硝酸甘油对冠状动脉计算机断层扫描（CT）血管造影中机器学习分数血流储备的影响。
Impact of nitroglycerin on machine-learning fractional flow reserve in coronary computed tomography (CT)-angiography.
作者信息
Zhou Yutao, Zhao Na, An Yunqiang, Ma Wei, Han Lei, Song Lei, Yang Weixian, Gao Yang, Lu Bin
机构信息
Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
出版信息
Quant Imaging Med Surg. 2024 Sep 1;14(9):6856-6868. doi: 10.21037/qims-23-1212. Epub 2024 Apr 29.
BACKGROUND
Nitroglycerin administration prior to examination improves stenosis assessment of coronary computed tomography (CT) angiography (CCTA). However, whether nitroglycerin influences CT-derived fractional flow reserve (FFR, CT-FFR) evaluation remains unclear. This study aimed to investigate the effect of nitroglycerin on diagnostic performance of CT-FFR.
METHODS
In this single-center retrospective study, 107 consecutive patients suspected of coronary artery disease (CAD) with nitroglycerin administration prior to CCTA in 2019 were matched to 107 patients without nitroglycerin in 2016 from Fuwai Hospital. All patients underwent CCTA and invasive FFR in a month. Vessel-based and patient-based accuracy and diagnostic performance of CT-FFR were compared between the two groups, as well as image quality, coronary artery diameter and evaluability. Quantitative variables were compared by Kruskal-Wallis H test. Categorical variables and rates were compared by χ test or Fisher exact test.
RESULTS
A total of 214 patients (56.1±8.9 years, 155 male) with 237 target lesion vessels were analyzed, including 120 vessels in nitroglycerin and 117 vessels in non-nitroglycerin group. Per-vessel based accuracy of CT-FFR was higher in nitroglycerin group {80.0% [95% confidence interval (CI): 71.7-86.7%] 68.4% (59.1-76.7%), P=0.041}. On a per-patient basis, nitroglycerin administration improved the accuracy [83.2% (74.7-89.7%) 68.2% (58.5-76.9%), P=0.01], specificity [82.7% (69.7-91.8%) 61.9% (48.8-73.9%), P=0.01], positive predictive value (PPV) [83.6% (73.6-90.4%) 58.6% (50.0-66.9%), P=0.004], and area under the curve (AUC) [0.83 (0.75-0.89) 0.71 (0.61-0.79), P=0.03] of CT-FFR. Vessel diameters (left main arteries: 4.3 3.8 mm, P<0.001; left anterior descending arteries: 3.1 2.9 mm, P=0.001; left circumflex arteries: 2.9 2.7 mm, P=0.01; right coronary arteries: 3.7 3.4 mm, P=0.001) and number of evaluable coronary arteries (11.0 8.0, P<0.001) were larger in nitroglycerin group.
CONCLUSIONS
Nitroglycerin administration prior to CCTA has positive effects on diagnostic performance of CT-FFR.
背景
检查前给予硝酸甘油可改善冠状动脉计算机断层扫描（CT）血管造影（CCTA）的狭窄评估。然而，硝酸甘油是否会影响CT衍生的血流储备分数（FFR，CT-FFR）评估仍不清楚。本研究旨在探讨硝酸甘油对CT-FFR诊断性能的影响。
方法
在这项单中心回顾性研究中，将2019年CCTA检查前给予硝酸甘油的107例疑似冠心病（CAD）患者与2016年阜外医院107例未使用硝酸甘油的患者进行匹配。所有患者在一个月内接受了CCTA和有创FFR检查。比较两组基于血管和基于患者的CT-FFR准确性和诊断性能，以及图像质量、冠状动脉直径和可评估性。定量变量采用Kruskal-Wallis H检验进行比较。分类变量和率采用χ检验或Fisher精确检验进行比较。
结果
共分析了214例患者（56.1±8.9岁，男性155例）的237条目标病变血管，其中硝酸甘油组120条血管，非硝酸甘油组117条血管。硝酸甘油组基于血管的CT-FFR准确性更高{80.0%[95%置信区间（CI）：71.7-86.7%]对68.4%（59.1-76.7%），P=0.041}。在基于患者的基础上，给予硝酸甘油提高了CT-FFR的准确性[83.2%（74.7-89.7%）对68.2%（58.5-76.9%），P=0.01]、特异性[82.7%（69.7-91.8%）对61.9%（48.8-73.9%），P=0.01]、阳性预测值（PPV）[83.6%（73.6-90.4%）对58.6%（50.0-66.9%），P=0.004]和曲线下面积（AUC）[0.83（0.75-0.89）对0.71（0.61-0.79），P=0.03]。硝酸甘油组的血管直径（左主干动脉：4.3对3.8mm，P<0.001；左前降支动脉：3.1对2.9mm，P=0.001；左旋支动脉：2.9对2.7mm，P=0.01；右冠状动脉：3.7对3.4mm，P=0.001）和可评估冠状动脉数量（11.0对8.0，P<0.001）更大。
结论
CCTA检查前给予硝酸甘油对CT-FFR的诊断性能有积极影响。
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