摘要
目的:评价CT血流储备分数(CT-FFR)不同操作者测量的一致性及诊断准确性。方法:前瞻性入选冠状动脉CT血管成像(CCTA)证实冠状动脉狭窄30%-90%且于1周内行冠状动脉造影及血流储备分数(FFR)测量的患者。FFR<0.8诊断为缺血。两操作者分别测量CT-FFR,计算Kappa值,评价二者测量CT-FFR诊断缺血的一致性。采用ROC曲线评价血管水平CCTA及CT-FFR对缺血病变的诊断效能。结果:共纳入152例患者173支冠状动脉血管,其中FFR<0.8血管85支(49.1%),FFR≥0.8血管88支(50.9%)。两操作者测量CT-FFR差值为0.032(0.008,0.092);FFR<0.8血管的两操作者测量差值显著高于FFR≥0.8血管[0.078(0.016,0.128)vs. 0.013(0.007,0.048),P<0.001]。两操作者测量CT-FFR诊断缺血的Kappa值为0.86;诊断缺血的AUC分别为0.913(95%CI:0.861-0.950)和0.948(95%CI:0.903-0.976),差异无统计学意义(P=0.079),均显著高于以CCTA管腔狭窄≥50%诊断缺血的AUC[0.690(95%CI:0.616-0.758)],P均<0.001。结论:不同操作者测量CT-FFR一致性良好,诊断缺血的准确性高。
Objectives: To evaluate the inter-operator measurement reproducibility and diagnostic accuracy of CT-derived fractional flow reserve(CT-FFR).Methods: Patients with coronary artery stenosis of 30%-90% detected by coronary CT angiography(CCTA) were prospectively enrolled. Invasive coronary angiography was performed within the following 1 week after CCTA, and fractional flow reserve(FFR) was measured. FFR <0.8 was considered as the gold standard for the diagnosis of ischemia. The CT-FFR was separately measured by two operators. The Kappa value was calculated to evaluate the inter-observer diagnostic accuracy agreement of CT-FFR for the diagnosis of ischemia. The diagnostic performance of CCTA and CT-FFR in ischemic lesions was evaluated by ROC curve analysis.Results: A total of 152 patients with 173 vessels were analyzed. Of all vessels, 85(49.1%) vessels had FFR <0.8, and 88(50.9%) vessels had FFR ≥0.8. The median value of the CT-FFR inter-operator difference was 0.032(0.008, 0.092) for all vessels. The inter-operator measurement difference was significantly higher for FFR <0.8 vessels than for FFR ≥0.8 vessels(0.078 [0.016, 0.128] vs. 0.013 [0.007, 0.048], P<0.001). For inter-operator agreement in CT-FFR diagnosis of ischemia, the Kappa value was 0.86. There was no statistically significant difference in the area under ROC curve for inter-operator CT-FFR diagnosis of ischemia(0.913 [95% CI: 0.861-0.950] vs. 0.948 [95% CI: 0.903-0.976], P=0.079), which were both significantly higher than the AUC for ischemia diagnosis based on CCTA stenosis ≥50%(0.690 [95% CI: 0.616-0.758], both P<0.001).Conclusions: The CT-FFR measurement has good reproducibility and high diagnostic accuracy for identifying hemodynamic stenosis.
作者
耿文磊
高扬
赵娜
安云强
宋雷
慕朝伟
胡奉环
尹栋
高立建
徐波
吕滨
GENG Wenlei;GAO Yang;ZHAO Na;AN Yunqiang;SONG Lei;MU Chaowei;HU Fenghuan;YIN Dong;GAO Lijian;XU Bo;LYU Bin(Department of Radiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第7期683-688,共6页
Chinese Circulation Journal
基金
北京市科技计划课题(Z201100005620013)
中国医学科学院临床与转化医学研究基金项目(2019XK320065)。
关键词
冠状动脉CT血管成像
CT血流储备分数
一致性
冠心病
coronary CT angiography
CT-derived fractional flow reserve
measurement reproducibility
coronary heart disease
