健康受试者充血性心肌血流知识有助于识别冠状动脉疾病患者的心肌缺血。
Knowledge of Hyperemic Myocardial Blood Flow in Healthy Subjects Helps Identify Myocardial Ischemia in Patients With Coronary Artery Disease.
作者信息
Lyu Lijuan, Pan Jichen, Li Dumin, Li Xinhao, Yang Wei, Dong Mei, Guo Chenghu, Lin Peixin, Han Yeming, Liang Yongfeng, Sun Junyan, Yu Dexin, Zhang Pengfei, Zhang Mei
机构信息
The Key Laboratory of Cardiovascular Remodeling and Function Research, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
出版信息
Front Cardiovasc Med. 2022 Feb 3;9:817911. doi: 10.3389/fcvm.2022.817911. eCollection 2022.
BACKGROUNDS
Dynamic CT myocardial perfusion imaging (CT-MPI) allows absolute quantification of myocardial blood flow (MBF). Although appealing, CT-MPI has not yet been widely applied in clinical practice, partly due to our relatively limited knowledge of CT-MPI. Knowledge of distribution and variability of MBF in healthy subjects helps in recognition of physiological and pathological states of coronary artery disease (CAD).
OBJECTIVES
To describe the distribution and normal range of hyperemic MBF in healthy subjects obtained by dynamic CT-MPI and validate whether it can accurately identify functional myocardial ischemia when the cut-off value of hyperemia MBF is set to the lower limit of the normal range.
MATERIALS AND METHODS
Fifty-one healthy volunteers (age, 38 ± 12 years; 15 men) were prospectively recruited. Eighty patients (age, 58 ± 10 years; 55 men) with suspected or known CAD who underwent interventional coronary angiography (ICA) examinations were retrospectively recruited. Comprehensive CCTA + dynamic CT-MPI protocol was performed by the third - generation dual-source CT scanner. Invasive fractional flow reserve (FFR) measurements were performed in vessels with 30-90% diameter reduction. ICA/FFR was used as the reference standard for diagnosing functional ischemia. The normal range for the hyperemic MBF were defined as the mean ± 1.96 SD. The cut-off value of hyperemic MBF was set to the lower limit of the normal range.
RESULTS
The global hyperemic MBF were 164 ± 24 ml/100 ml/min and 123 ± 26 ml/100 ml/min for healthy participants and patients. The normal range of the hyperemic MBF was 116-211 ml/100 ml/min. Of vessels with an ICA/FFR result ( = 198), 67 (34%) were functionally significant. In the per-vessel analysis, an MBF cutoff value of <116 ml/100 ml/min can identify myocardial ischemia with a diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 85.9% (170/198), 91.0% (61/67), 83.2 % (109/131), 73.5% (61/83), and 94.8% (109/115). CT-MPI showed good consistency with ICA/FFR in diagnosing functional ischemia, with a Cohen's kappa statistic of 0.7016 (95%CI, 0.6009 - 0.8023).
CONCLUSION
Recognizing hyperemic MBF in healthy subjects helps better understand myocardial ischemia in CAD patients.
背景
动态CT心肌灌注成像（CT-MPI）可实现心肌血流（MBF）的绝对定量。尽管CT-MPI很有吸引力，但尚未在临床实践中广泛应用，部分原因是我们对CT-MPI的了解相对有限。了解健康受试者MBF的分布和变异性有助于识别冠状动脉疾病（CAD）的生理和病理状态。
目的
描述通过动态CT-MPI获得的健康受试者充血性MBF的分布和正常范围，并验证当充血性MBF的截断值设定为正常范围下限值时，它是否能准确识别功能性心肌缺血。
材料与方法
前瞻性招募了51名健康志愿者（年龄38±12岁；15名男性）。回顾性招募了80名疑似或已知CAD且接受了介入性冠状动脉造影（ICA）检查的患者（年龄58±10岁；55名男性）。使用第三代双源CT扫描仪执行综合CCTA+动态CT-MPI方案。对直径减少30%-90%的血管进行有创血流储备分数（FFR）测量。ICA/FFR用作诊断功能性缺血的参考标准。充血性MBF的正常范围定义为平均值±1.96标准差。充血性MBF的截断值设定为正常范围下限值。
结果
健康参与者和患者的整体充血性MBF分别为164±24ml/100ml/min和123±26ml/100ml/min。充血性MBF的正常范围为116-211ml/100ml/min。在有ICA/FFR结果的血管中（n=198），67条（34%）具有功能意义。在逐血管分析中，MBF截断值<116ml/100ml/min可识别心肌缺血，诊断准确性、敏感性、特异性、阳性预测值和阴性预测值分别为85.9%（170/198）、91.0%（61/67）、83.2%（109/131）、73.5%（61/83）和94.8%（109/115）。CT-MPI在诊断功能性缺血方面与ICA/FFR具有良好的一致性，Cohen's kappa统计量为0.7016（95%CI，0.6009-0.8023）。
结论
了解健康受试者的充血性MBF有助于更好地理解CAD患者的心肌缺血情况。
Zotero 插件