床事件发生率。207例患者成功进行了FFR分析，7例失访，最终纳入分析200例患者（平均年龄±标准差，62.4岁±10.0岁；49例[24.5%]为女性）。在冠状动脉CT血管造影检查中，直径狭窄大于或等于50%的患者被归类为存在显著狭窄（SS）阳性，病变部位（即病变远端2 cm处测量的FFR）FFR小于0.80的患者被归类为存在血流受限（即FFR阳性）。血管相关临床事件（VOCE）定义为血管相关的晚期血运重建（>90天）、心肌梗死和心源性死亡。
在CT血管造影检查中，130例（65%）研究为SS阳性，63例（31.5%）为FFR阳性。在中位随访477天（范围，252 - 859天）时，22例患者出现26个VOCE终点：22例血运重建和4例非致死性心肌梗死。SS阴性且FFR阴性的58例患者（0%）中未出现VOCE终点，SS阳性且FFR阴性的79例患者中有8例（10.1%）出现VOCE终点，SS阴性且FFR阳性的12例患者中未出现VOCE终点，SS阳性且FFR阳性的51例患者中有18例（35.3%）出现VOCE终点（对数秩检验χ² = 30.1；P <.001）。在多变量Cox回归分析中，FFR（每降低0.1的风险比，1.54[95%置信区间：1.1, 2.2]；P = 0.013）和狭窄（每增加1个单位的风险比，2.16[95%置信区间：1.25, 3.72]；P = 0.006）均与VOCE独立相关。
狭窄和FFR是中期预后的独立预测因素。在不存在大于50%狭窄的情况下，FFR阳性结果与中期风险增加无关。©RSNA，2019另见本期Fairbairn和Bull的评论。
