基于CCTA的流体动力学参数预测右冠状动脉异常的异常侵入性阿西替尼FFR和多巴胺FFR
Fluid dynamics informed CCTA-derived geometric parameters in right coronary artery anomalies predict abnormal invasive Adenosine FFR and Dobutamine FFR
AI总结：
研究通过CCTA流体动力学参数预测右冠状动脉异常的异常侵入性阿西替尼FFR和多巴胺FFR，发现流体动力学参数在预测固定压缩的血流动力学相关性方面表现优异。
摘要：
背景：右冠状动脉异常起源（R-AAOCA）涉及固定压缩，可通过阿西替尼衍生的FFRAdnosine评估，以及通过多巴胺衍生的FFR（FFRDobutamine）捕捉额外的应力诱导动态压缩。我们假设CCTA衍生的流体动力学参数在预测两种FFR类型方面优于传统指标。方法：我们回顾性分析了接受侵入性FFRAdnosine和FFRDobutamine评估的R-AAOCA患者的CCTA数据。参数分为：（1）传统指标（横截面积、周长、短轴/长轴、壁内腔面积[ILA]、有效直径、面积和直径狭窄比）和（2）流体动力学指标（水力直径、椭圆比、圆度、水力直径狭窄比、阻力指数[RI]、开口角惩罚[OAP]和综合狭窄评分[CSS]）。血流动力学相关性定义为FFR≤0.80。结果：纳入81名患者。FFRAdnosine≤0.80发生于5例（6.2%），FFRDobutamine≤0.80发生于16例（19.8%）。对于FFRAdnosine，顶级判别因子为RI（AUC=0.97）、OAP（AUC=0.97）、开口面积（AUC=0.96）和CSS（AUC=0.95）。对于FFRDobutamine，开口短直径领先（AUC=0.85），随后是RI（AUC=0.83）和ILA短直径（AUC=0.81）。RI解释了FFRAdnosine和FFRDobutamine变异的45%和43%。在最佳阈值下，RI在FFRAdnosine中实现了100%灵敏度和95%特异性；开口短直径在FFRDobutamine中实现了100%灵敏度和57%特异性。结论：在R-AAOCA中，CCTA衍生的流体动力学参数在预测固定压缩的血流动力学相关性方面优于传统几何参数。
英文摘要：
Background: Right anomalous aortic origin of coronary arteries (R-AAOCA) involves fixed compression, assessable with adenosine-derived fractional flow reserve (FFRAdnosine), and additional stress-induced dynamic compression captured by dobutamine-derived FFR (FFRDobutamine). We hypothesized that coronary CT angiography (CCTA)-derived fluid dynamics-informed parameters outperform conventional metrics in predicting both FFR types. Methods: We retrospectively analyzed CCTA data from R-AAOCA patients who underwent invasive FFRAdnosine and FFRDobutamine assessment. Parameters were categorized as: (1) conventional metrics (cross-sectional area, perimeter, minor/major axis, intramural lumen area [ILA], effective diameter, area and diameter stenosis ratios) and (2) fluid dynamics-informed metrics (hydraulic diameter, elliptic ratio, circularity, hydraulic diameter stenosis ratio, resistance index [RI], ostial angulation penalty [OAP], and comprehensive stenosis score [CSS]). Hemodynamic relevance was defined as FFR$\leq$0.80. Results: 81 patients were included. FFRAdnosine$\leq$0.80 occurred in 5 (6.2%) and FFRDobutamine$\leq$0.80 in 16 (19.8%) patients. For FFRAdnosine, top discriminators were RI (AUC=0.97), OAP (AUC=0.97), ostial area (AUC=0.96), and CSS (AUC=0.95). For FFRDobutamine, ostial minor diameter led (AUC=0.85), followed by RI (AUC=0.83) and ILA minor diameter (AUC=0.81). RI explained 45% and 43% of FFRAdnosine and FFRDobutamine variance, respectively. At optimal thresholds, RI achieved 100% sensitivity and 95% specificity for FFRAdnosine; ostial minor diameter achieved 100% sensitivity and 57% specificity for FFRDobutamine. Conclusions: In R-AAOCA, CCTA-derived fluid dynamics-informed metrics provide excellent and superior performance compared with conventional geometric parameters in predicting hemodynamic relevance of fixed compression.
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