作者：董梦雅，苟棋玲，杨光，寿锡凌

单位：

710068陕西省西安市，陕西省人民医院心血管内二科

Units：

Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China

关键词：

冠状动脉疾病；斑块；病变特异性缺血；血流储备分数；CT血管造影术；诊断

Keywords：

Coronary artery disease; Plaque; Lesion-specific ischemia; Fractional flow reverse; CT angiography; Diagnosis

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2023.00.205

Funds：

摘要：

　目的　分析基于冠状动脉CT血管造影的血流储备分数（CT-FFR）对不同性质冠状动脉斑块患者发 生病变特异性缺血的诊断价值。方法　连续收集2019年12月至2021年4月在陕西省人民医院心血管内二科住院并接受 选择性冠状动脉造影（CAG）检查的35例疑似冠状动脉狭窄患者及2020年7月至2021年4月在四川大学华西医院住院 并接受选择性CAG检查的56例疑似冠状动脉狭窄患者为研究对象。根据冠状动脉斑块性质将所有患者分为钙化斑块 组（n=14）、非钙化斑块组（ n=34）和混合斑块组（n=42）。比较三组人口学资料、入院时心率、入院时血压、既 往史、入院时实验室检查指标、CT-FFR及血流储备分数（FFR）。以FFR≤0.80作为诊断病变特异性缺血的“金标 准”，绘制ROC曲线以评价CT-FFR对不同性质冠状动脉斑块患者发生病变特异性缺血的诊断价值；采用相关系数分 析FFR与CT-FFR诊断不同性质冠状动脉斑块患者发生病变特异性缺血结果的一致性，绘制Bland-Altman图以分析CT FFR与FFR诊断不同性质冠状动脉斑块患者发生病变特异性缺血结果的差异性。结果　三组年龄、入院时舒张压、有 糖尿病史者占比、有高血压史者占比及入院时血肌酐（Scr）比较，差异有统计学意义（P＜0.05）。以CT-FFR≤0.80 诊断为病变特异性缺血。在冠状动脉钙化斑块、非钙化斑块、混合斑块患者中，CT-FFR诊断病变特异性缺血的灵 敏度分别为55.55%、72.22%、75.00%，特异度分别为20.00%、81.25%、55.55%，正确率分别为42.86%、76.47%、 66.67%。ROC曲线分析结果显示，CT-FFR诊断冠状动脉钙化、非钙化、混合斑块患者发生病变特异性缺血的AUC 分别为0.40〔95%CI（0.07，0.73），P=0.549〕、0.75〔95%CI（0.58，0.93），P=0.011〕、0.66〔95%CI（0.48， 0.84），P=0.080〕。相关性分析结果显示，FFR 与CT-FFR 诊断冠状动脉钙化、混合斑块患者发生病变特异性缺血结 果均无线性关系（冠状动脉钙化斑块患者：R 2 ＜0.01 ，P=0.926 ；冠状动脉混合斑块患者： R 2 = 0.07， P=0.102 ），FFR 与CT-FFR诊断冠状动脉非钙化斑块患者发生病变特异性缺血结果的一致性良好（R 2 =0.19， P = 0.011 ）。 Bland-Altman 图分析结果显示，CT-FFR与FFR诊断冠状动脉非钙化斑块患者发生病变特异性缺血的所有散点基本在平均差值的 95%CI内，说明两种方法检测结果差异性小。结论　CT-FAR对冠状动脉非钙化斑块患者发生病变特异性缺血具有一 定诊断价值，对冠状动脉钙化、混合斑块患者发生病变特异性缺血的诊断价值较低。

Abstract：

Objective To analyze the diagnostic value of fractional flow reserve based on coronary CT angiography (CT-FFR) for lesion-specific ischemia in patients with different nature of coronary artery plaque. Methods A total of 35 patients with suspected coronary artery stenosis who were hospitalized in the Department of Cardiology, Shaanxi Provincial People's Hospital from December 2019 to April 2021 and underwent selective coronary angiography (CAG) examination and 56 patients with suspected coronary artery stenosis who were hospitalized in West China Hospital of Sichuan University from July 2020 to April 2021 and underwent selective CAG examination were continuously collected as the research objects. According to the nature of plaque, all patients were divided into calcified plaque group (n=14) , non-calcified plaque group (n=34) and mixed plaque group ( n=42) . The demographic data, heart rate at admission, blood pressure at admission, past history, laboratory examination indexes at admission, CT-FFR and fractional flow reserve (FFR) were compared among the three groups. Taking FFR ≤ 0.80 as the "gold standard" for the diagnosis of lesion-specific ischemia, ROC curve was drawn to evaluate the diagnostic value of CT FFR for lesion-specific ischemia in patients with different nature of coronary artery plaque. The correlation coefficient was used to analyze the consistency of results of FFR and CT-FFR in the diagnosis of lesion-specific ischemia in patients with different nature of coronary artery plaque, and the Bland-Altman plot was drawn to analyze the difference between the results of CT-FFR and FFR in the diagnosis of lesion-specific ischemia in patients with different nature of coronary artery plaque. Results There were significant differences in age, diastolic blood pressure at admission, proportion of patients with diabetes history, proportion of patients with hypertension history and serum creatinine (Scr) at admission among the three groups (P < 0.05) . CT-FFR ≤ 0.80 was diagnosed as lesion-specific ischemia. In patients with coronary calcified plaque, non-calcified plaque and mixed plaque, the sensitivity of CT-FFR in the diagnosis of lesion-specific ischemia was 55.55%, 72.22%, 75.00% respectively, the specificity of CT-FFR in the diagnosis of lesion-specific ischemia was 20.00%, 81.25%, 55.55%, respectively, the accuracy of CT-FFR in the diagnosis of lesion-specific ischemia was 42.86%, 76.47%, 66.67%, respectively. The results of ROC curve analysis showed that the AUC of CT-FFR in the diagnosis of lesion-specific ischemia in patients with coronary calcified plaque, coronary non calcified plaque and coronary mixed plaque was 0.40 [95%CI (0.07, 0.73) , P=0.549] , 0.75 [95%CI (0.58, 0.93) , P=0.011] and 0.66 [95%CI (0.48, 0.84) , P=0.080] , respectively. The results of correlation analysis showed that there was no linear relationship between results of FFR and CT-FFR in the diagnosis of lesion-specific ischemia in patients with coronary calcified plaque and coronary mixed plaque (coronary calcified plaque patients: R 2 < 0.01, P=0.926 ; coronary mixed plaque patients: R2 =0.07, P=0.102) . FFR and CT-FFR had good consistency in the diagnosis results of lesion-specific ischemia in patients with coronary non-calcified plaque ( R 2 =0.19, P=0.011) . The results of Bland-Altman plot analysis showed that all the scatter points of CT-FFR and FFR in the diagnosis of lesion-specific ischemia in patients with coronary non-calcified plaque were basically within 95% CI of the average difference, indicating that the difference between the two methods was small. Conclusion CT-FAR has a certain diagnostic value for lesion-specific ischemia in patients with coronary non-calcified plaque, and has low diagnostic value for lesion-specific ischemia in patients with coronary calcified plaque and coronary mixed plaque.

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