CT衍生的静息主动脉远端压力比值（静息Pd/Pa）及CT衍生的血流储备分数（CT-FFR）在冠状动脉病变严重程度评估中的诊断性能。

Diagnostic performance of CT-derived resting distal to aortic pressure ratio (resting Pd/Pa) CT-derived fractional flow reserve (CT-FFR) in coronary lesion severity assessment.

作者信息

Li Quan, Zhang Yang, Wang Chunliang, Dong Shiming, Mao Yijin, Tang Yida, Zeng Yong

机构信息

Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Departement of Biomedical Engineering and Health Systems, KTH - Royal Institute of Technology, Stockholm, Sweden.

出版信息

Ann Transl Med. 2021 Sep;9(17):1390. doi: 10.21037/atm-21-4325.

BACKGROUND

Computed tomography-derived fractional flow reserve (CT-FFR) has emerged as a promising non-invasive substitute for fractional flow reserve (FFR) measurement. Normally, CT-FFR providing functional signiﬁcance of coronary artery disease (CAD) by using a simplified total coronary resistance index (TCRI) model. Yet the error or discrepancy caused by this simplified model remains unclear.

METHODS

A total of 20 consecutive patients with suspected CAD who underwent CTA and invasive FFR measurement were retrospectively analyzed. CT-FFR and CT-(Pd/Pa) values derived from the coronary CTA images. The diagnostic performance of CT-FFR and CT-(Pd/Pa) were evaluated on a per-vessel level using C statistics with invasive FFR<0.80 as the reference standard.

RESULTS

Of the 25 vessels eventually analyzed, the prevalence of functionally signiﬁcant CAD were 64%. The Youden index of the ROC curve indicated that the best cutoff value of invasive resting Pd/Pa was 0.945 for identifying functionally significant lesions. Sensitivity, speciﬁcity, negative predictive value, positive predictive value and accuracy were 85%, 91%, 92%, 83% and 88% for CT-(Pd/Pa) and 85%, 58% 69%, 78% and 72% for CT-FFR. Area under the receiver-operating characteristic curve (AUC) to detect functionally signiﬁcant stenoses of CT-(Pd/Pa) and CT-FFR were 0.87 and 0.90.

CONCLUSIONS

In this study, the results suggest CT-derived resting Pd/Pa has a potential advantage over CT-FFR in triaging patients for revascularization.

背景

计算机断层扫描衍生的血流储备分数（CT-FFR）已成为一种有前景的用于测量血流储备分数（FFR）的非侵入性替代方法。通常，CT-FFR通过使用简化的总冠状动脉阻力指数（TCRI）模型来提供冠状动脉疾病（CAD）的功能意义。然而，这种简化模型所导致的误差或差异仍不明确。

方法

回顾性分析了连续20例疑似CAD且接受CT血管造影（CTA）和有创FFR测量的患者。从冠状动脉CTA图像中得出CT-FFR和CT-（Pd/Pa）值。以有创FFR<0.80作为参考标准，在每个血管水平上使用C统计量评估CT-FFR和CT-（Pd/Pa）的诊断性能。

结果

在最终分析的25条血管中，具有功能意义的CAD患病率为64%。ROC曲线的约登指数表明，用于识别具有功能意义病变的有创静息Pd/Pa的最佳截断值为0.945。CT-（Pd/Pa）的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为85%、91%、92%、83%和88%，CT-FFR的分别为85%、58%、69%、78%和72%。检测具有功能意义狭窄的CT-（Pd/Pa）和CT-FFR的受试者操作特征曲线下面积（AUC）分别为0.87和0.90。