The predictive values of myocardial blood flow and coronary flow reserve measured by CZT-SPECT in severe coronary stenosis
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摘要: 目的 探讨基于碲锌镉(CZT)心脏专用SPECT(CZT-SPECT)测定心肌血流量(MBF)及血流储备(CFR)对冠状动脉(冠脉)重度狭窄的预测价值。方法 回顾性分析2021年1月—2021年8月于泰达国际心血管病医院完成CZT-SPECT检查的可疑或已确诊冠心病患者129例。本研究根据患者是否存在冠脉重度狭窄病变分为缺血组和对照组(冠脉重度狭窄病变的定义标准为血管直径≥2 mm且狭窄≥70%的病变)。绘制静息MBF(rMBF)、负荷MBF(sMBF)及CFR预测冠脉重度狭窄的受试者工作特性(ROC)曲线，并根据Youden指数确定截断值。结果 共纳入129例患者，平均年龄为(60.3±9.6)岁，男性占比51.2%，单支病变患者33例(25.6%)，双支病变患者22例(17.1%)，三支病变患者18例(13.9%)。分别在血管水平和患者水平进行分析，结果显示缺血组rMBF、sMBF、CFR均明显低于对照组(P < 0.01)，其中sMBF差异最为明显。绘制rMBF、sMBF、CFR预测冠脉重度狭窄的ROC曲线，结果显示rMBF、sMBF、CFR预测冠脉重度狭窄的AUC分别为0.641、0.808、0.781，截断值分别为0.735 mL·g-1·min-1、1.885 mL·g-1·min-1、2.185。有效预测指标为sMBF和CFR，灵敏度分别为78.5%、83.5%，特异度分别为88.2%、70.1%。结论 CZT-SPECT较容易获得rMBF、sMBF、CFR心肌定量血流参数，缺血组参数值明显低于对照组。sMBF和CFR预测心肌缺血表现出较好的诊断性能，其中sMBF最为突出。临床应用CFR进行缺血评估时，需要同时关注sMBF、rMBF绝对值。
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关键词:
- 心肌血流量 /
- 冠状动脉血流储备 /
- 单光子发射型断层成像 /
- 心肌灌注显像
Abstract: Objective To investigate the predictive value of myocardial blood flow ( MBF) and blood flow reserve (CFR) based on cadmium zinc telluride (CZT) cardiac-specific SPECT (CZT-SPECT) for severe coronary stenosis.Methods From January 2021 to August 2021, 129 patients with suspected or confirmed coronary heart disease who completed the CZTSPECT examination in TEDA International Cardiovascular Hospital were retrospectively analyzed. In this study, patients were divided into the ischemia group and control group according to the presence or absence of severe coronary stenosis (the definition criteria for severe coronary stenosis were lesions with a vessel diameter ≥2 mm and stenosis ≥70%). The receiver operating characteristic (ROC) curves of resting MBF (rMBF), stress MBF (sMBF) and CFR for predicting severe coronary stenosis were drawn, and the cutoff value was selected according to the maximum Youden index.Results A total of 129 patients with an average age of (60.3±9.6) years, 51.2% males, were included. Among them, 33 patients (25.6%) with singlevessel disease, 22 (17.1%) with doublevessel disease, and 18 with threevessel disease. example (13.9%). The rMBF, sMBF, and CFR of the ischemia group were significantly lower than those of the control group (P<0.01). The AUCs of rMBF, sMBF, and CFR for predicting severe coronary stenosis were 0 641, 0 808, and 0 781, and the cut-off values were 0 735 mL·g-1·min-1, 1 885 mL·g-1·min-1, 2 185, respectively. The effective predictors were sMBF and CFR, with sensitivities of 78.5% and 83.5%, and specificities of 88.2% and 70.1%, respectively. Conclusion CZT-SPECT could easily obtain rMBF, sMBF, and CFR, and the parameter values in the ischemic group were significantly lower than those in the control group. sMBF and CFR showed good diagnostic performance in predicting myocardial ischemia, of which sMBF was the most outstanding. -
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图 3 rMBF、sMBF、CFR对预测冠脉重度狭窄的ROC曲线
Figure 3. ROC curves of rMBF, sMBF, and CFR for predicting severe coronary stenosis
表 1 缺血组和对照组MBF、CFR在血管水平及患者水平的比较
Table 1. MBF and CFR in the ischemic group and the control group
例(%), X±S 参数 缺血组 对照组 t P 血管水平(387支)/支 127 242 rMBF/(mL·min-1·g-1) 0.78±0.19 0.87±0.31 3.03 0.003 sMBF/(mL·min-1·g-1) 1.52±0.46 2.36±0.91 9.91 < 0.001 CFR 2.02±0.60 2.83±0.92 9.01 < 0.001 患者水平(129例)/例 73 56 rMBF-LAD/(mL·min-1·g-1) 0.81±0.16 0.88±0.09 3.03 0.003 sMBF-LAD/(mL·min-1·g-1) 1.76±0.59 2.52±0.89 5.75 < 0.001 CFR-LAD 2.24±0.72 2.87±0.96 4.22 < 0.001 rMBF-LCX/(mL·min-1·g-1) 0.79±0.20 0.87±0.18 2.07 0.040 sMBF-LCX/(mL·min-1·g-1) 1.70±0.58 2.26±0.88 4.31 < 0.001 CFR-LCX 2.20±0.73 2.68±0.89 3.36 0.001 rMBF-RCA/(mL·min-1·g-1) 0.79±0.14 0.87±0.58 2.48 0.014 sMBF-RCA/(mL·min-1·g-1) 1.88±0.77 2.67±1.11 4.67 < 0.001 CFR-RCA 2.40±0.77 3.17±1.04 4.82 < 0.001 
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表 2 CFR < 2.0在患者水平和血管水平预测冠脉重度狭窄的诊断价值
Table 2. Diagnostic value of CFR < 2.0 in predicting severe coronary stenosis
参数 血管水平(387支) 患者水平(129例) 灵敏度 56.9%(74/130) 57.5%(42/73) 特异度 87.9%(226/257) 85.7%(48/56) 阳性预测值 70.5%(74/105) 84.0%(42/50) 阴性预测值 80.1%(226/282) 60.8%(48/79) 准确性 77.5%(300/387) 69.8%(90/129)
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表 3 rMBF、sMBF、CFR预测冠脉重度狭窄的ROC曲线相关参数
Table 3. ROC curve parameters of rMBF, sMBF and CFR for predicting severe coronary stenosis
指标 AUC 95%CI Youden指数 截断值 灵敏度/% 特异度/% rMBF 0.641 0.581~0.700 0.201 0.735 mL·min-1·g-1 64.7 56.4 sMBF 0.808 0.761~0.855 0.667 1.885 mL·min-1·g-1 78.5 88.2 CFR 0.781 0.732~0.831 0.536 2.185 83.5 70.1
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