medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2018-2-47-55medvis-543Research ArticleГРУДНАЯ КЛЕТКАTHORAXНЕИНВАЗИВНАЯ ОЦЕНКА ФРАКЦИОННОГО РЕЗЕРВА КРОВОТОКА У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА ПО ДАННЫМ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ: ПЕРВЫЕ РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ. СРАВНЕНИЕ С ДАННЫМИ ИНВАЗИВНОГО ИЗМЕРЕНИЯNON-INVASIVE FFR DERIVED FROM STANDARD ACQUIRED CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) DATASETS (FFRCT) FOR THE DIAGNOSIS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY ARTERY DISEASE (CAD): FIRST DATA OF CLINICAL USE. COMPARISON WITH INVASIVE MEASUREMENTПершинаЕ. С.PershinaE. S.

Першина Екатерина Сергеевна – аспирант, врач-рентгенолог Центра лучевой диагностики.

Москва. 

Ekaterina S. Pershina – postgraduate student, radiologist of the Federal State autonomous institution.

Moscow. 

pershina86@mail.ruСиницынВ. Е.SinitsinV. E.

Синицын Валентин Евгеньевич – доктор мед. наук, профессор, руководитель Центра лучевой диагностики.

Москва. 

Valentin E. Sinitsyn – professor, doct. of med. sci., Director of the Center of Diagnostic Radiology of the Federal State autonomous institution. 

Moscow. 

МершинаЕ. А.MershinaE. A.

Мершина Елена Александровна – канд. мед. наук, заведующая отделением Центра лучевой диагностики. 

Москва. 

Elena A. Mershina – cand. of med. sci., Clinical Chief of the Diagnostic Radiology Department of the Federal State autonomous institution.

Moscow. 

АрхиповаИ. М.ArkhipovaI. M.

Архипова Ирина Михайловна – канд. мед. наук, врач-рентгенолог Центра лучевой диагностики. 

Москва. 

Irina M. Arkhipova – cand. of med. sci., Radiologist of the Diagnostic Radiology Department of the Federal State autonomous institution.

 Moscow. 

СемиткоС. П.SemitkoS. P.

Семитко Сергей Петрович – доктор мед. наук, профессор, заведующий отделением рентген-хирургических методов диагностики и лечения.

Москва. 

Sergey P. Semitko – doct. of med. sci., professor, Chief of the Department of roentgen-surgical methods of diagnosis andtreatment. 

Moscow. 

ИвановВ. А.IvanovV. A.

Иванов Владимир Александрович – профессор, начальник Центра рентгенэндовакулярной хирургии УЗ Минобороны России. 

Москва. 

Vladimir A. Ivanov – doct. of med. sci., professor, Chief of the Center of roentgen-endovascular surgery.

Moscow. 

 

ФГАУ “Лечебно-реабилитационный центр” Минздрава России.РоссияCenter of Treatment and Rehabilitation.Russian FederationФГАУ “Лечебно-реабилитационный центр” Минздрава России.РоссияCity clinical hospital №81.Russian FederationУЗ МО России “Центральный военный клинический госпиталь им. А.А. Вишневского”.РоссияThe Central A.V. Vishnevky military clinical hospital.Russian Federation201828042018024755Copyright © Першина Е.С., Синицын В.Е., Мершина Е.А., Архипова И.М., Семитко С.П., Иванов В.А., 20182018Першина Е.С., Синицын В.Е., Мершина Е.А., Архипова И.М., Семитко С.П., Иванов В.А.Pershina E.S., Sinitsin V.E., Mershina E.A., Arkhipova I.M., Semitko S.P., Ivanov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/543Цель исследования

Цель исследования: оценить диагностическую значимость неинвазивного измерения фракционного резерва кровотока (FFR) по данным МСКТ-коронарографии (FFRCT) в определении значимых стенозов коронарных артерий у пациентов с ишемической болезнью сердца (ИБС).

Материал и методы

Материал и методы. В проспективное исследование было включено 16 пациентов (м/ж – 13/3, средний возраст 47,8 ± 2,3 года) с ИБС и стенозами коронарных артерий 40–75% просвета артерии. Вначале пациентам выполняли КТ-ангиографию, затем – инвазивную коронарографию с измерением FFR. Измерение FFRCT проводили слепым методом независимой лабораторией Core Laboratory (HeartFlow, США). Результаты FFRCT были сопоставлены с инвазивным измерением FFR. Пороговое значение значимости стеноза определялось как FFR и FFRCT ≤ 0,80.

Результаты

Результаты. Площадь под ROC-кривой (AUC) (95% CI) для FFRCT составила 0,9. Чувствительность и специфичность в определении гемодинамически значимых стенозов для FFRCT составили 91 и 79% соответственно.

Выводы

Выводы. FFRCT представляет собой инновационный метод, демонстрирующий высокую диагностическую значимость для выявления или исключения поражения коронарных артерий, вызывающих ишемию.

Objectives

Objectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).

Methods

Methods. Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.

Results

Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.

Conclusion

Conclusion. FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. 

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The authors declare that there are no conflicts of interest present.