张瑞涛,徐昕晔,何立芸,米琳,郭丽君

• 1:北京大学第三医院心内科国家卫生健康委员会心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室心血管受体研究北京市重点实验室

摘要(Abstract)：

目的以血流储备分数(FFR)为标准,比较定量血流分数(QFR)和瞬时无波形比值(i FR)评估冠状动脉临界病变的准确性,并分析QFR与i FR的相关性及诊断一致率。方法回顾性纳入北京大学第三医院2015年5月至2020年6月因冠心病进行冠状动脉造影(CAG)并接受FFR和i FR检测的62例患者,收集患者的临床和CAG病变解剖学资料、靶血管i FR和FFR值,并测量同一靶血管的QFR值。以FFR≤0.80为判断心肌缺血的临界值,比较QFR和i FR与FFR评估冠状动脉临界病变的准确性,并分析QFR与i FR的相关性及诊断一致率。结果 62例患者中,有53例(85.5%)靶血管为左前降支,基线直径狭窄率为48.0%(41.1%,55.7%)。i FR、QFR与FFR均具有较好的相关性[r=0.773(95%CI 0.649～0.857)、r=0.626(95%CI 0.445～0.757),均P<0.001]。QFR、i FR预测FFR≤0.80的受试者工作特征曲线下面积(AUC)比较,差异无统计学意义[0.859(95%CI 0.748～0.935)比0.875(95%CI 0.766～0.945),P=0.801];二者与FFR诊断一致率的差异无统计学意义(74.2%比79.0%,P=0.615)。QFR与i FR的相关性较弱(r=0.396,95%CI0.162～0.587,P=0.0015)。QFR对应i FR≤0.89的AUC为0.663(95%CI 0.524～0.801,P=0.028)。QFR、i FR联合诊断策略可以与FFR达到88.7%的诊断一致率,同时减少58.1%的压力导丝使用。结论 i FR与QFR评估冠状动脉临界病变具有相似的诊断准确率,但二者相关性较弱。二者联合诊断策略可进一步提高诊断准确率。

关键词(KeyWords)： 血流储备分数;瞬时无波形比值;定量血流分数;临界病变

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张瑞涛,徐昕晔,何立芸,米琳,郭丽君

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