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Objective To investigate the clinical value of coronary computed tomography angiography (CCTA) based CT derived fractional flow reserve (CT-FFR) and ΔCT-FFR in improving the diagnostic efficiency for coronary abnormal hemodynamics in patients with severe calcification. Methods We retrospectively analyzed the clinical data of coronary artery disease (CAD) patients who underwent CCTA, CT-FFR, invasive coronary angiography (ICA) and FFR during hospitalization from January 2018 to June 2019 in Chinese PLA General Hospital. Severe calcification was defined as coronary artery calcium score (CACS) ≥100 on single vessel level. A total of 107 CAD patients with 149 coronary arteries were included in the present study. The enrolled coronary arteries were assigned to CACS≥100 group (n=56) and CACS<100 group (n=93). CT-FFR was performed on the deep FFR platform based on machine learning (ML) algorithms and ΔCT-FFR was defined as CT-FFR difference between proximal and distal to the coronary lesion. The correlation and consistency between CT-FFR and FFR values were analyzed by Pearson and Bland-Altman methods. We attempted to analyze the incremental value of ΔCT-FFR for coronary functional evaluation, especial for coronary arteries with severe calcification, regarding FFR≤0.8 as the diagnostic gold standard. Comparison of receiver operating characteristic curves (ROC) between different diagnostic methods was presented by Delong test. Results Pearson and Bland-Altman analyses showed appreciable correlation (CACS≥100 group, r=0.71, P<0.01; CACS<100 group, r=0.73, P<0.01) and consistency (CACS≥100 group, Mean=-0.01, P=0.25; CACS<100 group, Mean=0, P=0.96) between CT-FFR and FFR values in both groups. FFR (0.80±0.08 vs. 0.84±0.09, P=0.004) and CT-FFR (0.81±0.06 vs. 0.85±0.06, P<0.001) levels were significant lower in CACS≥100 group than those in CACS<100 group, while ΔCT-FFR (0.14±0.06 vs. 0.09±0.06, P<0.001) levels were significant higher in CACS≥100 group. Moreover, the diagnostic efficiency of CT-FFR in CACS≥100 group was inferior to that in CACS<100 group [AUC=0.792(95%CI 0.663-0.889) vs. AUC=0.929(95%CI 0.856-0.972), P=0.04], while it achieved significant improvement after ΔCT-FFR adjustment [AUC=0.876(95%CI 0.760-0.949) vs. AUC=0.792(95%CI 0.663-0.889), P=0.02] and was similar to that in CACS<100 group (P=0.37). Conclusion For coronary arteries with severe calcification, CT-FFR demonstrated significant incremental value in improving the diagnostic efficiency of coronary abnormal hemodynamics after ΔCT-FFR adjustment.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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