Computed Tomography-Derived Fractional Flow Reserve in the Detection of Lesion-Specific Ischemia: An Integrated Analysis of 3 Pivotal Trials.
Computed Tomography-Derived Fractional Flow Reserve in the Detection of Lesion-Specific Ischemia: An Integrated Analysis of 3 Pivotal Trials.
复制标题
计算机断层扫描衍生的血流储备分数在检测病变特异性缺血中的应用：3 个关键试验的综合分析。
DOI：
10.1097/md.0000000000001963
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发表时间：
2015-11
期刊：
影响因子：
1.6
通讯作者：
Ge J
中科院分区：
文献类型：
--
作者：
Xu R;Li C;Qian J;Ge J
有创分数血流储备（FFR）是确定生理性狭窄严重程度和是否需要血运重建的金标准。从标准获得的冠状动脉计算机断层血管成像数据集（FFRCT）计算FFR是一项新兴技术，它允许使用冠状动脉计算机断层血管成像（CCTA）的静息图像数据计算FFR。然而，FFRCT在评估病变特异性心肌缺血中的诊断准确性仍有待证实，特别是在中度冠状动脉狭窄患者中。我们对3项前瞻性、国际性和多中心试验的数据进行了综合分析，以有创性FFR作为参考标准评估FFRCT的诊断性能。纳入了评估609名患者和1050条血管的三项研究。FFRCT的总计算灵敏度、特异性、阳性预测值、阴性预测值和准确性在单支分析中分别为82.8%、77.7%、60.8%、91.6%和79.2%，在单例分析中分别为89.4%、70.5%、69.7%、89.7%和78.7%。与单独CCTA相比，FFRCT在检测病变特异性缺血方面的准确性显著提高（P < 0.001）。在中度冠状动脉狭窄的患者中，FFRCT在诊断缺血方面仍然具有高度的敏感性和特异性。总之，FFRCT似乎是一种可靠的非侵入性替代有创性FFR，因为它在确定解剖结构和病变特异性缺血方面具有很高的准确性，这证明了额外的随机对照试验的进行，以评估FFRCT引导的冠状动脉血运重建术的临床益处和成本效益。
Invasive fractional flow reserve (FFR) is the gold standard for the determination of physiologic stenosis severity and the need for revascularization. FFR computed from standard acquired coronary computed tomographic angiography datasets (FFRCT) is an emerging technology which allows calculation of FFR using resting image data from coronary computed tomographic angiography (CCTA). However, the diagnostic accuracy of FFRCT in the evaluation of lesion-specific myocardial ischemia remains to be confirmed, especially in patients with intermediate coronary stenosis. We performed an integrated analysis of data from 3 prospective, international, and multicenter trials, which assessed the diagnostic performance of FFRCT using invasive FFR as a reference standard. Three studies evaluating 609 patients and 1050 vessels were included. The total calculated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFRCT were 82.8%, 77.7%, 60.8%, 91.6%, and 79.2%, respectively, for the per-vessel analysis, and 89.4%, 70.5%, 69.7%, 89.7%, and 78.7%, respectively, for the per-patient analysis. Compared with CCTA alone, FFRCT demonstrated significantly improved accuracy (P < 0.001) in detecting lesion-specific ischemia. In patients with intermediate coronary stenosis, FFRCT remained both highly sensitive and specific with respect to the diagnosis of ischemia. In conclusion, FFRCT appears to be a reliable noninvasive alternative to invasive FFR, as it demonstrates high accuracy in the determination of anatomy and lesion-specific ischemia, which justifies the performance of additional randomized controlled trials to evaluate both the clinical benefits and the cost-effectiveness of FFRCT-guided coronary revascularization.