目的 探讨采用基于冠状动脉CT血管成像（CCTA）的无创血流储备分数（FFR）评估冠心病患者功能性心肌缺血的可行性。 方法 横断面研究。纳入2022年1月—2023年3月在蚌埠市第一人民医院完成CCTA、经皮冠状动脉造影有创FFR测量的疑似冠心病患者43例（61支血管），其中男28例、女15例，年龄48~76（63.5±5.8）岁。基于CCTA图像数据通过采用流体力学模型原理计算CCTA FFR（CT-FFR）值，以有创FFR值为参考“金标准”，分别以患者计数和血管计数计算CT-FFR诊断心肌缺血的灵敏度、特异度、阳性预测值、阴性预测值及准确率；采用受试者操作特征曲线（ROC曲线）获得曲线下面积（AUC）；采用Pearson分析基于患者计数和血管计数的CT-FFR与有创FFR的相关性，并应用Bland Altman法评价二者之间的一致性。 结果 基于患者计数，CT-FFR诊断心肌缺血的灵敏度为85.71%，特异度为90.09%，阳性预测值为90.00%，阴性预测值86.96%、准确率为88.37%；基于血管计数，CT-FFR 诊断心肌缺血的灵敏度为87.50%，特异度为93.10%，阳性预测值为93.33%，阴性预测值87.10%、准确率为90.16%。ROC曲线分析结果显示，基于患者计数和血管计数的CT-FFR诊断心肌缺血的AUC值分别为0.774和0.758。Pearson分析显示，基于患者计数和血管计数的CT-FFR值与有创FFR值均呈正相关性（r患者=0.963、r血管=0.980，P值均<0.001）；经Bland-Altman法分析，CT-FFR与有创FFR 之间的一致性良好（95%CI-0.064~0.035）。 结论 CT-FFR技术在评估冠心病患者心肌功能性缺血方面具有较高的诊断效能，具有可行性，临床应用前景广阔。 Objective This study aims to investigate the feasibility of the noninvasive fractional flow reserve (FFR) based on coronary CT angiography (CCTA) in evaluating functional myocardial ischemia in patients with coronary heart disease. Methods This was a cross-sectional study. Data related to 43 patients (61 vessels) with suspected coronary artery disease who completed CCTA, percutaneous coronary angiography, and invasive FFR measurements at Bengbu First People's Hospital from January 2022 to March 2023 were included. The study participants included 28 males and 15 females, aged 48-76 (63.5±5.8) years old. The CT-FFR value was calculated by using the principle of hydrodynamics model based on the CCTA image data, and the invasive FFR value was taken as the "gold standard". The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT-FFR in the diagnosis of myocardial ischemia were calculated from the patient and vascular levels. The area under the curve (AUC) was obtained by using the receiver operating characteristic (ROC) curve. Pearson was used to analyze the correlation between two levels of CT-FFR and invasive FFR, and kappa test or Bland-Altman method was utilized to evaluate the consistency between the two groups. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 85.71%, 90.09%, 90.00%, 86.96%, and 88.37%, respectively. Based on the vascular level, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 87.50%, 93.10%, 93.33%, 87.10%, and 90.16%, respectively. ROC curve analysis showed that the two CT-FFR diagnostic myocardial ischemia ROC AUC values were 0.774 and 0.758 based on patient and vessel levels, respectively. Pearson analysis showed a positive correlation between the CT-FFR values and the invasive FFR values based on the patient and vascular levels (rpatient=0.963, rvascular=0.980 all P values <0.001). Good agreement between the CT-FFR and the invasive FFR was analyzed by the Bland-Altman method (95% CI -0.064-0.035). Conclusion CT-FFR technology has high diagnostic efficacy and feasibility in diagnosing functional myocardial ischemia of coronary heart disease patients and has promising clinical applications.
Evaluation of functional myocardial ischemia by noninvasive fractional flow reserve based on coronary CT angiography
Objective This study aims to investigate the feasibility of the noninvasive fractional flow reserve (FFR) based on coronary CT angiography (CCTA) in evaluating functional myocardial ischemia in patients with coronary heart disease. Methods This was a cross-sectional study. Data related to 43 patients (61 vessels) with suspected coronary artery disease who completed CCTA, percutaneous coronary angiography, and invasive FFR measurements at Bengbu First People's Hospital from January 2022 to March 2023 were included. The study participants included 28 males and 15 females, aged 48-76 (63.5±5.8) years old. The CT-FFR value was calculated by using the principle of hydrodynamics model based on the CCTA image data, and the invasive FFR value was taken as the "gold standard". The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT-FFR in the diagnosis of myocardial ischemia were calculated from the patient and vascular levels. The area under the curve (AUC) was obtained by using the receiver operating characteristic (ROC) curve. Pearson was used to analyze the correlation between two levels of CT-FFR and invasive FFR, and kappa test or Bland-Altman method was utilized to evaluate the consistency between the two groups. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 85.71%, 90.09%, 90.00%, 86.96%, and 88.37%, respectively. Based on the vascular level, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 87.50%, 93.10%, 93.33%, 87.10%, and 90.16%, respectively. ROC curve analysis showed that the two CT-FFR diagnostic myocardial ischemia ROC AUC values were 0.774 and 0.758 based on patient and vessel levels, respectively. Pearson analysis showed a positive correlation between the CT-FFR values and the invasive FFR values based on the patient and vascular levels (rpatient=0.963, rvascular=0.980 all P values <0.001). Good agreement between the CT-FFR and the invasive FFR was analyzed by the Bland-Altman method (95% CI -0.064-0.035). Conclusion CT-FFR technology has high diagnostic efficacy and feasibility in diagnosing functional myocardial ischemia of coronary heart disease patients and has promising clinical applications.
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