基于冠状动脉 CT 血管造影的形态学指数,用于预测血流动力学意义上的冠状动脉狭窄。

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology. Cardiothoracic imaging Pub Date : 2023-12-01 DOI:10.1148/ryct.230064
Chenxi Wang, Shuang Leng, Ru-San Tan, Ping Chai, Jiang Ming Fam, Lynette Li San Teo, Chee Yang Chin, Ching Ching Ong, Lohendran Baskaran, Yung Jih Felix Keng, Adrian Fatt Hoe Low, Mark Yan-Yee Chan, Aaron Sung Lung Wong, Siang Jin Terrance Chua, Qinghua Wu, Swee Yaw Tan, Soo Teik Lim, Liang Zhong
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Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD<sup>4</sup>. Diagnostic performance and accuracy of α×LL/MLD<sup>4</sup> and LL/MLD<sup>4</sup> in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD<sup>4</sup> was 54.0 degree/mm<sup>3</sup> (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm<sup>3</sup> (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (<i>P</i> < .001). 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引用次数: 0

摘要

目的 开发一种基于冠状动脉 CT 血管造影 (CCTA) 的新指数 α×LL/MLD4,该指数除考虑病变长度 (LL) 和最小管腔直径 (MLD) 外,还考虑病变入口角 (α),并评估其与有创冠状动脉造影 (ICA) 得出的分数血流储备 (FFR) 相比在预测血流动力学显著性冠状动脉狭窄方面的疗效。材料和方法 这项前瞻性研究招募了来自两个中心的参与者(2016 年 9 月至 2020 年 3 月),他们都接受了 CCTA 检查,然后进行了 ICA(ClinicalTrials.gov 识别码:NCT03054324)。对 CCTA 图像进行半自动处理,测量 LL、MLD 和 α,以计算 α×LL/MLD4。将α×LL/MLD4 和 LL/MLD4 在检测血流动力学显著性冠状动脉狭窄方面的诊断性能和准确性与参考标准(有创 FFR ≤ 0.80)进行比较。结果 共分析了 133 名参试者(平均年龄 63 岁 ± 9 [SD];99 [74%] 男性)的 210 支狭窄冠状动脉。有创 FFR 为 0.80 或以下的参与者的中位 α×LL/MLD4 为 54.0 度/mm3(IQR,25.3-128.7),有创 FFR 为 0.80 以上的参与者的中位 α×LL/MLD4 为 6.7 度/mm3(IQR,3.3-12.8)(P < .001)。α×LL/MLD4的每血管准确性、敏感性、特异性、阳性预测值和阴性预测值分别为86.2%、83.1%、88.4%、84.1%和87.7%,LL/MLD4的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为80.5%、66.3%、90.9%、84.3%和78.6%。α×LL/MLD4判别血流动力学显著狭窄的接收者操作特征曲线下面积为0.93,明显高于LL/MLD4的0.84和直径狭窄的0.63(P均<0.001)。结论 与直径狭窄和 LL/MLD4 相比,包含病变入口角的新形态学指标 α×LL/MLD4 在检测有血流动力学意义的病变方面具有更高的诊断性能。关键词CT 血管造影 心脏 冠状动脉 缺血 梗死 技术评估 临床试验注册号NCT03054324 本文有补充材料。© RSNA, 2023 另请参阅本期 Fairbairn 和 Nørgaard 的评论。
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Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis.

Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD4, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD4. Diagnostic performance and accuracy of α×LL/MLD4 and LL/MLD4 in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD4 was 54.0 degree/mm3 (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm3 (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (P < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD4 and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD4, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD4, which was significantly greater than the values of 0.84 for LL/MLD4 and 0.63 for diameter stenosis (both P < .001). Conclusion The new morphologic index, α×LL/MLD4, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD4. Keywords: CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.

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