文章摘要
薛 源,孟浩宇,王连生.定量血流分数在光学相干断层成像评估冠状动脉临界病变中的诊断价值[J].南京医科大学学报,2021,(4):540~544
定量血流分数在光学相干断层成像评估冠状动脉临界病变中的诊断价值
Diagnostic value of quantitative flow ratio in intermediate coronary lesions assessed by optical coherence tomography
投稿时间:2020-12-11  
DOI:10.7655/NYDXBNS20210411
中文关键词: 冠状动脉临界病变  定量血流分数  光学相干断层成像  心肌缺血
英文关键词: intermediate coronary lesions  quantitative flow ratio  optical coherence tomography  myocardial ischemia
基金项目:国家自然科学基金(81770361)
作者单位
薛 源 南京医科大学第一附属医院心血管内科江苏 南京 210029 
孟浩宇 南京医科大学第一附属医院心血管内科江苏 南京 210029 
王连生 南京医科大学第一附属医院心血管内科江苏 南京 210029 
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中文摘要:
      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—2020年2月于南京医科大学第一附属医院入院行冠脉造影患者89例,冠状动脉临界病变109处(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% 作为诊断标准将病例分为明显狭窄组和非明显狭窄组,引入QFR并评估其在此类病变中的诊断价值。结果:与非明显狭窄组相比,明显狭窄组的QFR值显著降低(P<0.001)。与OCT及QFR评估的3D?QCA相比,2D?QCA下AS值更大(P=0.007,P<0.001)。3D?QCA及OCT评估的AS值之间差异无统计学意义(P=0.356)。线性回归显示,OCT?MLA与QFR正相关(r=0.56,P<0.001),OCT?AS与QFR负相关(r=-0.60,P<0.001)。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,QFR诊断血管明显狭窄的截断值为0.81,曲线下面积为0.837(95%CI:0.754~0.901,P<0.001),灵敏度为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。
英文摘要:
      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 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)<2.5 mm2 or area stenosis(AS)≥75% by OCT. Results:Compared with the non?significant stenosis group,QFR in the 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 had 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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