基于冠状动脉计算机断层扫描血管造影术的血流储备分数三种解读方法的前瞻性比较。
Prospective comparisons of three interpretation methods of fractional flow reserve derived from coronary computed tomography angiography.
作者信息
Xu Kun, Yang Lin, Zhang Jingyuan, Huang Wenhao, Hu Yumeng, Leng Xiaochang, Liu Yajun, Liu Xiaowei, Jin Hongfeng, Tang Yiming, Wang Jiangting, Guo Yitao, Ye Chen, Zhang Jianjun, Xiang Jianping, Tang Lijiang, Du Changqing
机构信息
Department of Internal Medicine, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou, China.
Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Quant Imaging Med Surg. 2025 Mar 3;15(3):2146-2161. doi: 10.21037/qims-24-600. Epub 2025 Feb 26.
BACKGROUND
The selection of fractional flow reserve derived from computed tomography (CT-FFR) calculation locations is of particular importance when determining ischemic lesions for guiding therapeutic strategies. However, to date, there has been no prospective research comparing different measured locations of CT-FFR. The study aimed to prospectively compare the diagnostic efficiency of three interpretation methods of CT-FFR, using invasive fractional flow reserve (FFR) as the reference standard.
METHODS
Patients with stable coronary heart disease (CHD) who underwent coronary computed tomography angiography (CCTA) examination and met the inclusion criteria at Zhejiang Hospital from January 2019 to June 2021 were prospectively enrolled. All patients underwent invasive coronary angiography and FFR within 60 days after the CCTA examination. The CT-FFR values were computed using the novel computational fluid dynamics (CFD)-based model, AccuFFRct. Diagnostic performance of vessel-level CT-FFR, lesion-specific CT-FFR, and ΔCT-FFR were evaluated with invasive FFR ≤0.8 as the reference standard and multivariate logistic regression was used to further analyze the influencing factors of their inconsistency with FFR.
RESULTS
In total, 124 patients with 143 vessels were included in this prospective study. On a per-vessel basis, vessel-level AccuFFRct and lesion-specific AccuFFRct had good correlation with invasive FFR (r=0.70 and r=0.66, respectively). With invasive FFR ≤0.8 as the reference standard for the diagnosis of myocardial ischemia, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and area under the curve (AUC) values of CCTA, vessel-level AccuFFRct, lesion-specific AccuFFRct, and ΔAccuFFRct in the diagnosis of myocardial ischemia were 82.0%, 40.2%, 50.5%, 75.0%, 58.0%, 0.611; 93.4%, 89.0%, 86.4%, 94.8%, 90.9%, 0.937; 62.3%, 92.7%, 86.4%, 76.8%, 79.7%, 0.880 and 62.3%, 92.7%, 86.4%, 76.8%, 79.7%, and 0.854, respectively.
CONCLUSIONS
Vessel-level AccuFFRct, lesion-specific AccuFFRct, and ΔAccuFFRct provided better diagnostic performance compared with CCTA, with vessel-level AccuFFRct being superior in predicting myocardial ischemia, whereas lesion-specific AccuFFRct and ΔAccuFFRct had higher specificity than vessel-level AccuFFRct.
背景
在确定缺血性病变以指导治疗策略时，从计算机断层扫描（CT）计算得出的血流储备分数（CT-FFR）计算位置的选择尤为重要。然而，迄今为止，尚无前瞻性研究比较CT-FFR的不同测量位置。本研究旨在以前瞻性方式比较三种CT-FFR解读方法的诊断效率，以有创血流储备分数（FFR）作为参考标准。
方法
前瞻性纳入2019年1月至2021年6月在浙江大学医学院附属第二医院接受冠状动脉计算机断层扫描血管造影（CCTA）检查且符合纳入标准的稳定型冠心病（CHD）患者。所有患者在CCTA检查后60天内接受有创冠状动脉造影和FFR检查。使用基于新型计算流体动力学（CFD）的模型AccuFFRct计算CT-FFR值。以有创FFR≤0.8作为参考标准，评估血管水平CT-FFR、病变特异性CT-FFR和ΔCT-FFR的诊断性能，并采用多因素逻辑回归进一步分析其与FFR不一致的影响因素。
结果
本前瞻性研究共纳入124例患者的143条血管。在每条血管基础上，血管水平AccuFFRct和病变特异性AccuFFRct与有创FFR具有良好的相关性（分别为r=0.70和r=0.66）。以有创FFR≤0.8作为心肌缺血诊断的参考标准，CCTA、血管水平AccuFFRct、病变特异性AccuFFRct和ΔAccuFFRct在诊断心肌缺血时的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、诊断准确性和曲线下面积（AUC）值分别为82.0%、40.2%、50.5%、75.0%、58.0%、0.611；93.4%、89.0%、86.4%、94.8%、90.9%、0.937；62.3%、92.7%、86.4%、76.8%、79.7%、0.880和62.3%、92.7%、86.4%、76.8%、79.7%、0.854。
结论
与CCTA相比，血管水平AccuFFRct、病变特异性AccuFFRct和ΔAccuFFRct具有更好的诊断性能，血管水平AccuFFRct在预测心肌缺血方面更具优势，而病变特异性AccuFFRct和ΔAccuFFRct比血管水平AccuFFRct具有更高的特异性。
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