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Time:2019-05-27 By:
人工智能技术分析影像

(1) resting trans-stenosis pressure ratio (Pd/Pa): Pd is distal stenosis pressure, Pa is coronary orifice pressure. The positive predictive value (PPV) of resting Pd/Pa < 0.85 predicting FFR < 0.75 was 95%, while the negative predictive value (NPV) of resting Pd/Pa < 0.93 predicting FFR > 0.75 was 95.7%; that of resting Pd/Pa < 0.87 predicting FFR < 0.80 was 94.6%, and that of Pd/Pa < 0.96 predicting FFR > 0.80 was 93%. The retrospective study used resting Pd/Pa as the first time to determine the drug treatment, and PCI was performed at < 0.86. The standard of treatment was whether FFR was < 0.80 or not at 0.87-0.99. The results showed that the 5-year event-free survival rate of patients with Pd/PaFFR hybridization-guided treatment strategy was 70.8%, similar to 76.3% of patients with FFR-guided treatment strategy.

(2) instantaneous waveform-free Ratio (iFR): iFR is the ratio of distal lesion to oral pressure in waveform-free period of cardiac cycle. It has a good correlation with FFR (r=0.90). The diagnostic accuracy is 95%, PPV is 97%, NPV is 93%. Some studies used iFR < 0.86 as the threshold (PPV92%) for PCI, while iFR > 0.93 as the threshold (NPV91%) delayed PCI. Adenosine was only used to detect FFR in patients with iFR between 0.86 and 0.93. This method of iFR-FFR hybridization can reduce the use of adenosine by 57%, and has 95% consistency with the detection of FFR only.

(3) Contrast medium induced Pd/Paratio (CMR): The osmotic pressure of contrast medium can also induce a certain degree of coronary microcirculation dilatation. During the operation, 6 ML-10 ml contrast medium was injected into the coronary artery instead of adenosine to induce the secondary maximum dilatation of the coronary artery, and then Pd/Pa was detected. CMR was strongly correlated with FFR (r=0.94). The threshold value of predicting FFR < 0.80 was <0.83 (specificity 96.1%, sensitivity 85.7%). When CMR < 0.88, FFR was > 0.80 (accuracy 85%, specificity 78.9%, NPV 100%, PPV 63%). When CMR was between 0.84 and 0.87, it was suggested to use CMR/FFR hybridization to evaluate lesions in order to reduce adenosine use. Personal experience shows that the above three functional indicators are consistent with FFR, CMR > iFR > Pd/Pa.

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