冠状动脉CT血管造影衍生的定量血流比在疑似冠状动脉疾病中的预后价值
Prognostic Value of Coronary CT Angiography-Derived Quantitative Flow Ratio in Suspected Coronary Artery Disease.
作者信息
Li Zehang, Tu Shengxian, Matheson Matthew B, Li Guanyu, Chen Yankai, Rochitte Carlos E, Chen Marcus Y, Dewey Marc, Miller Julie M, R Scarpa Matuck Bruna, Yang Wenjie, Qin Le, Yan Fuhua, Lima João A C, Arbab-Zadeh Armin
机构信息
From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China (Z.L., W.Y., L.Q., F.Y.); College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Z.L.); Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Med-X Research Institute, 1954 Hua Shan Rd, Room 123, Shanghai 200030, China (Z.L., S.T., G.L., Y.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, Md (M.B.M.); InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil (C.E.R., B.R.S.M.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany (M.D.); and Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md (J.M.M., B.R.S.M., J.A.C.L., A.A.Z.).
出版信息
Radiology. 2024 Dec;313(3):e240299. doi: 10.1148/radiol.240299.
Background The prognostic value of coronary CT angiography (CTA)-derived quantitative flow ratio (CT-QFR) remains unknown. Purpose To determine the prognostic value of CT-QFR in predicting the long-term outcomes of patients with suspected coronary artery disease (CAD) in comparison with invasive coronary angiography (ICA)/SPECT and to determine the influence of prior percutaneous coronary intervention (PCI) on the prognostic value of CT-QFR. Materials and Methods In this secondary analysis of the prospective international CORE320 study, 379 participants who underwent coronary CTA and SPECT within 60 days before ICA between November 2009 and July 2011 were included for follow-up. The coronary CTA images were analyzed to determine CT-QFR. The primary outcome was major adverse cardiovascular events (MACEs) in the 5-year follow-up. Kaplan-Meier curves, multivariable Cox regression models adjusted for clinical variables, and areas under the receiver operating characteristic curves (AUCs) were used to assess and compare the predictive ability of CT-QFR and ICA/SPECT. Results CT-QFR computation and 5-year follow-up data were available for 310 participants (median age, 62 years), of whom 205 (66%) were male. CT-QFR (hazard ratio, 1.9 [95% CI: 1.0, 3.5]; = .04) and prior myocardial infarction (hazard ratio, 2.5 [95% CI: 1.5, 4.0]; < .001) were independent predictors of MACE occurrence in the 5-year follow-up. MACE-free survival rates were similar in participants with normal CT-QFR and ICA/SPECT (82% vs 80%; = .45) and in participants with abnormal CT-QFR and ICA/SPECT findings (60% vs 57%; = .40). In participants with prior PCI, CT-QFR had a lower AUC in predicting MACEs than in participants without prior PCI (0.44 vs 0.70; < .001). Conclusion CT-QFR was an independent predictor of MACEs in the 5-year follow-up in participants with suspected CAD and showed similar 5-year prognostic value to ICA/SPECT; however, prior PCI affected CT-QFR ability to predict MACEs. Clinical trial registration no. NCT00934037 © RSNA, 2024
背景
冠状动脉CT血管造影（CTA）衍生的定量血流比（CT-QFR）的预后价值尚不清楚。目的：与有创冠状动脉造影（ICA）/单光子发射计算机断层扫描（SPECT）相比，确定CT-QFR在预测疑似冠状动脉疾病（CAD）患者长期预后方面的预后价值，并确定既往经皮冠状动脉介入治疗（PCI）对CT-QFR预后价值的影响。材料与方法：在这项对前瞻性国际CORE320研究的二次分析中，纳入了2009年11月至2011年7月期间在ICA前60天内接受冠状动脉CTA和SPECT检查的379名参与者进行随访。分析冠状动脉CTA图像以确定CT-QFR。主要结局是5年随访中的主要不良心血管事件（MACE）。采用Kaplan-Meier曲线、针对临床变量进行调整的多变量Cox回归模型以及受试者工作特征曲线下面积（AUC）来评估和比较CT-QFR与ICA/SPECT的预测能力。结果：310名参与者（中位年龄62岁）可获得CT-QFR计算结果和5年随访数据，其中205名（66%）为男性。CT-QFR（风险比，1.9[95%CI：1.0，3.5]；P = 0.04）和既往心肌梗死（风险比，2.5[95%CI：1.5，4.0]；P < 0.001）是5年随访中MACE发生的独立预测因素。CT-QFR和ICA/SPECT正常的参与者的无MACE生存率相似（82%对80%；P = 0.45），CT-QFR和ICA/SPECT结果异常的参与者也是如此（60%对57%；P = 0.40）。在有既往PCI的参与者中，CT-QFR预测MACE的AUC低于无既往PCI的参与者（0.44对0.70；P < 0.001）。结论：CT-QFR是疑似CAD参与者5年随访中MACE的独立预测因素，并且与ICA/SPECT具有相似的5年预后价值；然而，既往PCI影响CT-QFR预测MACE的能力。临床试验注册号：NCT00934037 © RSNA，2024
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