使用分割自由降阶(一维)血流模型的常规冠状动脉造影所得的虚拟分数血流储备的诊断性能。

IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
JRSM Cardiovascular Disease Pub Date : 2020-11-05 eCollection Date: 2020-01-01 DOI:10.1177/2048004020967578
Kevin Mohee, Jonathan P Mynard, Gauravsingh Dhunnoo, Rhodri Davies, Perumal Nithiarasu, Julian P Halcox, Daniel R Obaid
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引用次数: 2

摘要

简介:与传统血管造影相比,分数血流储备(FFR)提高了对冠状动脉病变生理意义的评估。然而,这是一项侵入性调查。我们使用常规血管造影图像和快速执行的降阶计算模型测试了虚拟FFR (1D-vFFR)的性能。方法:对102例经有创FFR评估冠状动脉病变的患者行定量冠脉造影(QCA)。每个病变的1D-vFFR是使用降阶(一维)计算血流模型创建的,该模型来源于常规血管造影图像和患者特定的冠状动脉血流估计。将1D-vFFR和QCA衍生狭窄的诊断准确性与有创FFR的金标准进行比较,采用受者操作者特征曲线下面积(AUC)。结果:QCA显示冠脉狭窄平均直径为44%±12%,病变长度为13±7 mm。血管造影后计算1DvFFR用时不到1分钟。冠状动脉狭窄(QCA)与FFR有显著但较弱的相关性(r = -0.2, p = 0.04),对FFR病变的诊断效果较差。结论:与传统血管造影相比,1D-vFFR可提高对功能显著的冠状动脉病变的确定,无需压力线或充血诱导。它足够快,可以立即影响临床决策,但需要进一步的临床评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic performance of virtual fractional flow reserve derived from routine coronary angiography using segmentation free reduced order (1-dimensional) flow modelling.

Introduction: Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model.

Methods: Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC).

Results: QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = -0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity - 58% and specificity - 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity - 92% and specificity - 29% at a 1D-vFFR of 0.7).

Conclusions: 1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation.

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来源期刊
JRSM Cardiovascular Disease
JRSM Cardiovascular Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
6.20%
发文量
12
审稿时长
12 weeks
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