Li Changling, Leng Xiaochang, He Jingsong, Xia Yongqing, Jiang Wenbing, Pan Yibin, Dong Liang, Sun Yong, Hu Xinyang, Wang Jian'an, Xiang Jianping, Jiang Jun
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
ArteryFlow Technology Co., Ltd., Hangzhou, China.
Front Cardiovasc Med. 2021 Oct 12;8:714077. doi: 10.3389/fcvm.2021.714077. eCollection 2021.
A new method for calculating fraction flow reserve (FFR) without pressure-wire (angiography-derived FFR) based on invasive coronary angiography (ICA) images can be used to evaluate the functional problems of coronary stenosis. The aim of this study was to assess the diagnostic performance of a novel method of calculating the FFR compared to wire-based FFR using retrospectively collected data from patients with stable angina. Three hundred patients with stable angina pectoris who underwent ICA and FFR measurement were included in this study. Two ICA images with projections >25° apart at the end-diastolic frame were selected for 3D reconstruction. Then, the contrast frame count was performed in an angiographic run to calculate the flow velocity. Based on the segmented vessel, calculated velocity, and aortic pressure, AccuFFRangio distribution was calculated through the pressure drop equation. Using FFR ≤ 0.8 as a reference, we evaluated AccuFFRangio performance for 300 patients with its accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Comparison of AccuFFRangio with wire-measured FFR resulted in an area under the curve (AUC) of 0.954 (per-vessel, < 0.0001). Accuracy for AccuFFRangio was 93.7% for Pa set from measurement and 87% for Pa = 100 mmHg in this clinical study. Overall sensitivity, specificity, PPV, and NPV for per-vessel were 90, 95, 86.7, 96.3, and 57.5, 97.7, 90.2, 86.3%, respectively. Overall accuracy, sensitivity, specificity, PPV, and NPV for 2-dimensional (2D) quantitative coronary angiography (QCA) were 63.3, 42.5, 70.9, 34.7, and 77.2%, respectively. The average processing time of AccuFFRangio was 4.30 ± 1.87 min. AccuFFRangio computed from coronary ICA images can be an accurate and time-efficient computational tool for detecting lesion-specific ischemia of coronary artery stenosis.
一种基于有创冠状动脉造影（ICA）图像、无需压力导丝计算血流储备分数（FFR）的新方法（血管造影衍生FFR）可用于评估冠状动脉狭窄的功能问题。本研究的目的是使用从稳定型心绞痛患者回顾性收集的数据，评估一种计算FFR的新方法与基于导丝的FFR相比的诊断性能。本研究纳入了300例行ICA和FFR测量的稳定型心绞痛患者。选择舒张末期帧投影角度相差>25°的两张ICA图像进行三维重建。然后，在血管造影过程中进行对比帧数计数以计算流速。基于分割的血管、计算出的流速和主动脉压力，通过压降方程计算AccuFFRangio分布。以FFR≤0.8为参考，我们评估了300例患者的AccuFFRangio性能，包括其准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。AccuFFRangio与导丝测量的FFR比较，曲线下面积（AUC）为0.954（每支血管，<0.0001）。在本临床研究中，测量得到的Pa时AccuFFRangio的准确性为93.7%，Pa = 100 mmHg时为87%。每支血管的总体敏感性、特异性、PPV和NPV分别为90%、95%、86.7%、96.3%，以及57.5%、97.7%、90.2%、86.3%。二维（2D）定量冠状动脉造影（QCA）的总体准确性、敏感性、特异性、PPV和NPV分别为63.3%、42.5%、70.9%、34.7%和77.2%。AccuFFRangio的平均处理时间为4.30±1.87分钟。从冠状动脉ICA图像计算出的AccuFFRangio可以成为检测冠状动脉狭窄病变特异性缺血的准确且高效的计算工具。
