摘要
目的 探讨心血管磁共振(CMR)心肌灌注成像联合 CT 血流储备分数(CT-FFR)参数对阻塞性冠心病患者心血管不良事件发生的预测价值.方法 选取 2018 年 6 月—2022 年 6 月在河北北方学院附属第二医院治疗的 180 例阻塞性冠心病(冠状动脉狭窄程度≥50%)患者进行前瞻性研究.所有患者行 CT 血管成像及 CMR 心肌灌注成像检查,并通过现场随访或电话随访等方式,收集患者 1 年内的心血管不良事件发生情况.采用单因素及多因素 logistic 回归模型分析发生心血管不良事件的影响因素;ROC 曲线评估不同的预测模型对心血管不良事件发生的预测效能.结果 发生心血管不良事件的患者共45 例为观察组,其余 135 例为对照组.与对照组比较,观察组年龄、男性占比、吸烟者占比、总胆固醇水平、合并糖尿病者占比、合并高脂血症者占比、首过灌注时间及心肌延迟强化信号值等指标升高,CT-FFR 及最大上升斜率(Slopemax)指标则降低,差异均有统计学意义(P<0.05).将以上指标进一步做单因素及多因素 logistic 回归分析,得出年龄、男性、吸烟、合并糖尿病、合并高脂血症及首过灌注时间、心肌延迟强化信号值是阻塞性冠心病患者发生心血管不良事件的独立危险因素(P<0.05),CT-FFR 及Slopemax是其保护因素(P<0.05).仅使用临床参数(包括年龄、性别、吸烟、糖尿病、高脂血症等疾病)时的 ROC 曲线下面积为 0.721(95%CI:0.645～0.812);CMR 心肌灌注成像联合 CT-FFR 的 ROC曲线下面积为 0.793(95%CI:0.713～0.873);在 CMR 心肌灌注成像联合 CT-FFR 的基础上加入临床参数的 ROC 曲线下面积为 0.893(95%CI:0.835～0.952).结论 CMR 心肌灌注成像联合 CT-FFR 是阻塞性冠心病患者心血管不良事件发生的独立预测因素,在临床模型基础上加入 CMR 心肌灌注成像联合 CT-FFR 可显著提高对阻塞性冠心病患者心血管不良事件发生风险的预测效能.
Abstract
Objective To analyze the predictive value of cardiovascular magnetic resonance(CMR)myocardial perfusion imaging combined with CT fractional flow reserve(CT-FFR)parameters in predicting cardiovascular adverse events in obstructive coro-nary heart disease.Methods A prospective study was conducted in 180 patients with obstructive coronary heart disease(coronary ar-tery stenosis≥50%)who were treated in the Second Affiliated Hospital of Hebei North University from June 2018 to June 2022.All patients underwent CT angiography and CMR myocardial perfusion imaging,and the occurrence of cardiovascular adverse events within 1 year was collected by on-site follow-up or telephone follow-up.Univariate and multivariate logistic regression models were used to an-alyze the influencing factors of cardiovascular adverse events;ROC curves were used to assess the predictive efficacy of different predic-tion models for the occurrence of cardiovascular adverse events.Results A total of 45 patients developed cardiovascular adverse e-vents(observation group),and the remaining 135 patients were controls.Compared with the control group,the age,male ratio,smok-ing patient ratio,total cholesterol level,diabetes mellitus ratio,hyperlipidemia ratio,first-pass perfusion time and myocardial delayed enhancement signal value of the observation group increased,while the CT-FFR and maximum slope(Slopemax)index decreased,and the differences were statistically significant(P<0.05).Further univariate and multivariate logistic analysis of the above indica-tors showed that age,male,smoking,diabetes,hyperlipidemia,the first pass perfusion time,and the value of myocardial delayed en-hancement signal were independent risk factors for adverse cardiovascular events in patients with obstructive coronary heart disease(P<0.05),and the CT-FFR and Slopemax were its protection factors(P<0.05).The ROC area under the curve was 0.721(95%CI:0.645-0.812)when only using clinical parameters(including age,gender,smoking history,hypertension,diabetes,hyperlipidemia and other diseases).The ROC area under the curve of CMR myocardial perfusion imaging combined with CT-FFR was 0.793(95%CI:0.713-0.873).The ROC area under the curve with clinical parameters added on the basis of CMR myocardial perfusion imaging combined with CT-FFR was 0.893(95%CI:0.835-0.952).Conclusion CMR myocardial perfusion imaging combined with CT-FFR is an independent forecast factor for the development of cardiovascular adverse events in patients with obstructive coronary heart disease.The addition of CMR myocardial perfusion imaging combined with CT-FFR to clinical models significantly improves the predic-tive efficacy for the risk of cardiovascular adverse events in patients with obstructive coronary heart disease.
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