| ObjectiveTo provide more clinical strategy choices for the diagnosis and treatment of coronary artery disease,this study verified the diagnostic efficacy of FFRCT by comparing the fractional flow reserve derived from coronary computed tomography(FFRCT)and coronary angiography(CAG)in the diagnosis of coronary atherosclerotic artery disease(CAD).MethodThis study is a retrospective study.Data of 309 main coronary arteries in 136 patients with suspected coronary artery disease from January 2020 to February 2022 in the medical record system of Northern Jiangsu Peope’s Hospital were selected consecutively.The patients who have completed coronary computed tomography angiography(CCTA),FFRCT and coronary angiography(CAG)examinations and the interval between CCTA and CAG examinations is not more than 30 days.Record and analyze the FFRCT measurements and CCTA parameters of 156 main coronary arteries,including the narrowest lumen diameter,stenosis plaque length,diameter stenosis rate,area stenosis rate,stenosis lumen area,and plaque properties.According to the 2010 diagnostic guidelines for coronary artery disease,98 cases with major coronary artery stenosis greater than or equal to 50%stenosis were included in the coronary artery disease group,while the remaining 58 cases with stenosis less than 50%were excluded from ischemic stenosis and included in the non coronary artery disease group.Compare the accuracy,positive predictive value,negative predictive value,sensitivity,and specificity of CCTA and FFRCT in the diagnosis of stenosis of 309 main coronary arteries;Use consistency test to analyze the correlation between FFRCT and coronary angiography;The relationship between the parameters related to 156 blood vessels and coronary artery disease was analyzed using univariate and multivariate logistic regression.The diagnostic value of each parameter individually and in combination for coronary artery disease was analyzed using receiver operating characteristic curve(ROC).Result1.Among the 309 main coronary arteries included in the study,143 cases had FFRCT≤0.8,and 19 cases showed stenosis<50%on CAG;166 cases had FFRCT>0.8,of which 40 cases showed stenosis≥50%on CAG.146 cases showed stenosis≥50%on CCTA,of which 33 cases showed stenosis<50%on CAG;163 cases showed stenosis<50%on CCTA,of which 51 cases showed stenosis≥50%on CAG.The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of FFRCT were 80.91%,75.61%,86.90%,86.71%,and 75.90%,respectively;The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of coronary CTA were 72.82%,68.90%,77.24%,77.40%,and 68.71%,respectively.The diagnostic value of FFRCT for coronary artery disease is higher than that of CCTA,and the difference is statistically significant(P<0.01).2.FFRCT≤0.8 as a criterion for the diagnosis of ischaemic stenosis was tested for consistency with the findings of coronary angiography with kappa=0.620(p<0.05),indicating that FFRCT≤0.8 as a criterion for the diagnosis of coronary artery disease was in high agreement with the findings of coronary angiography.3.156 blood vessels with imaging parameters were recorded,including 98 cases in the coronary artery disease group and 58 cases in the non coronary artery disease group.Univariate analysis showed that in the coronary artery disease group,FFRCT≤0.8 and imaging parameters,the narrowest diameter of luminal stenosis was smaller than that in the non coronary artery disease group(P<0.05);The length,diameter stenosis rate,and area stenosis rate of stenosis plaques in the imaging parameters were higher than those in the non coronary artery disease group(P<0.05);There was no significant difference in lumen area,calcified plaques compared to the non coronary artery disease group(P>0.05).Multivariate logistic regression analysis showed that FFRCT≤0.8,the narrowest diameter of the stenosis,and the length of the plaque at the stenosis were independent risk factors for the diagnosis of coronary artery disease(P<0.05).4.ROC analysis showed that the AUC,sensitivity and specificity for the diagnosis of ischaemic vessels with FFRCT ≤0.8,narrowest lumen diameter and plaque length at the stenosis were 0.730,68.4%and 77.6%;0.688,60.3%and 70.4%;0.729,72.4%and 67.2%,respectively;and the AUC,sensitivity and specificity for the combined diagnosis of the three The AUC,sensitivity and specificity of the three combined diagnostics were 0.853,78.6%and 79.3%.ConclusionCompared with CCTA,FFRCT has higher diagnostic value in the diagnosis of coronary artery disease and has better clinical application prospects.The combined diagnosis of FFRCT≤0.8,the narrowest diameter of the lumen,and the length of narrow plaques can further improve the accuracy of FFRCT alone in diagnosing coronary artery disease,providing more reference value for the diagnosis and treatment of coronary artery disease. |
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