2025 年第 12 期 第 20 卷

冠状动脉CT血管造影与血流储备分数在心肌缺血评估中的应用价值研究

Study on the application value of coronary CT angiography and fractional flow reserve in the evaluation of myocardial ischemia

作者：刘甜1张嘉祺2黄波3陈夏欢2高海1刘梅林2

英文作者：Liu Tian1 Zhang Jiaqi2 Huang Bo3 Chen Xiahuan2 Gao Hai1 Liu Meilin2

单位：1首都医科大学附属北京安贞医院心血管内科，北京100029；2北京大学第一医院老年病内科，北京100034；3北京大学第一医院心血管内科，北京100034

英文单位：1Department of Cardiovascular Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Geriatrics Peking University First Hospital Beijing 100034 China; 3Department of Cardiovascular Medicine Peking University First Hospital Beijing 100034 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；心肌缺血；冠状动脉CT血管造影；CT血流储备分数；定量血流分数

英文关键词：Coronaryatheroscleroticheartdisease;Myocardialischemia;CoronaryCTangiography;CTfractionalflowreserve;Quantitativeflowfraction

• 摘要：

• 目的 探讨冠状动脉CT血管造影（CCTA）及CT血流储备分数（CT-FFR）在评估冠状动脉病变所致心肌缺血中的临床应用价值。方法 回顾性纳入2018年1月至2022年12月于北京大学第一医院接受冠状动脉造影及血流储备分数（FFR）测量的冠心病（冠状动脉粥样硬化性心脏病）患者106例，共114支狭窄程度为50%～89%的冠状动脉血管。所有患者术前3个月内接受CCTA检查，获取冠状动脉疾病报告和数据系统（CAD-RADS）分级和CT-FFR数值，并基于冠状动脉造影图像计算定量血流分数（QFR）。以FFR≤0.80作为心肌缺血的诊断标准，评估各指标的诊断效能，并进行Spearman相关性及亚组分析。结果 CAD-RADS分级诊断心肌缺血的曲线下面积（AUC）为0.663（95%置信区间：0.569～0.749）。CT-FFR与FFR无相关性（r=0.18，P=0.054），对心肌缺血的总体诊断效能有限（AUC=0.562，95%置信区间：0.466～0.655），但在女性患者中表现出更佳的诊断性能（AUC=0.845），显著优于男性（AUC=0.504，P＜0.001）。QFR与FFR高度相关（r=0.82，P＜0.001），诊断心肌缺血的AUC达0.965（95%置信区间：0.913～0.991）。结论 在冠状动脉狭窄50%～89%的患者中，QFR具有较高的诊断一致性和准确性，可作为参考指标验证无创评估的准确性。CAD-RADS分级及CT-FFR单独用于功能性心肌缺血的诊断价值有限。CT-FFR在女性患者中的诊断性能较好，提示其在特定人群中可能具有一定应用价值。

• Objective To investigate the clinical value of coronary CT angiography (CCTA) and CT fractional flow reserve (CT-FFR) in the evaluation of myocardial ischemia caused by coronary artery disease. Methods A total of 106 patients with coronary atherosclerotic heart disease who underwent coronary angiography and fractional flow reserve (FFR) measurement at Peking University First Hospital from January 2018 to December 2022 were enrolled retrospectively. A total of 114 coronary vessels with 50% to 89% stenosis were included. All patients underwent CCTA examination within 3 months before surgery to obtain coronary disease reporting and data system (CAD-RADS) grades and CT-FFR values, and quantitative flow ratio (QFR) was calculated based on coronary angiography images. FFR≤0.80 was used as the diagnostic criterion for myocardial ischemia, and the diagnostic efficacy of each index was evaluated, and Spearman correlation and subgroup analysis were performed. Results The area under the curve (AUC) of CAD-RADS classification for the diagnosis of myocardial ischemia was 0.663 (95% confidence interval: 0.569-0.749). There was no correlation between CT-FFR and FFR (r=0.18, P=0.054), and the overall diagnostic efficacy of CT-FFR for myocardial ischemia was limited (AUC=0.562, 95% confidence interval: 0.466-0.655), but it showed better diagnostic performance in female patients (AUC=0.845) than in male patients (AUC=0.504, P＜0.001). QFR was highly correlated with FFR (r=0.82, P＜0.001), and the AUC for diagnosing myocardial ischemia was 0.965 (95% confidence interval: 0.913-0.991). Conclusion In patients with coronary artery stenosis ranging from 50% to 89%, QFR has high diagnostic consistency and accuracy, which can be used as a reference index to verify the accuracy of non-invasive assessment. CAD-RADS classification and CT-FFR alone have limited diagnostic value for functional myocardial ischemia. CT-FFR has a better diagnostic performance in female patients, suggesting that it may have certain application value in specific population.