Long Jili, Lin Jingru, Tao Jia, Wang Hao
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100006 Beijing, China.
Rev Cardiovasc Med. 2024 Dec 5;25(12):431. doi: 10.31083/j.rcm2512431. eCollection 2024 Dec.
Quantitative flow ratio (QFR) can identify functionally significant coronary disease non-invasively. Myocardial contrast echocardiography (MCE) is a non-invasive and effective procedure for detecting abnormalities in hemodynamic coronary artery stenosis. Currently, there is no research confirming the correlation between MCE and QFR. This study aims to compare the capacity of the perfusion index (PI) from MCE to diagnose functionally significant coronary disease in patients with chest pain. The investigators use QFR as the gold standard for comparison.
112 patients referred for coronary angiography (CAG) due to suspicion of coronary artery disease (CAD) were included. 64 patients with functionally significant coronary disease were diagnosed. 48 patients were defined as CAD without functionally significant coronary disease. MCE was performed 24 h before angiography. PI was calculated for each triggering interval by adding the perfusion scores of segments and dividing by the number of segments. Logistic regression analyses were performed to evaluate the association among functionally significant coronary disease, echocardiographic and clinical parameters. Spearman correlation analysis was used to investigate the correlation between PI and QFR. A receiver operating characteristic (ROC) curve was used to assess the capability of echocardiographic and clinical parameters to diagnose functionally significant coronary disease.
Patients with functionally significant coronary disease had the worse perfusion in MCE compared with those without functionally significant coronary disease. In multivariable logistic regression analysis, global perfusion index (GPI) (OR: 43.409, < 0.001) was associated with functionally significant coronary disease in patients with CAD. Based on the Spearman correlation analysis. Left anterior descending artery (LAD)-PI showed a strong negative correlation with LAD-QFR (r = -0.652, < 0.01). ROC curves showed LAD-PI to be superior to GPI, left circumflex artery PI (LCX-PI) and right coronary artery PI (RCA-PI) in identifying functionally significant coronary disease.
The PI derived from MCE has diagnostic value for functionally significant coronary disease with QFR ≤0.80 in 1 or more vessels, with LAD-PI showing the highest diagnostic efficiency. GPI is independently associated with functionally significant coronary disease, but among the branch PIs, LAD-PI has the highest diagnostic efficiency.
定量血流比（QFR）能够无创地识别具有功能意义的冠状动脉疾病。心肌对比超声心动图（MCE）是检测冠状动脉狭窄血流动力学异常的一种无创且有效的方法。目前，尚无研究证实MCE与QFR之间的相关性。本研究旨在比较MCE灌注指数（PI）诊断胸痛患者功能性显著冠状动脉疾病的能力。研究者采用QFR作为比较的金标准。
纳入112例因疑似冠状动脉疾病（CAD）而接受冠状动脉造影（CAG）检查的患者。其中64例被诊断为具有功能性显著冠状动脉疾病，48例被定义为无功能性显著冠状动脉疾病的CAD患者。在造影检查前24小时进行MCE检查。通过将各节段的灌注分数相加并除以节段数，计算每个触发间期的PI。进行逻辑回归分析以评估功能性显著冠状动脉疾病、超声心动图参数和临床参数之间的关联。采用Spearman相关分析研究PI与QFR之间的相关性。使用受试者工作特征（ROC）曲线评估超声心动图参数和临床参数诊断功能性显著冠状动脉疾病的能力。
与无功能性显著冠状动脉疾病的患者相比，有功能性显著冠状动脉疾病的患者MCE灌注情况更差。在多变量逻辑回归分析中，整体灌注指数（GPI）（OR：43.409，P < 0.001）与CAD患者的功能性显著冠状动脉疾病相关。基于Spearman相关分析，左前降支（LAD）-PI与LAD-QFR呈强负相关（r = -0.652，P < 0.01）。ROC曲线显示，在识别功能性显著冠状动脉疾病方面，LAD-PI优于GPI、左旋支PI（LCX-PI）和右冠状动脉PI（RCA-PI）。
MCE得出的PI对于1支或多支血管QFR≤0.80的功能性显著冠状动脉疾病具有诊断价值，其中LAD-PI诊断效率最高。GPI与功能性显著冠状动脉疾病独立相关，但在分支PI中，LAD-PI诊断效率最高。
