冠状动脉旁路移植术前基于计算机断层扫描的分流量储备预测移植失败:规划冠状动脉疾病侵入性治疗的意义。

IF 1 4区 医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Łukasz Wardziak, Mariusz Kruk, Marcin Demkow, Cezary Kępka
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引用次数: 0

摘要

研究目的该研究旨在评估冠状动脉旁路移植术(CABG)前冠状动脉计算机断层扫描(CCTA)在未来吻合部位的分数血流储备(FFR-CT)结果是否能预测接受冠状动脉旁路移植术患者的移植失败:方法:43 名患者在接受 CABG 手术前进行了冠状动脉计算机断层扫描(CCTA),并在 CABG 术后 12 个月以上进行了 CCTA 随访。根据 CABG 术前的 CCTA 模拟了 FFR-CT 值。根据随访 CCTA,确定吻合部位和移植物的通畅性。移植失败的定义是血管狭窄>50%或闭塞:结果:共评估了 98 例移植物(44 例隐静脉移植物、54 例左右乳内动脉移植物)。16名患者的18条移植物在后续CCTA检查中出现功能障碍。功能障碍移植物未来吻合位置的 FFR-CT 值高于正常移植物(分别为 0.77 [0.71-0.81] vs 0.60 [0.56-0.66],P = 0.0007)。CABG前FFR-CT(危险比=1.1;95% CI:1.012-1.1,P=0.0230)和右冠状动脉旁路移植(危险比=3.7;95% CI:1.4-9.3 vs 左前降支动脉)是随访期间移植物功能障碍的独立预测因素。FFR-CT预测移植物失败的最佳阈值大于0.68(敏感性88.9%(95% CI:65.3-98.6),特异性63.7%(95% CI:52.2-74.2),阳性预测值35.6%(95% CI:28.3%-43.5%),阴性预测值96.2%(95% CI:87.2%-99.0%)):CABG前功能性FFR-CT可预测未来冠状动脉旁路移植失败。结论:CABG 前功能性 FFR-CT 可预测未来的冠状动脉旁路移植失败,这表明 FFR-CT 在指导冠状动脉血运重建方面的实用性,同时也提示了 CABG 前生理评估的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pre-Coronary Artery Bypass Grafting Computed Tomography-Based Fractional Flow Reserve Predicts Graft Failure: Implications for Planning Invasive Treatment of Coronary Artery Disease.

Objective: The aim of the study is to evaluate whether a pre-coronary artery bypass grafting (CABG) coronary computed tomography-based fractional flow reserve (FFR-CT) result at the site of a future anastomosis would predict the graft failure in patients undergoing CABG.

Methods: In 43 patients who had coronary computed tomography angiography (CCTA) prior to the CABG, follow-up CCTA were acquired >12 months post-CABG procedure. The FFR-CT values were simulated on the basis of the pre-CABG CCTA. Based on follow-up CCTA, the anastomosis sites and the graft patency were determined. The graft failure was defined as either its stenosis >50% or occlusion.

Results: Ninety eight (44 saphenous, 54 left or right internal mammary artery) grafts were assessed. Eighteen grafts from 16 patients were dysfunctional on follow-up CCTA. The FFR-CT values at the location of future anastomosis were higher in dysfunctional than in normal grafts (0.77 [0.71-0.81] vs 0.60 [0.56-0.66], respectively, P = 0.0007). Pre-CABG FFR-CT (hazard ratio = 1.1; 95% CI: 1.012-1.1, P = 0.0230), and bypass graft to right coronary artery (hazard ratio = 3.7; 95% CI: 1.4-9.3 vs left anterior descending artery) were independent predictors of graft dysfunction during follow-up. The optimal threshold of FFR-CT to predict graft failure was >0.68 (sensitivity 88.9% (95% CI: 65.3-98.6), specificity 63.7% (95% CI: 52.2-74.2), positive predictive value 35.6% (95% CI: 28.3%-43.5%), negative predictive value 96.2% (95% CI: 87.2%-99.0%)).

Conclusions: Pre-CABG functional FFR-CT predicts future coronary bypass graft failure. This shows utility of FFR-CT for guiding coronary revascularization and also suggests significance of physiological assessment prior to CABG.

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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
230
审稿时长
4-8 weeks
期刊介绍: The mission of Journal of Computer Assisted Tomography is to showcase the latest clinical and research developments in CT, MR, and closely related diagnostic techniques. We encourage submission of both original research and review articles that have immediate or promissory clinical applications. Topics of special interest include: 1) functional MR and CT of the brain and body; 2) advanced/innovative MRI techniques (diffusion, perfusion, rapid scanning); and 3) advanced/innovative CT techniques (perfusion, multi-energy, dose-reduction, and processing).
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