Xu Changwu, Xue Qiang, Liang Jianwen, Fu Guosheng, Wu Qiang, Jin Qing, Wei Wenbin, Qiu Fuyu, Yao Huali, Jiang Hong
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Department of Cardiology, Yan'an Hospital of Kunming City (Yan'an Hospital Affiliated to Kunming Medical University), Kunming 650051, China.
J Clin Med. 2025 Jun 25;14(13):4503. doi: 10.3390/jcm14134503.
Synchronous computation of coronary angiography-derived fractional flow reserve (CAG-FFR) and coronary angiography-derived index of microcirculatory resistance (CAG-IMR) is a novel coronary angiography-based method for on-site assessment of suspected myocardial ischemia in patients with coronary artery disease (CAD). This trial is a prospective, multicenter, controlled study designed to assess the diagnostic performance of CAG-FFR and CAG-IMR in patients with suspected myocardial ischemia using wire-based FFR and IMR as reference standards. The functional parameters were calculated using a reduced order computational fluid dynamics solver that incorporates thrombolysis in myocardial infarction (TIMI) frame count and aortic pressure recorded by a disposable invasive pressure sensor. CAG-FFR was computed in 325 patients, demonstrating a patient-level diagnostic accuracy of 95.4%, sensitivity of 95.9%, and specificity of 95.1%. The area under the receiver operating characteristic curve (AUC) of CAG-FFR was 0.977. Patient-specific aortic pressure adoption significantly improved the accuracy of CAG-FFR in the "gray zone" compared to fixed-pressure models. In addition, CAG-IMR was successfully computed in 180 patients, showing a patient-level diagnostic accuracy of 95.5%, sensitivity of 96.4%, and specificity of 95.2%. The AUC of CAG-IMR in diagnosing abnormal coronary microcirculatory dysfunction was 0.973. Synchronous computation of CAG-FFR and CAG-IMR demonstrated higher feasibility and excellent diagnostic accuracy compared to wire-based FFR and IMR, highlighting its clinical potential for CAD evaluation.
同步计算冠状动脉造影衍生的血流储备分数（CAG-FFR）和冠状动脉造影衍生的微循环阻力指数（CAG-IMR）是一种基于冠状动脉造影的新型方法，用于现场评估冠心病（CAD）患者疑似心肌缺血情况。本试验是一项前瞻性、多中心、对照研究，旨在以基于导丝的FFR和IMR作为参考标准，评估CAG-FFR和CAG-IMR在疑似心肌缺血患者中的诊断性能。使用一种降阶计算流体动力学求解器计算功能参数，该求解器纳入了心肌梗死溶栓（TIMI）帧数和由一次性侵入性压力传感器记录的主动脉压力。对325例患者计算了CAG-FFR，显示患者水平的诊断准确率为95.4%，敏感性为95.9%，特异性为95.1%。CAG-FFR的受试者工作特征曲线下面积（AUC）为0.977。与固定压力模型相比，采用患者特异性主动脉压力显著提高了CAG-FFR在“灰色区域”的准确性。此外，对180例患者成功计算了CAG-IMR，显示患者水平的诊断准确率为95.5%，敏感性为96.4%，特异性为95.2%。CAG-IMR诊断异常冠状动脉微循环功能障碍的AUC为0.973。与基于导丝的FFR和IMR相比，CAG-FFR和CAG-IMR的同步计算显示出更高的可行性和优异的诊断准确性，突出了其在CAD评估中的临床潜力。
