龚艳君,易铁慈,杨帆,邱建星,范芳芳,王梓鸣,王文烨,霍云龙,李建平,霍勇

• 1:北京大学第一医院心内科
• 2:北京大学第一医院影像科
• 3:北京大学香港科技大学深圳研修院

摘要(Abstract)：

目的评价应用国产自主研发的基于CT血管造影(CTA)的血流储备分数(FFR_(CT))软件对心肌缺血的诊断价值。方法回顾性纳入2009年7月至2018年4月在北京大学第一医院行冠状动脉CTA及血流储备分数(FFR)检查的患者。使用FFR_(CT)软件计算出FFR_(CT)值,以有创的FFR值为金标准,分别从患者水平和血管水平计算出FFR_(CT)对心肌缺血诊断的准确性、敏感度、特异度、阳性预测值和阴性预测值。分别在患者水平和血管水平统计FFR_(CT)的ROC曲线下面积(AUC)。在血管水平,采用Pearson’s相关分析绘制FFR_(CT)值与FFR值的相关散点图,并绘制Bland-Altman图检验FFR_(CT)与FFR值的一致性。结果纳入患者71例,共计80支血管。患者水平FFR_(CT)的准确性为81.7%,敏感度为71.4%,特异度为91.7%,阳性预测值为89.3%,阴性预测值为76.7%;血管水平FFR_(CT)的准确性为81.3%,敏感度为67.6%,特异度为93.0%,阳性预测值为89.3%,阴性预测值为76.9%。在患者水平,FFR_(CT)用于诊断心肌缺血的ROC AUC为0.852(95%CI 0.758～0.946,P<0.001),最佳诊断界值为0.805;在血管水平,FFR_(CT)用于诊断心肌缺血的ROC AUC为0.848(95%CI 0.758～0.938,P<0.001),最佳诊断界值为0.805。Pearson’s相关分析显示,在血管水平,FFR_(CT)值与FFR值呈正相关(r=0.542,95%CI 0.366～0.681,P<0.001)。FFR_(CT)值与FFR值的BlandAltman图显示两者具有良好的一致性。结论以FFR值为金标准,应用国产FFR_(CT)软件诊断心肌缺血有较高的准确率,具有一定的临床应用前景。

关键词(KeyWords)： 心肌缺血;血流储备分数;冠状动脉;计算机断层扫描血管造影

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项（2016-2-4073）

作者(Author): 龚艳君,易铁慈,杨帆,邱建星,范芳芳,王梓鸣,王文烨,霍云龙,李建平,霍勇

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