Evaluation of Significant Coronary Artery Disease Based on CT Fractional Flow Reserve and Plaque Characteristics Using Random Forest Analysis in Machine Learning
Evaluation of Significant Coronary Artery Disease Based on CT Fractional Flow Reserve and Plaque Characteristics Using Random Forest Analysis in Machine Learning
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DOI：
10.1016/j.acra.2019.12.013
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发表时间：
2020-12-01
影响因子：
4.8
通讯作者：
Utsunomiya, Daisuke
中科院分区：
文献类型：
--
作者：
Kawasaki, Tomohiro;Kidoh, Masafumi;Utsunomiya, Daisuke
原理和目的：血流储备分数（FFR）是一种用于检测病变特异性缺血的成熟技术，但具有侵入性。本研究的目的是通过与有创血流储备分数（FFR）的比较，探讨联合评估冠状动脉CT血管造影（CCTA）成像特征和CT-FFR在检测病变特异性缺血中的作用。测量了6个解剖CCTA描述符（Agatston评分、狭窄严重程度、平均斑块CT衰减值、非钙化和钙化斑块体积、重塑指数）和功能描述符（CT-FFR）。随机森林被用来确定哪些描述符是有用的，以确定缺血相关病变。计算了2个模型的受试者工作特征（ROC）曲线：即解剖CT描述符的模型1和解剖CT描述符加CT-FFR的模型2。狭窄严重程度（40.8 ± 15.7% vs 57.6 ± 14.1%），非钙化斑块体积缺血相关性病变组的心肌缺血指数（190 ± 100 vs 254.8 ± 133.3）和重塑指数（1.04 ± 0.12 vs 1.11 ± 0.13）显著高于非缺血相关性病变组。缺血相关和非缺血相关病变的CT-FFR分别为0.84 +/- 0.14和0.71 +/- 0.14，差异具有显著性。模型1和模型2的ROC曲线下面积分别为0.738和0.835。增加CT-FFR后缺血性病变风险的重新分类显著改善：净重新分类改善为0.297，综合区分改善为0.254。结论：结合解剖学CCTA特征和功能性CT-FFR有助于检测病变特异性缺血。
Rationale and Objectives: Fractional flow reserve (FFR) is an established technique for detecting lesion-specific ischemia but is invasive. Our objective was to investigate the effects of combined assessment of coronary CT angiography (CCTA) imaging features and CT-FFR on detecting lesion-specific ischemia by comparing with invasive FFR.Materials and Methods: Forty-seven patients who had 60 coronary vessels with 30%-90% stenosis were included. Six anatomic CCTA descriptors (Agatston score, stenosis severity, mean plaque CT attenuation value, noncalcified and calcified plaque volumes, remodeling index) and a functional descriptor (CT-FFR) were measured. Random forest was used to identify which descriptors were useful to identify ischemia-related lesion. Receiver-operating characteristic (ROC) curves were calculated for 2 models: i.e. Model-1 for anatomical CT descriptors and Model-2 for anatomical CT descriptors plus CT-FFR.Results: Stenosis severity (40.8 +/- 15.7% vs 57.6 +/- 14.1%), noncalcified plaque volume (190 +/- 100 vs 254.8 +/- 133.3), and remodeling index (1.04 +/- 0.12 vs 1.11 +/- 0.13) were significantly higher in ischemia-related lesions than nonischemia-related lesions. CT-FFR was 0.84 +/- 0.14 and 0.71 +/- 0.14, respectively, for ischemia-related and nonischemia-related lesions, and the difference was significant. The area under the ROC curve was 0.738 and 0.835 in Model-1 and Model-2, respectively. Reclassification of ischemic lesion risk was significantly improved after adding CT-FFR: net reclassification improvement was 0.297 and integrated discrimination improvement was 0.254.Conclusion: Combined assessment of anatomical CCTA features and functional CT-FFR was helpful for detecting lesion-specific ischemia.