Diagnostic Value Of FFRct And Plaque Analysis Based On CCTA For Coronary Artery Ischemia

Research objectives 1)To analyze the diagnostic value of domestic fractiongal flow reserve based on CT imaging reserve in coronary ischemia.2)To assess the predictive value of highrisk plaque,calcified plaque and global non-calcified plaque burden analyzed by coronary computed tomography angiography for coronary ischemia.Research methods According to the inclusion criteria and exclusion criteria,a total of 152 patients with coronary heart disease from August 2018 to January 2021 who underwent CCTA in the Department of Cardiology,the Fifth Affiliated Hospital of Zhengzhou University were retrospectively analyzed.30 patients(32 vessels)underwent fractional flow reserve,the correlation between domestic FFRct and invasive fractional flow reserve(FFR)was analyzed by Spearman correlation analysis.Bland Altman diagram was used to analyze the consistency between FFRct and FFR.The ROC curve of domestic FFRct in the diagnosis of coronary ischemia was drawn to further clarify the diagnostic value of domestic FFRct.In 152 patients with coronary heart disease,141 lesions with the best image quality were selected.Philips semi-automatic software was used to analyze CCTA images to distinguish high-risk plaques,calcified plaques and noncalcified plaques and to measured coronary artery calcification score,plaque density and stenosis degree(minimum lumen area,minimum lumen diameter,maximum area stenosis rate and maximum diameter stenosis rate).The FFRct of lesion location and distal were measured by domestic FFRct.Use t test,chi-square test,Mann-Whitney U test to compare high-risk plaques and calcified plaques lesions and distal FFRct value and Whether the quantitative stenosis parameter of CCTA is statistically significant.Spearman correlation analysis was used to analyze the correlation between plaque density and lesion location,distal FFRct value,and the correlation between positive remodeling index,coronary artery calcification score,non-calcified mixed plaque burden(G score)and distal FFRct value.Research results 1.This study included 152 CHD patients with an average age of 62.64±9.75 years old and 89 males(58.55%).141 lesions with the best image quality were selected from 152 patients.Among them,96 lesions(68.09%)had moderate stenosis,and mild and severe stenosis were rare(2.84%,6.38%).Among the plaque types,66(46.8%)were calcified plaques.The anterior descending artery(56.03%)was the most common lesion.The FFRct value of the lesion is in the range of 0.58-0.95,the median is 0.82,and the distal FFRct The value range is 0.53-0.88,and the median is 0.75.2.30 patients(32 vessels)underwent FFR examination,Spearman correlation analysis was used to analyze the correlation between domestic FFRct value and FFR value.The results showed that there was a high positive correlation between domestic FFRct value and FFR value(r = 0.774,P < 0.001).The results of Bland Altman diagram show that FFRct value is in good agreement with FFR value.AUC was used to evaluate the diagnostic efficacy of domestic FFRct for coronary ischemia.ROC curve showed that the AUC of domestic FFRct for coronary ischemia was 0.94.3.Compared with calcified plaques,the lesion location and distal FFRct value of high-risk plaques were lower and the lesion location and distal ischemia rate of highrisk plaques(FFRct < 0.8)were higher,the differences are statistically significant(P <0.001;P < 0.001;P = 0.027).There was no significant difference in MLA,MLD,MAS%,MDS% of high-risk plaques compared with calcified plaques(P>0.05).In low density plaques(n =49),there was no significant difference between napkin ring sign and non-napkin ring sign,or between punctate calcification and non-punctate calcification(P > 0.05).4.Spearman correlation analysis showed that low density plaque density was moderately positively correlated with FFRct value of lesion(r = 0.347,P = 0.015),but not significantly correlated with FFRct value of distal(r = 0.215,P = 0.138);all plaque density(n = 141)was positively correlated with FFRct value of lesion and distal(r = 0.464,P < 0.001;r = 0.384,P < 0.001);positive remodeling index was negatively correlated with FFRct value of distal(r =-0.301,P = 0.047).There was no significant correlation between calcification score and distal FFRct value(r = 0.096,P = 0.360).There was a moderate negative correlation between G score and distal FFRct value(r =-0.427,P < 0.001).Conclusions 1)There is a significant correlation between domestic FFRct and invasive FFR,and domestic FFRct has a high diagnostic value for coronary artery ischemia.2)FFRct combined with G score can further evaluate the coronary ischemia of CHD patients,and help clinically use non-invasive methods to screen out high-risk patients requiring interventional diagnosis and treatment..