The value of fractional flow reserve based on coronary computed tomography angiography with low-dose contrast agent in noninvasive diagnosis of coronary artery disease.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2025-03-01 Epub Date: 2024-12-02 DOI:10.1097/MCA.0000000000001448

Zengkun Wang, Xiaomei Luan, Qian Zhang, Chu Chu, Xiaodie Xu, Huijing Chai, Peiji Song

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引用次数: 0

Abstract

Aim: The study aimed, using invasive coronary angiography (ICA) as the gold standard, to investigate the noninvasive diagnostic value of flow reserve fraction derived from coronary computed tomography angiography (CCTA) with low-dose contrast agent in coronary artery disease (CAD).

Methods: A total of 163 patients with clinical symptoms related to CAD were enrolled between 1 January 2022 and 30 January 2023. The patients received CCTA with a low dose of contrast agent to rule out CAD. If significant (CCTA ≥ 50%) stenosis is suspected, ICA is performed to further evaluate the CCTA for coronary lesions. CT-FFR is calculated from the CCTA dataset using a machine learning-based algorithm. Compared with ICA as a reference standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of low-dose contrast agent CT-FFR in the diagnosis of myocardial ischemia were calculated. Coronary lesions with CT-FFR ≤0.80 were defined as hemodynamically significant.

Results: Obstructive CAD was excluded by low-contrast CCTA in 87 of 163 patients (53.7%). In the remaining 75 patients (42.35%), at least one coronary artery stenosis was greater than 50%. The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a patient-based evaluation in diagnosing CAD were 93.06, 93.44, 90.01, 98.28, and 71.43%, respectively (Kappa = 0.759). The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a vessel-based evaluation in diagnosing CAD were 86.72, 82.76, 91.58, 92.31, and 81.31%, respectively (Kappa = 0.735). Pearson correlation analysis showed that the ICA examination had a good correlation with CT-FFR value of low-dose contrast media ( r = 0.731, P < 0.01). Moreover, in 81.31% of cases, additional analysis of CT-FFR correctly excluded the hemodynamic significance of stenosis.

Conclusion: CT-FFR based on low-dose contrast agent CCTA is a very promising noninvasive approach to exclude hemodynamically significant coronary artery stenosis in patients with suspected coronary heart disease while reducing renal burden and helping to reduce the rate of ICA in this high-risk population.

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基于小剂量造影剂的冠状动脉ct血管造影分数血流储备在冠状动脉疾病无创诊断中的价值。

目的：本研究旨在以有创冠状动脉造影（ICA）为金标准，探讨低剂量造影剂冠状动脉计算机断层造影（CCTA）血流储备分数在冠状动脉疾病（CAD）中的无创诊断价值。方法：在2022年1月1日至2023年1月30日期间，共纳入163例与CAD相关的临床症状患者。患者接受低剂量造影剂CCTA以排除CAD。如果怀疑明显（CCTA≥50%）狭窄，则行ICA进一步评估CCTA对冠状动脉病变的影响。CT-FFR是使用基于机器学习的算法从CCTA数据集计算出来的。与ICA作为参考标准比较，计算低剂量造影剂CT-FFR诊断心肌缺血的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。冠状动脉病变CT-FFR≤0.80定义为血流动力学显著。结果：163例患者中有87例（53.7%）通过低对比CCTA排除梗阻性CAD。其余75例（42.35%）患者至少有一例冠状动脉狭窄大于50%。低剂量造影剂CT-FFR诊断CAD的准确性、敏感性、特异性、PPV和NPV分别为93.06、93.44、90.01、98.28和71.43% （Kappa = 0.759）。低剂量造影剂CT-FFR血管评价诊断CAD的准确性、敏感性、特异性、PPV和NPV分别为86.72、82.76、91.58、92.31和81.31% （Kappa = 0.735）。Pearson相关分析显示，ICA检查与低剂量造影剂CT-FFR值有很好的相关性（r = 0.731， P）。结论：基于低剂量造影剂CCTA的CT-FFR是一种非常有前途的无创方法，可以排除疑似冠心病患者血流动力学上显著的冠状动脉狭窄，同时减轻肾脏负担，有助于降低这一高危人群的ICA发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.