ABSTRACT
Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.
ABSTRACT
Objective:To investigate the reproducibility of left ventricular strain assessed by CT feature tracking(CT-FT) and its correlation and agreement with speckle tracking echocardiography (STE).Methods:Thirty outpatients with suspected coronary heart disease who underwent whole cardiac cycle coronary CTA and transthoracic echocardiography within one week were prospectively enrolled in November 2019. Left ventricular volume and strain parameters were measured by CT-FT and STE, including left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), global longitudinal strain(GLS), global radial strain (GRS),and global circumferential strain(GCS). GLS included endocardial global longitudinal strain (EndoGLS) and myocardial global longitudinal strain (MyoGLS), GCS included endocardial global circumferential strain (EndoGCS) and myocardial global circumferential strain (MyoGCS). ICC was used to evaluate intra-and inter-observer differences in strain measured by CT-FT. The differences of measurements between CT-FT and STE were compared by paired-samples t test. Pearson correlation coefficient was used to analyze the correlation between CT-FT and STE measurements. Agreement between measurements of two modalities was assessed by Bland-Altman analysis. Results:There was a good consistency in EDV, ESV, EF, EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT between intra-and inter-observer (ICC was 0.775-0.964, P<0.001). There was no significant difference in EF measured by CT-FT and STE [(60.27±8.70) % and (61.22±5.64) %, P=0.443]. EndoGLS, MyoGLS, GRS and MyoGCS measured by CT-FT were (-20.47±4.01)%, (-18.06±3.75)%, (73.90±20.58) % and (-18.48±3.65)%, respectively, while the strain measured by STE were (-18.97±3.33)%, (-16.49±2.60)%, (18.56±3.06)% and (-20.26±4.45)%, respectively. The differences were statistically significant between CT-FT and STE ( t=-2.367, -2.945, 12.161, 2.459, P<0.05). The EndoGCS measured by CT-FT and STE were (-27.78±6.66)% and (-29.18±7.24)%, respectively, with no statistical significance ( P=0.223).The correlation coefficients of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE were 0.566, 0.629, 0.509, 0.606 and 0.539, respectively ( P<0.05). The average difference of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE was -1.5%, -1.6%, 55.3%, 1.4% and 1.8%, respectively, with 95% limits of agreement was -8.3%-5.3%, -7.3%-4.2%, 18.1%-92.5%, -10.7%-13.6% and -6.0%-9.5%, respectively. Conclusions:The left ventricular global strain evaluated by CT-FT was feasible, and the agreement of global strain between CT-FT and STE was good but not interchangeable. CT can be an alternative method for "one-stop" evaluation of cardiac anatomy and function in patients with poor echogenic windows and contraindications for MRI.
ABSTRACT
Objective To evaluate the perioperative period safety of improved transurethral plasma kinetic enucleation of prostate (TUPKEP) in high-risk benign prostatic hyperplasia (BPH) patients with coronary heart disease (CHD).Methods One hundred and twenty-eight BPH patients were selected,24 patients had CHD (with CHD group),among whom 10 patients were given transurethral vapor-resection of prostate (TUVP),and 14 patients were given improved TUPKEP; 104 patients didn't have CHD,among whom 22 patients were given TUVP,and 82 patients were given improved TUPKEP.The serum endothelin (ET)-1 was measured by specific radioimmunoassay at preoperative 2 h and postoperative 1,2,6 d,and complication was observed.Results All the patients were cured by operation,and left hospital smoothly.There were no statistical differences in the preoperative 2 h serum ET-1 in with CHD group and without CHD group (including all TUVP patients and improved TUPKEP patients) (P ＞ 0.05).The postoperative 1 and 2 d serum ET-1 levels of TUVP patients were significantly higher than those of improved TUPKEP patients,in with CHD group:(114.09 ± 15.33) ng/L vs.(94.77 ± 12.14) ng/L and (99.67 ± 9.87) ng/L vs.(88.21 ± 9.55) ng/L; in without CHD group:(70.21 ± 12.44) ng/L vs.(53.67 ± 9.02) ng/L and (61.18 ± 9.52) ng/L vs.(48.54 ± 9.15) ng/L,and there were statistical differences (P ＜ 0.05).There were no statistical differences in postoperative 6 d serum ET-1 in TUVP patients and improved TURKEP patients (P ＞ 0.05).In with CHD group,5 patients had ischemic ST-T change in the early postoperative period,and 3 patients had angina pectoris.They all were promptly treated,and the events were controlled.Serious complications did not present such as acute myocardial infarction (AMI),acute heart failure and sudden cardiac death,etc.Conclusions The postoperative BPH patients have vascular endothelial injury catholically,especially the high-risk patients with CHD.Furthermore,it might be one of the causes of the postoperative adverse cardiovascular events.Compared with TUVP,improved TUPKEP has a minor impact on vascular endothelial function,and it can reduce the postoperative adverse cardiovascular events in the BPH patients with CHD.Improved TUPKEP is a relatively safer surgical method for high-risk BPH with CHD.