心脏超声斑点成像联合基于冠状动脉CTA的瞬时无波形比率与血流储备分数对心肌缺血型冠心病的诊断价值

Diagnostic value of cardiac ultrasound speckle imaging combined with instantaneous wave-free ratio from coronary computed tomography angiography and fractional flow reserve for myocardial ischemic coronary artery disease

摘要:

目的 探讨心脏超声斑点成像联合基于冠状动脉计算机体层血管成像（CTA）的瞬时无波形比率（iFRCT）与血流储备分数（FFRCT）对心肌缺血型冠心病的诊断价值。方法 回顾性分析2020年1月—2023年12月在长安医院接受治疗的106例疑似冠心病心肌缺血患者的病历资料。以冠状动脉造影检查结果为金标准，分为冠心病组与非冠心病组，比较两组的心脏超声斑点成像定量参数、iFRCT、FFRCT，分析冠心病患者发生心肌缺血型冠心病的影响因素，以及心脏超声斑点成像联合iFRCT、FFRCT对心肌缺血型冠心病的诊断价值。结果 冠状动脉造影检查显示，106例研究对象中，心肌缺血42例（39.62%）。冠心病组患者的三维左心室整体应变值、左心室整体径向收缩期峰值应变（GRS）、iFRCT、FFRCT低于非冠心病组（P <0.05）。三维左心室整体应变值［O^R =3.688（95% CI：1.315，10.342）］、GRS水平［O^R =3.557（95% CI：1.268，9.976）］、iFRCT水平［O^R =3.438（95% CI：1.226，9.643）］和FFRCT水平［O^R =3.714（95% CI：1.324，10.415）］是发生心肌缺血型冠心病的危险因素（P <0.05）。三维左心室整体应变值、GRS、iFRCT、FFRCT及联合诊断心肌缺血型冠心病的敏感性分别为72%（95% CI：0.63，0.84）、79%（95% CI：0.64，0.92）、67%（95% CI：0.59，0.74）、75%（95% CI：0.66，0.81）、88%（95% CI：0.79，0.97），特异性分别为78%（95% CI：0.61，0.85）、80%（95% CI：0.68，0.87）、73%（95% CI：0.65，0.81）、60%（95% CI：0.52，0.71）、94%（95% CI：0.81，0.99）。结论 心脏超声斑点成像联合iFRCT、FFRCT可用于辅助诊断心肌缺血型冠心病，且诊断效能良好。

Abstract:

Objective To explore the value of echocardiography spot imaging combined with instantaneous waveform free ratio (iFRCT) and flow reserve fraction (FFRCT) based on coronary computed tomography angiography (CTA) in evaluating myocardial ischemic coronary heart disease.Methods Retrospective analysis of medical records of 106 suspected coronary heart disease patients with myocardial ischemia who received treatment at Chang'an Hospital from January 2020 to December 2023. Using coronary angiography results as the gold standard, they were divided into myocardial ischemic coronary heart disease group and non coronary heart disease group. The quantitative parameters of cardiac ultrasound spot imaging, iFRCT, and FFRCT were compared between the two groups. The influencing factors of myocardial ischemic coronary heart disease in coronary heart disease patients were analyzed, and the value of cardiac ultrasound spot imaging combined with iFRCT and FFRCT in evaluating myocardial ischemic coronary heart disease was also evaluated.Results Coronary angiography showed that 42 out of 106 suspected coronary heart disease patients had myocardial ischemia, accounting for 39.62%. The three-dimensional global left ventricular strain, global radial peak systolic strain (GRS), iFRCT, and FFRCT of patients with myocardial ischemic coronary heart disease were lower than those in the non coronary heart disease group (P <0.05). 3D global longitudinal strain [O^R = 3.688 (95% CI: 1.315, 10.342)], global radial strain (GRS) level [O^R = 3.557 (95% CI: 1.268, 9.976)], iFRCT level [O^R = 3.438 (95% CI: 1.226, 9.643)], and FFRCT level [O^R = 3.714 (95% CI: 1.324, 10.415)] are risk factors for ischemic coronary heart disease (P <0.05). The sensitivity of 3D global longitudinal strain, GRS, iFRCT, FFRCT alone, and in combination for diagnosing ischemic coronary heart disease was 72% (95% CI: 0.63,0.84), 79% (95% CI: 0.64,0.92), 67% (95% CI: 0.59,0.74), 75% (95% CI: 0.66,0.81), 88% (95% CI: 0.79,0.97), respectively, while specificity was 78% (95% CI: 0.61,0.85), 80% (95% CI: 0.68,0.87), 73% (95% CI: 0.65,0.81), 60% (95% CI: 0.52,0.71), 94% (95% CI: 0.81,0.99).Conclusion Cardiac ultrasound spot imaging combined with iFRCT and FFRCT can be used to assist in the diagnosis of myocardial ischemic coronary heart disease, and the diagnostic efficacy is good.