周沛,聂文畅,刘健,侯昌,曹成富,李琪,马玉良,卢明瑜,赵红,王伟民

• 1:北京大学人民医院心血管内科急性心肌梗死早期预警和干预北京市重点实验室

摘要(Abstract)：

目的 分析冠心病患者有创血流储备分数（FFR）和基于冠状动脉造影的血流储备分数（caFFR）的检测结果，评估caFFR对冠状动脉狭窄病变缺血的临床诊断价值。方法 收集2018年10月至2020年11月于北京大学人民医院择期行冠状动脉造影、FFR检查的冠心病患者，同时对所有患者进行caFFR检查，探讨两者的相关性和caFFR对冠状动脉缺血病变诊断的准确性。结果 收集98例患者的100处病变冠状动脉FFR和caFFR数据，FFR平均值为（0.85±0.09）,caFFR平均值为（0.84±0.08）。FFR和ca FFR平均差值为–0.013(95%一致性界限：–0.150～0.124,P=0.06)，两者呈线性相关（r=0.678,P<0.001）。以FFR<0.80为阈值，caFFR诊断冠状动脉功能学缺血的准确性为89.0%[95%置信区间（CI）81.2%～94.4%]，受试者工作特征曲线下面积为0.934(95%CI 0.881～0.987,P<0.001)。caFFR最佳截断值为0.815，以caFFR<0.815为冠状动脉功能学缺血的阈值时，caFFR诊断准确性可提高至90.0%(95%CI 82.4%～94.7%)，敏感度91.7%(95%CI 71.5%～98.5%)，特异度89.5%(95%CI 79.8%～95.0%)，阳性预测值73.3%(95%CI 53.8%～87.0%)，阴性预测值97.1%(95%CI89.1%～99.5%)。结论 caFFR与FFR有良好的相关性，caFFR在诊断冠状动脉狭窄功能学缺血方面具有较高的准确性。

关键词(KeyWords)： 基于冠状动脉造影的血流储备分数;血流储备分数;冠心病;冠状动脉功能学评价

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（11832003）;; 北京大学人民医院研究与发展基金项目（RDX2018-09）;; 首都特色临床医学应用发展项目（Z171100001017099）

作者(Author): 周沛,聂文畅,刘健,侯昌,曹成富,李琪,马玉良,卢明瑜,赵红,王伟民

参考文献(References)：

• [1] Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization:the Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for CardioThoracic Surgery(EACTS). Developed with the special contribution of the European Association of Percutaneous C a r d i o v a s c u l a r I n t e r v e n t i o n s(E A P C I)[J]. E u r J Cardiothorac Surg, 2014, 46(4):517-592.
• [2]中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南（2016）[J].中华心血管病杂志，2016, 44(5):382-400.
• [3] Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram:fractional fl ow reserve discordances in 4000 coronary stenoses[J]. Eur Heart J, 2014, 35(40):2831-2838.
• [4] Tonino PAL, Fearon WF, De Bruyne B, et al. Angiographic versus functional severity of coronary artery stenoses in the fame study:fractional flow reserve versus angiography in multivessel evaluation[J]. J Am Coll Cardiol, 2010, 55(25):2816-2821.
• [5] Jeremias A, Stone GW. Fractional fl ow reserve for the evaluation of coronary stenoses:limitations and alternatives[J]. Catheter Cardiovasc Interv, 2015, 85(4):602-603.
• [6] Pijls NHJ, van Schaardenburgh P, Manoharan G, et al.Percutaneous coronary intervention of functionally nonsignifi cant stenosis:5-year follow-up of the DEFER Study[J]. J Am Coll Cardiol, 2007, 49(21):2105-2111.
• [7] De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional fl ow reserve-guided PCI versus medical therapy in stable coronary disease[J]. N Engl J Med, 2012, 367(11):991-1001.
• [8] Collet C, Onuma Y, Sonck J, et al. Diagnostic performance of angiography-derived fractional flow reserve:a systematic review and Bayesian meta-analysis[J]. Eur Heart J, 2018,39(35):3314-3321.
• [9]苏州润迈德医疗科技有限公司. CAFFR精准计算新方案[EB/OL].(2021-01-05)[2021-01-09]. http：//www.rainmed.com/index.php?m=&c=index&a=about&catid=106&id=43.
• [10] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018ESC/EACTS guidelines on myocardial revascularization[J].EuroIntervention, 2019, 14(14):1435-1534.
• [11] Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes[J].Eur Heart J, 2020, 41(3):407-477.
• [12] Li J, Gong Y, Wang W, et al. Accuracy of computational pressure-fl uid dynamics applied to coronary angiography to derive fractional flow reserve:FLASH FFR[J]. Cardiovasc Res,2020, 116(7):1349-1356.
• [13] Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemiacausing coronary stenoses by noninvasive fractional fl ow reserve computed from coronary computed tomographic angiograms.Results from the prospective multicenter DISCOVER-FLOW(diagnosis of ischemia-causing stenoses obtained via noninvasive fractional fl ow reserve)study[J]. J Am Coll Cardiol, 2011,58(19):1989-1997.
• [14] Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional fl ow reserve from anatomic CT angiography[J].JAMA, 2012, 308(12):1237-1245.
• [15] N?rgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease:the NXT trial(analysis of coronary blood fl ow using CT angiography:next steps)[J]. J Am Coll Cardiol, 2014, 63(12):1145-1155.
• [16] Douglas PS, Pontone G, Hlatky MA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease:the prospective longitudinal trial of FFR(CT):outcome and resource impacts study[J]. Eur Heart J, 2015, 36(47):3359-3367.
• [17]中华医学会放射学分会质量控制与安全管理专业委员会，江苏省医学会放射学分会智能影像与质量安全学组.冠状动脉CT血流储备分数应用中国专家建议[J].中华放射学杂志，2020, 54(10):925-933.
• [18] Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional fl ow reserve from diagnostic coronary angiography:the international multicenter FAVOR pilot study[J]. JAC C Cardiovasc Interv, 2016, 9(19):2024-2035.
• [19] Xu B, Tu S, Qiao S, et al. Diagnostic accuracy o f angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis[J]. J Am Coll Cardiol,2017, 70(25):3077-3087.
• [20] Fearon WF, Achenbach S, Engstrom T, et al. Accuracy of fractional fl ow reserve derived from coronary angiography[J].Circulation, 2019, 139(4):477-484.
• [21] Montone RA, Niccoli G, Crea F, et al. Management of non-culprit coronary plaques in patients with acute coronary syndrome[J]. Eur Heart J, 2020, 41(37):3579-3586.
• [22] Morris PD, Silva Soto DA, Feher JFA, et al. Fast virtual fractional fl ow reserve based upon steady-state computational fl uid dynamics analysis:results from the VIRTU-Fast study[J].JACC Basic Transl Sci, 2017, 2(4):434-446.