Background: In-stent restenosis (ISR) usually develops from stent neointimal hyperplasia (SNH), which will seriously weaken the effect of treatment. In this study, both SNH and ISR were classified as in-stent stenosis (ISS), and a non-invasive parameter – myocardial blood flow index (MBFI) was used to analyze its value in the diagnosis of stent abnormalities. Objectives: Analyzing the application of MBFI in the diagnosis of ISS. Patients and Methods: Clinical follow-up data for 572 patients with drug-eluting stent (DES) was collected continuously. Ninety cases were screened with the protocol of computed coronary tomography angiography (CCTA) and invasive coronary angiography (ICA) for the unrelieved symptoms. In-stent abnormalities included SNH (ISS < 50%) and ISR (ISS ≥ 50%). The ROC curve was analyzed using the optimal cutoff value of MBFI to evaluate the in-stent abnormalities. T-test of independent samples was used for the comparison data with normal distribution, and chi-square test was used for comparison of nominal variables P < 0.05 was considered statistically significant. Results: Frequency of ISS was not statistically different between genders (χ2 = 0.105) (P = 0.7463). The optimal cutoff value was 0.082 with the area under the curve (AUC) of 0.829 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 91.4%, 89.1%, 84.2%, and 94.2%, respectively, and the accuracy was 90.0%. Among 39 cases with MBFI ≤ 0.082, 34 (87.18%, 34/39) were with ISS, including 18 (20%, 18/90) of SNH, and 16 (17.9%, 16/90) of ISR. In the 39 cases with MBFI ≤ 0.082, there were eight (20.5%, 8/39) presented new lesions, and seven (17.9%, 7/39) presented severe lesions. Conclusion: MBFI could be used for evaluating ISS, and more attention should be paid to the new accompanying lesions for the high risk of severe lesions.
Background: There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics. Objectives: This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and Methods: The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant. Results: In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 mSv. There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017). Conclusion: In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.
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