北京生物醫(yī)學(xué)工程

狹窄幾何參數(shù)評(píng)估穩(wěn)定型冠心病心肌灌注效能的指導(dǎo)價(jià)值

Guiding value of stenosis geometrical parameters in evaluating myocardial perfusion efficacy in stable coronary heart disease

作者：白蘭李娜馮懿俐席曉璐孫昊許可喬愛(ài)科楊海勝劉健劉有軍

單位：北京工業(yè)大學(xué)環(huán)境與生命學(xué)部生命科學(xué)與化學(xué)學(xué)院（北京100124） ，北京大學(xué)人民醫(yī)院（北京100044） 通信作者：劉有軍。E-mail: [email protected]

關(guān)鍵詞：冠狀動(dòng)脈狹窄；病變累及長(zhǎng)度；病變嚴(yán)重程度；心肌灌注；效能評(píng)估

分類號(hào)：R318.04

出版年·卷·期（頁(yè)碼）：2021·40·4（360-366）

摘要：

目的探討?yīng)M窄病變嚴(yán)重程度和病變累及長(zhǎng)度等狹窄形態(tài)特征對(duì)穩(wěn)定型冠心病心肌灌注效能的評(píng)估價(jià)值，提出一項(xiàng)定性定量描述冠心病局域心肌灌注效能的預(yù)測(cè)指標(biāo)。方法將54例穩(wěn)定型冠心病患者納入統(tǒng)計(jì)研究，對(duì)其行冠狀動(dòng)脈造影及FFR檢查測(cè)量，對(duì)反映心肌灌注效能的狹窄病變嚴(yán)重程度和病變累及長(zhǎng)度等狹窄形態(tài)幾何參數(shù)進(jìn)行量化分析，包括α值(反映病變嚴(yán)重程度，α=D min/D normal)，β值(反映病變累及長(zhǎng)度)，α×β值(反映局部心肌血流供需關(guān)系)。結(jié)果納入分析的54組病變數(shù)據(jù)中，未發(fā)生心肌灌注不良者(FFR ≥0.8)43例，心肌灌注不良者(FFR <0.8)11例，心肌灌注不良組α值，β值與未發(fā)生心肌灌注不良組間無(wú)顯著相關(guān)性(P >0.05)，但心肌灌注不良組的α×β明顯大于未發(fā)生心肌灌注不良組(P <0.05)。ROC曲線分析顯示，通過(guò)α×β值評(píng)估病變對(duì)于心肌灌注影響的曲線下面積為0.783 (95% CI:0.603~0.964)，敏感度為63.6%，特異度為93.0%，陽(yáng)性預(yù)測(cè)值為70.0%，陰性預(yù)測(cè)值為90.9%，評(píng)估準(zhǔn)確度為92.6%。結(jié)論 α×β值較大組別對(duì)應(yīng)的臨床FFR值更小，該項(xiàng)指標(biāo)與心肌灌注效能之間具有較強(qiáng)敏感性，這與臨床現(xiàn)象一致。提示α×β這一指標(biāo)可定性定量描述冠心病心肌灌注效能，為輔助評(píng)價(jià)狹窄支血管是否發(fā)生局域心肌灌注不足提供理論支持。

Objective

Objective To explore the value of the stenosis morphological characteristics. We would propose a predictor to evaluate the efficacy of myocardial perfusion in stable coronary heart disease. The severity of stenosis lesion and the length of lesion involvement are included. It can qualitatively and quantitatively evaluate efficacy of regional myocardial perfusion in coronary heart disease. Methods 54 patients with stable coronary artery disease are included in research. They were measured by coronary angiography and FFR. The stenosis geometrical parameters including α (reflecting lesion severity, α=D min/D normal), β (reflecting lesion involvement length) and α×β (reflecting local supply and demand relationship of myocardial blood flow) were quantitatively analyzed. Results Among the 54 groups, 43 patients with no myocardial ischemia (FFR ≥0.8) and 11 patients with poor myocardial perfusion (FFR <0.8). There was no significant correlation between the FFR ≥0.8 group and FFR <0.8, but the α×β of FFR <0.8 group was significantly higher than that the FFR ≥0.8 group (P <0.05). And the area under the ROC curve for evaluating myocardial perfusion by α×β value was 0.783 (95%CI: 0.603-0.964), the sensitivity, specificity, positive predictive value, negative predictive value and evaluation accuracy were respectively 63.6%, 93.0%, 70.0%, 90.9% and 92.6%. Conclusions Patients with higher α×β value had lower FFR There was a strong sensitivity between this index and myocardial perfusion efficacy. It was consistent with the clinical phenomenon.

The α×β index can qualitatively and quantitatively describe the efficacy of myocardial perfusion in coronary heart disease, it can provide a theoretical support for the auxiliary evaluation whether myocardial insufficiency occurs.

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