Xu Tianxiao, Yu Wei, Ding Daixin, Li Chunming, Huang Jiayue, Kubo Takashi, Wijns William, Tu Shengxian
Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and Curam, National University of Ireland, Galway, Ireland.
J Soc Cardiovasc Angiogr Interv. 2023 May 31;2(5):101043. doi: 10.1016/j.jscai.2023.101043. eCollection 2023 Sep-Oct.
A novel method for fast computation of Murray law-based quantitative flow ratio (μQFR) from coregistered angiography and optical coherence tomography (OCT) was recently developed. This study aimed to evaluate the diagnostic performance of this OCT-modulated μQFR (OCT-μFR).
Patients who underwent coronary angiography, OCT, and fractional flow reserve (FFR) were retrospectively enrolled. μQFR was computed from a single angiographic projection. Subsequently, OCT image pullback was coregistered with the angiogram, and OCT-μFR was calculated based on the coregistered data. The same cut-off value of 0.80 was used for OCT-μFR, μQFR, and FFR to define ischemia.
A paired comparison of OCT-μFR and μQFR was performed in 269 vessels from 218 patients. The mean FFR was 0.81 ± 0.11, and 45.0% of vessels had an FFR ≤0.80. OCT-μFR showed a better correlation with FFR than μQFR (r = 0.83 vs 0.76, = .018) and numerically higher diagnostic performance (area under the curve [AUC] = 0.95 vs 0.92, = .057). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for OCT-μFR to identify ischemia-causing stenosis were 89.3%, 93.2%, 91.5%, 91.4%, 13.2, and 0.1, respectively. In addition, OCT-μFR showed significantly higher diagnostic performance compared with μQFR in vessels with suboptimal angiographic image quality (AUC = 0.93 vs 0.87, = .028) and tandem lesions (AUC = 0.94 vs 0.87, = .017).
Computation of OCT-μFR was feasible and accurately identified physiologically significant coronary stenosis with simultaneous morphological assessment. In vessels with suboptimal angiographic image quality or tandem lesions, OCT-μFR had a higher diagnostic performance than angiography-based μQFR.
最近开发了一种从配准的血管造影和光学相干断层扫描（OCT）快速计算基于默里定律的定量血流比（μQFR）的新方法。本研究旨在评估这种OCT调制的μQFR（OCT-μFR）的诊断性能。
回顾性纳入接受冠状动脉造影、OCT和血流储备分数（FFR）检查的患者。从单个血管造影投影计算μQFR。随后，将OCT图像回撤与血管造影图像配准，并根据配准数据计算OCT-μFR。OCT-μFR、μQFR和FFR使用相同的截断值0.80来定义缺血。
对218例患者的269支血管进行了OCT-μFR和μQFR的配对比较。平均FFR为0.81±0.11，45.0%的血管FFR≤0.80。OCT-μFR与FFR的相关性优于μQFR（r = 0.83对0.76，P = 0.018），诊断性能在数值上更高（曲线下面积[AUC]=0.95对0.92，P = 0.057）。OCT-μFR识别缺血性狭窄的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为89.3%、93.2%、91.5%、91.4%、13.2和0.1。此外，在血管造影图像质量欠佳的血管（AUC = 0.93对0.87，P = 0.028）和串联病变血管（AUC = 0.94对0.87，P = 0.017）中，OCT-μFR的诊断性能显著高于μQFR。
计算OCT-μFR是可行的，并且在进行形态学评估的同时能够准确识别具有生理意义的冠状动脉狭窄。在血管造影图像质量欠佳或存在串联病变的血管中，OCT-μFR的诊断性能高于基于血管造影的μQFR。
