范迪，崔光彬，李强，朱佳，王玮，夏国志，项羽

计算机断层摄影术冠状动脉造影对血流储备的评价

范迪，崔光彬，李强，朱佳，王玮，夏国志，项羽

目的：计算机断层摄影术冠状动脉（冠脉）造影（CTA）评价血流储备的准确性及临床应用价值。

方法：回顾性分析2013-10至2015-10于第四军医大学唐都医院、陕西省人民医院住院患者43例，男29例（67.4%），平均年龄（60.2±10.1）岁。入选患者均在冠脉造影术前1周内行CTA检查，两项检查的间隔时间均为（5.4±1.6）d。选择冠脉临界病变（狭窄50%～70%）为靶血管，经导管压力导丝测定血流储备分数（FFR），记录相关影像数据，计算CTA测定的血流储备分数（FFRCT）。

结果：入选43例患者中共计48段冠脉为靶血管，以FFR为金标准，FFRCT诊断准确性83.3%，敏感性75.0%，特异性89.3%，阳性预测值83.3%，阴性预测值83.3%；与FFR呈显著相关（r=0.704，P＜0.001）；Bland-Altman分析显示95%一致界限为（-0.12～0.16），95.8%（46/48）点落在一致性界限内，4.2%（2/48）点在95%一致性界限外，两者具有良好一致性；受试者工作特征曲线下面积0.871（95%可信区间：0.770～0.973）。

结论：CTA能够准确评价血流储备，有望成为指导冠脉临界病变治疗策略选择的检查方法。

冠状动脉疾病； 体层摄影术， X线计算机； 血流储备分数， 心肌 ； 心血管造影术

Abstract

Objective: To evaluate the accuracy and clinical value of fractional flow reserve （FFR） determined by CT coronary angiography（CTA） in relevant patients.

Methods: A total of 43 patients treated in our hospitals from 2013-10 to 2015-10 were retrospectively studied. There were 29（67.40%） with male gender， the average age was （60.2±10.1） years. The patients received CTA at 1 week prior coronary angiography（CAG）， the interval between CTA and CAG was （5.4±1.6） days. FFR was measured by both CAG and CTA （FFRCT） in selected target vessel which was defined as maximal diameter reduction 50% to 70%. The imaging data were recorded and compared， FFRCT was calculated.

Results: 48 vessels from 43 patients were eligible for analysis as target vessels. FFRCTvas evaluated based on the gold criteria of FFR. FFRCThad the diagnostic accuracy at 83.3%， sensitivity 75.0%， specificity 89.3% and positive predictive value was 83.3%，negative predictive value was 83.3% respectively. FFR and FFRCTshowed obvious correlation （r=0.704， P＜0.001）； Bland-Altman analysis presented good concordance with 95% limits of agreement for FFRCTand FFR value ranged from -0.12 to 0.16， and 95.8% of the points （46/48） fell in the 95% limit of agreement， Receiver operating characteristic curve indicated that AUC of FFRCTwas 0.871（95% CI 0.770-0.973）.

Conclusion: CTA could accurately assess FFR， and FFRCTmight be used in guiding the treatment for patients with intermediate coronary stenosis in clinical practice.

（Chinese Circulation Journal， 2016，31:840.）

冠状动脉（冠脉）临界病变干预策略的选择一直颇受争议，经导管压力导丝测定血流储备分数（FFR）是评价临界病变是否引起心肌缺血的金标准［1］；但因其有创性、费用昂贵及手术并发症等，临床开展有一定难度。结合计算机断层摄影术（CT）冠脉造影（CTA）与计算流体动力学技术，模拟冠脉血流动力学，计算病变血管CTA测定的血流储备分数（FFRCT），是一项崭新无创检测体系，其诊断准确性及临床应用价值引起广泛关注［2］。……