定量血流分数在光学相干断层成像评估的冠状动脉临界病变中的诊断价值
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南京医科大学第一附属医院心血管内科

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国家自然科学基金(81770361)


Diagnostic value of quantitative flow ratio in intermediate coronary lesions assessed by optical coherence tomography
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Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University

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The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan)(81770361)

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    摘要:

    目的:在冠状动脉临界病变中,结合光学相干断层成像(optical coherence tomography, OCT)评估血管狭窄的相关参数,探究应用定量血流分数(quantitative flow ratio,QFR)在其中的诊断价值。方法:共纳入2016年10月至2020年2月于南京医科大学第一附属医院入院患者89例,共计109处病变。所有患者行冠脉造影(coronary angiography,CAG)提示冠状动脉临界病变(目测病变血管狭窄程度50%-90%),并于术中行OCT评估病变血管。收集患者基线资料、定量冠状动脉造影(quantitative coronary angiography,QCA)数据及相关冠状动脉病变特征,运用QFR回顾性分析相关病变。以OCT下最小管腔面积(minimal lumen area, MLA)<2.5 mm2或面积狭窄率(area stenosis, AS)≥75% 作为OCT诊断血管明显狭窄的标准,引入QFR并评估其在此类病变中的诊断价值。结果:与血管非明显狭窄组相比,明显狭窄组的QFR值显著降低(P<0.001)。与OCT(P=0.007)及QFR评估的3D-QCA(P<0.001)相比,2D-QCA下AS值更大。3D-QCA及OCT评估的AS值之间无明显统计学差异(P=0.356)。线性回归显示,OCT-MLA与QFR呈明显正相关(r=0.56; P<0.001),OCT-AS与QFR呈明显负相关(r= -0.60; P<0.001)。ROC分析显示,QFR诊断血管明显狭窄的ROC诊断截点为0.81,曲线下面积为0.837(95%CI: 0.754-0.901, P<0.001),敏感度为83.3%,特异度为80.0%。结论:在冠状动脉临界病变中应用QFR结合OCT,可在精确测量血管狭窄程度的同时,评估冠脉的功能学参数,共同指导临界病变的介入诊疗。

    Abstract:

    Objective:To investigate the diagnostic value of quantitative flow ratio (QFR) combined with coronary stenosis assessed by related optical coherence tomography (OCT) parameters in intermediate coronary lesions. Methods:From October 2016 to February 2020, a total of 89 patients with 109 lesions were enrolled in the First Affiliated Hospital of Nanjing Medical University. All patients underwent coronary angiography (CAG) suggesting intermediate lesions (stenosis between 50% and 90% by visual estimation) and lesions were evaluated by OCT. Baseline data,quantitative coronary angiography data (QCA) and coronary lesions characteristics were collected and lesions were retrospectively analyzed by QFR. The diagnostic value of QFR in intermediate coronary lesions was evaluated when coronary significant stenosis defined as minimal lumen area (MLA)<2.5mm2 or area stenosis (AS) ≥75% by OCT. Results:Compared with the non-significant stenosis group, QFR in significant stenosis group was significantly lower (P<0.001). AS assessed by 2D-QCA was significantly higher than that assessed by OCT(P=0.007) and 3D-QCA(P<0.001) derived from QFR. AS evaluated by 3D-QCA and OCT has no significant difference(P=0.356). According to linear regression,OCT-MLA was correlated positively with QFR significantly (r=0.56, P<0.001). OCT-AS was correlated negatively with QFR significantly (r=-0.60, P<0.001). ROC-analysis revealed that 0.81 is the ideal QFR cut-off to identify coronary lesions with significant stenosis (AUC: 0.837, 95% CI 0.754-0.901, P<0.001, sensitivity 83.3% and accuracy 80.0%). Conclusion:The application of QFR combined with OCT can accurately predict the coronary stenosis and evaluate the coronary functional parameters, which can guide the diagnosis and treatment in intermediate coronary lesions.

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  • 收稿日期:2020-12-11
  • 最后修改日期:2021-03-07
  • 录用日期:2021-08-12
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