Fang Zhang, Cai Wenyi, Chen Bei, Li Chunxiang, Zhao Jihong, Tian Zhiqiang, Chen Limei, Bu Ju, Zhao Zhongqiang, Li Dianfu
Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
Exp Ther Med. 2023 May 30;26(1):350. doi: 10.3892/etm.2023.12049. eCollection 2023 Jul.
The association between the quantitative and semi-quantitative parameters of myocardial blood flow obtained using cadmium-zinc-telluride single photon emission computed tomography (CZT-SPECT) and coronary stenosis remains unclear. Therefore, the objective of the present study was to evaluate the diagnostic value of two parameters obtained using CZT-SPECT in patients with suspected or known coronary artery disease. A total of 24 consecutive patients who underwent CZT-SPECT and coronary angiography within 3 months of each other were included in the study. To evaluate the predictive ability of the regional difference score (DS), coronary flow reserve (CFR), and the combination thereof for positive coronary stenosis at the vascular level, receiver operating characteristic (ROC) curves were plotted and the area under the curves (AUCs) were calculated. Comparisons of the reclassification ability for coronary stenosis between different parameters were assessed by calculating the net reclassification index (NRI) and the integrated discrimination improvement (IDI). The 24 participants (median age: 65 years; range: 46-79 years; 79.2% male) included in this study had a total of 72 major coronary arteries. When stenosis ≥50% was defined as the criteria for positive coronary stenosis, the AUCs and the 95% confidence interval (CI) for regional DS, CFR, and the combination of the two indices were 0.653 (CI, 0.541-0.766), 0.731 (CI, 0.610-0.852) and 0.757 (CI, 0.645-0.869), respectively. Compared with single DS, the combination of DS and CFR increased the predictive ability for positive stenosis, with an NRI of 0.197-1.060 (P<0.01) and an IDI of 0.0150-0.1391 (P<0.05). When stenosis ≥75% was considered as the criteria, the AUCs were 0.760 (CI, 0.614-0.906), 0.703 (CI, 0.550-0.855), and 0.811 (CI, 0.676-0.947), respectively. Compared with DS, CFR had an IDI of -0.3392 to -02860 (P<0.05) and the combination of DS and CFR also enhanced the predictive ability, with an NRI of 0.0313-1.0758 (P<0.01). In conclusion, both regional DS and CFR had diagnostic values for coronary stenosis, but the diagnostic abilities differed in distinguishing between different degrees of stenosis, and the efficiency was improved with a combination of DS and CFR.
使用碲化镉锌单光子发射计算机断层扫描（CZT-SPECT）获得的心肌血流定量和半定量参数与冠状动脉狭窄之间的关联仍不清楚。因此，本研究的目的是评估使用CZT-SPECT获得的两个参数对疑似或已知冠状动脉疾病患者的诊断价值。共有24例在3个月内先后接受CZT-SPECT和冠状动脉造影的连续患者纳入本研究。为了评估区域差异评分（DS）、冠状动脉血流储备（CFR）及其组合对血管水平上冠状动脉狭窄阳性的预测能力，绘制了受试者工作特征（ROC）曲线并计算曲线下面积（AUC）。通过计算净重新分类指数（NRI）和综合判别改善（IDI）来评估不同参数之间对冠状动脉狭窄的重新分类能力。本研究纳入的24名参与者（中位年龄：65岁；范围：46 - 79岁；79.2%为男性）共有72支主要冠状动脉。当将狭窄≥50%定义为冠状动脉狭窄阳性标准时，区域DS、CFR以及这两个指标组合的AUC及其95%置信区间（CI）分别为0.653（CI，0.541 - 0.766）、0.731（CI，0.610 - 0.852）和0.757（CI，0.645 - 0.869）。与单一DS相比，DS和CFR的组合提高了对狭窄阳性的预测能力，NRI为0.197 - 1.060（P<0.01），IDI为0.0150 - 0.139（P<0.05）。当将狭窄≥75%视为标准时，AUC分别为0.760（CI，0.614 - 0.906）、0.703（CI，0.550 - 0.855）和0.811（CI，0.676 - 0.947）。与DS相比，CFR的IDI为 - 0.3392至 - 0.2860（P<0.05），DS和CFR的组合也增强了预测能力，NRI为0.0313 - 1.0758（P<0.01）。总之，区域DS和CFR对冠状动脉狭窄均具有诊断价值，但在区分不同程度狭窄时诊断能力有所不同，DS和CFR组合可提高诊断效率。
