Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China.
Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710068, Shaanxi, China.
Sci Rep. 2024 Jul 23;14(1):16969. doi: 10.1038/s41598-024-68212-1.
Fractional flow reserve (FFR) has become the gold standard for evaluating coronary lesion-specific ischemia. However, FFR is an invasive method that may cause possible complications in the coronary artery and requires expensive equipment, which limits its use. Promising noninvasive diagnostic methods, such as computed tomography angiography-derived FFR (CT-FFR) and the quantitative flow ratio (QFR), have been proposed. In this study, we evaluated the diagnostic performance of the QFR and CT-FFR in predicting coronary lesion-specific ischemia, with the FFR serving as the reference standard. Patients with suspected or known coronary artery disease who underwent coronary CT angiography revealing 30-90% diameter stenosis in the main coronary artery (≥ 2.0 mm reference diameter) were enrolled. The FFR was measured during invasive coronary angiography (within 15 days after coronary CT angiography). An FFR ≤ 0.8 was the reference standard for coronary lesion-specific ischemia. A total of 103 vessels from 92 consecutive patients (aged 59.8 ± 9.2 years; 60.9% were men) were evaluated. The diagnostic performance of a QFR ≤ 0.80 for predicting coronary lesion-specific ischemia demonstrated good diagnostic accuracy, sensitivity, and specificity (92.2%, 87.2%, and 96.4%, respectively), with an area under the receiver operating characteristic curve (AUC) of 0.987 (P < 0.0001). The diagnostic performance of a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia also demonstrated good diagnostic accuracy, sensitivity, and specificity (96.1%, 95.7%, and 96.4%, respectively), with an AUC of 0.967 (P < 0.0001). However, there was no significant difference in the AUC between a QFR ≤ 0.80 and a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia (P = 0.319). There was an excellent correlation between the QFR and FFR (r = 0.856, P < 0.0001). The CT-FFR and FFR also showed a good direct correlation (r = 0.816, P < 0.0001). The QFR and CT-FFR are strongly correlated with the FFR and can provide excellent clinical diagnostic performance for coronary lesion-specific ischemia detection.
分数血流储备（FFR）已成为评估冠状动脉特定病变缺血的金标准。然而，FFR 是一种有创方法，可能导致冠状动脉的潜在并发症，并需要昂贵的设备，这限制了其使用。已经提出了有前途的非侵入性诊断方法，例如基于计算机断层扫描血管造影的 FFR（CT-FFR）和定量血流比（QFR）。在这项研究中，我们评估了 QFR 和 CT-FFR 在预测冠状动脉特定病变缺血方面的诊断性能，以 FFR 作为参考标准。纳入了疑似或已知患有冠状动脉疾病的患者，其冠状动脉 CT 血管造影显示主要冠状动脉的 30-90%直径狭窄（≥ 2.0 毫米参考直径）。在冠状动脉 CT 血管造影后 15 天内进行了有创冠状动脉造影术以测量 FFR。FFR ≤ 0.8 为冠状动脉特定病变缺血的参考标准。共评估了 92 例连续患者的 103 支血管（年龄 59.8 ± 9.2 岁；60.9%为男性）。QFR ≤ 0.80 预测冠状动脉特定病变缺血的诊断性能表现出良好的诊断准确性、敏感性和特异性（分别为 92.2%、87.2%和 96.4%），其受试者工作特征曲线下面积（AUC）为 0.987（P < 0.0001）。CT-FFR ≤ 0.80 预测冠状动脉特定病变缺血的诊断性能也表现出良好的诊断准确性、敏感性和特异性（分别为 96.1%、95.7%和 96.4%），其 AUC 为 0.967（P < 0.0001）。然而，QFR ≤ 0.80 和 CT-FFR ≤ 0.80 预测冠状动脉特定病变缺血的 AUC 之间无显著差异（P = 0.319）。QFR 与 FFR 之间具有极好的相关性（r = 0.856，P < 0.0001）。CT-FFR 与 FFR 也显示出良好的直接相关性（r = 0.816，P < 0.0001）。QFR 和 CT-FFR 与 FFR 密切相关，可为冠状动脉特定病变缺血检测提供出色的临床诊断性能。
