摘要
目的评价CT血流储备分数(CT-FFR)对冠心病患者主要心血管不良事件(MACE)的预测价值。方法选取2018年1月~2019年12月期间接受两次冠状动脉CT血管造影(CCTA)检查,且结果显示为一支或多支冠状动脉狭窄程度在30%~90%范围内的患者109例。收集并记录临床资料。使用CT-FFR软件对CCTA图像进行分析并得到病变的CT-FFR值,治疗前后的CT-FFR值和狭窄率分别记录为CT-FFR1、CT-FFR2、狭窄率1、狭窄率2。结合狭窄率、CT-FFR值和临床指标构建以下模型:功能学联合模型model 0(CT-FFR1+CT-FFR2),治疗前功能模型model 1(CT-FFR1+临床指标),治疗前解剖功能模型model 2(狭窄率1+CT-FFR1+临床指标)。分三组绘制受试者工作特征曲线(receiver operator characteristic curve,ROC):第一组CT-FFR1 vs狭窄率1,第二组CT-FFR1 vs CT-FFR2 vs model 0,第三组CT-FFR1 vs model 1 vs model 2,比较其对冠心病患者发生MACE的诊断效能。结果MACE组患者的CT-FFR值显著低于非MACE组(P<0.05)。CT-FFR1的AUC为0.747(95%CI:0.671~0.814),狭窄率1的AUC为0.633(95%CI:0.551~0.709),CT-FFR1的诊断效能高于狭窄率1(P=0.026);CT-FFR2的AUC为0.822(95%CI:0.752~0.879),model 0的AUC为0.829(95%CI:0.760~0.884),联合CT-FFR1和CT-FFR2诊断效能明显提高(P=0.011);model 1、model 2的AUC分别为0.863(95%CI:0.799~0.913)、0.866(95%CI:0.801~0.915),功能模型的诊断效能高于单独使用CT-FFR(P=0.014),解剖功能模型的诊断效能最高(P=0.014)。结论CT-FFR值对冠心病患者发生MACE事件具有良好的诊断效能,结合狭窄率和临床指标,可显著提升对患者MACE事件的诊断价值。
Objective To evaluate the predictive value of CT flow reserve fraction(CT-FFR)for major adverse cardiovascular events(MACE)in patients with coronary artery disease.Methods A total of 109 patients who underwent two coronary CT angiography(CCTA)between January 2018 and December 2019 and whose results showed one or more coronary stenoses in the range of 30%to 90%were retrospectively included.Clinical data were collected and recorded.The CT-FFR images were analyzed and the CT-FFR values of the lesions were obtained using CT-FFR software,and the CT-FFR values and stenosis rates before and after treatment were recorded as CT-FFR1,CT-FFR2,stenosis rate 1,and stenosis rate 2,respectively.The following models were constructed by combining the stenosis rates,CT-FFR values,and clinical indices the combined functional model model 0(CT-FFR1+CT-FFR2),pre-treatment functional model model 1(CT-FFR1+clinical indicators),and pre-treatment anatomical functional model model 2(stenosis rate1+CT-FFR1+clinical indicators).The receiver operator characteristic curve(ROC)was plotted in three groups group 1 CT-FFR1 vs.stenosis rate 1,group 2 CT-FFR1 vs.CT-FFR2 vs.model 0,group 3 CT-FFR1 vs.model1 vs.model2,to compare their diagnostic efficacy for the occurrence of MACE events in patients with coronary artery disease.Results Patients in the MACE group had significantly lower CT-FFR values than those in the no-MACE group(P<0.05).The AUC for CT-FFR1 was 0.747(95%CI 0.671~0.814)and the AUC for stenosis 1 was 0.633(95%CI 0.551~0.709),and the diagnostic efficacy of CT-FFR1 was higher than that of stenosis 1(P=0.026).The AUC of CT-FFR2 was 0.822(95%CI 0.752~0.879)and model 0 was 0.829(95%CI 0.760~0.884),and the diagnostic efficacy of combining CT-FFR1 and CT-FFR2 was significantly improved(P=0.011);the AUC of model 1 and model 2 AUC were 0.863(95%CI 0.799~0.913)and 0.866(95%CI 0.801~0.915),respectively,and the diagnostic efficacy of the functional model was higher than that of CT-FFR alone(P=0.014),with the highest diagnostic efficacy of the anatomical-functional model(P=0.014).Conclusion CT-FFR values have good diagnostic efficacy for the occurrence of MACE in patients with coronary artery disease,and in combination with stenosis rate and clinical indices can significantly improve the diagnostic value of MACE in patients.
作者
茆雯雯
胡春洪
胡粟
陈蒙
陶青
杨义文
MAO Wenwen;HU Chunhong;HU Su;CHEN Meng;TAO Qing;YANG Yiwen(Department of Radiology, The First Affiliated Hospital, Soochow University, Suzhou 215006, China)
出处
《医学影像学杂志》
2022年第7期1144-1149,共6页
Journal of Medical Imaging
基金
江苏省苏州市姑苏卫生人才计划项目(编号:GSWS2020003)。
