Abstract：Objective This study aims to investigate the feasibility of the noninvasive fractional flow reserve (FFR) based on coronary CT angiography (CCTA) in evaluating functional myocardial ischemia in patients with coronary heart disease. Methods This was a cross-sectional study. Data related to 43 patients (61 vessels) with suspected coronary artery disease who completed CCTA, percutaneous coronary angiography, and invasive FFR measurements at Bengbu First People's Hospital from January 2022 to March 2023 were included. The study participants included 28 males and 15 females, aged 48-76 (63.5±5.8) years old. The CT-FFR value was calculated by using the principle of hydrodynamics model based on the CCTA image data, and the invasive FFR value was taken as the "gold standard". The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT-FFR in the diagnosis of myocardial ischemia were calculated from the patient and vascular levels. The area under the curve (AUC) was obtained by using the receiver operating characteristic (ROC) curve. Pearson was used to analyze the correlation between two levels of CT-FFR and invasive FFR, and kappa test or Bland-Altman method was utilized to evaluate the consistency between the two groups. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 85.71%, 90.09%, 90.00%, 86.96%, and 88.37%, respectively. Based on the vascular level, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT-FFR in the diagnosis of myocardial ischemia were 87.50%, 93.10%, 93.33%, 87.10%, and 90.16%, respectively. ROC curve analysis showed that the two CT-FFR diagnostic myocardial ischemia ROC AUC values were 0.774 and 0.758 based on patient and vessel levels, respectively. Pearson analysis showed a positive correlation between the CT-FFR values and the invasive FFR values based on the patient and vascular levels (rpatient=0.963, rvascular=0.980; all P values <0.001). Good agreement between the CT-FFR and the invasive FFR was analyzed by the Bland-Altman method (95% CI -0.064-0.035). Conclusion CT-FFR technology has high diagnostic efficacy and feasibility in diagnosing functional myocardial ischemia of coronary heart disease patients and has promising clinical applications.
祁冬, 乔晓春, 姚传顺, 董晨, 何兴义, 姚木子. 基于冠状动脉CT血管成像的无创血流储备分数评估功能性心肌缺血的可行性研究[J]. 中华解剖与临床杂志, 2024, 29(3): 153-158.
Qi Dong, Qiao Xiaochun, Yao Chuanshun, Dong Chen, He Xingyi, Yao Muzi. Evaluation of functional myocardial ischemia by noninvasive fractional flow reserve based on coronary CT angiography. Chinese Journal of Anatomy and Clinics, 2024, 29(3): 153-158.
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