| Chapter 1 Correlative analysis between coronary artery CTA-based fractional flow reserve and cardiac functionObjective:There is no absolute correlation between the degree of coronary artery stenosis and myocardial ischemia,and Fractional Flow Reserve(FFR)is the "gold standard"for judging coronary artery ischemia.However,it is limited in clinical use because of the risks associated with its use of pressure wires and adenosine drugs.Coronary CTA based fractional flow reserve(CT-FFR)is a novel noninvasive detection technique that combines anatomy and function,and there is no correlation analysis between CT-FFR and cardiac function parameters.The purpose of this study is to investigate the correlation between CT-FFR and cardiac function parameters and provide a research basis for future assessment of cardiac function damage caused by myocardial ischemia by noninvasive coronary function tests.Methods:We retrospectively analyzed the relevant parameters and data of coronary angiography(CCTA),invasive coronary angiography(ICA)and echocardiography in 47 patients with borderline coronary artery disease during hospitalization.These patients underwent CCTA and echocardiography 3 months before angiography,and were divided into ischemic group(CT-FFR ≤0.8)and non-ischemic group(CT-FFR>0.8)according to CT-FFR values.All data were analyzed by SPSS 25 software.Of the 47 patients,31 were male and 16 were female,with a mean age of 64 years.The relationship between myocardial ischemia and myocardial markers,cardiac structure and function parameters was analyzed by statistical methods.The basic data of patients in the two groups were compared,including:(age,sex,blood lipid,smoking history,history of coronary heart disease,history of diabetes,history of hypertension and cardiac function indicators(brain natriuretic peptide NT-proBNP,troponin T(cTnT),creatine kinase(CK),creatine kinase isoenzyme(CKMB),left ventricular ejection fraction(LVEF),left atrial diameter,left ventricular end-systolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),mitral forward blood flow(E peak),mitral forward blood flow(A peak),E/e’,interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPW)),the correlation between CT-FFR values and cardiac function indicators was analyzed in the two groups.Result:Forty-seven patients with coronary heart disease were included in this study,including 18 patients in ischemic group and 29 patients in non-ischemic group.Spearman correlation analysis was performed between CT-FFR and left atrial size(R=-0.307),CKMB(R=-0.339)(P<0.05),but not with NT-proBNP,cTnT,CK,LVEF,left atrial diameter,LVESD,LVEDD,E peak,A peak,E/e’,posterior ventricular wall thickness;there was statistical significance in left atrial size and CKMB results between ischemic group and non-ischemic group(P<0.05),NT-proBNP,cTnT,LVEF,left atrial diameter,LVESD,LVEDD,E peak,A peak,E/e’,IVST,and LVPW were not statistically significant(P>0.05).Conclusion:There was no correlation between myocardial ischemia assessed by CT-FFR and cardiac function parameters.Charter Ⅱ Impact of left ventricular diastolic dysfunction on diagnostic performance of coronary CTA-based fractional flow reserveObjective:Coronary revascularization guided by fractional flow reserve(CT-FFR)based coronary CTA has similar clinical outcomes to revascularization strategy guided by fractional flow reserve(FFR).Numerous studies have shown that CT-FFR has a high diagnostic performance using FFR as the gold standard,and although various factors have been reported in the literature to affect the agreement between CT-FFR and FFR accuracy,whether diastolic dysfunction affects both has not been verified.In this study,FFR was used as a diagnostic criterion to investigate whether left ventricular diastolic dysfunction had an effect on the diagnostic performance of CT-FFR.Methods:Patients who underwent CCTA and invasive coronary angiography(ICA)at Guangdong General Hospital from 2015 to March 2022 were retrospectively enrolled and underwent CCTA and echocardiography within 90 days before angiography.The study population was divided into normal and dysfunction groups according to left ventricular diastolic function,Sensitivity,specificity,accuracy,positive predictive value,negative predictive value,and receiver operating characteristic(ROC)curves were calculated and compared between the two groups to assess statistical differences using invasive FFR as the gold standard,and Pearson correlation analysis and Bland-Altman analysis were used for correlation analysis between CT-FFR and invasive FFR within the group.Result:A total of 100 vessels in 90 patients were included in this study.On a per-vessel basis,FFR results suggested 34 cases of vasculopathy specific ischemia and CT-FFR results suggested 40 cases of vasculopathy specific ischemia,with a good correlation between CT-FFR and FFR(R=0.768 P<0.001).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CT-FFR for detecting myocardial ischemia were 82.3%,81.8%,82%,70%,and 90%,respectively.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were 84.6%,88.5%,87.2%,78.6%,and 92%in the normal left ventricular diastolic function group and 81%,77.5%,78.7%,65.4%,and 88.6%in the left ventricular diastolic dysfunction group,respectively.CT-FFR showed no statistical difference in AUC between the two groups(AUC:0.920[95%CI 0.787-0.983]vs.0.871[95%CI 0.761-0.943],Z=0.772 p=0.440).However,CT-FFR remained well correlated,with a mean difference of 0.035,95%confidence interval 0.018-0.053 in the normal group(R=0.76,P<0.001)and 0.037 95%confidence interval 0.017-0.057 in the decreased group(R=0.76 P<0.001).Conclusion:Left ventricular diastolic dysfunction had no significant impact on the diagnostic accuracy of CT-FFR.CT-FFR has good diagnostic performance for both left ventricular diastolic dysfunction and normal groups and can be used as an effective tool to detect functional ischemia of the lesion when screening patients for arterial disease. |
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