Diagnostic value of coronary CT fractional flow reserve combined with serum Krüppel like factor 2 and Soluble tumor necrosis factor receptor 1 in ischemic cardiomyopathy

ZHANG Qing-jun; MAO Wen; WANG Hui; ZHANG Miao-miao; DENG Mao-song; CHANG Xin; YIN Xiao-ming; WU Di; FAN Yu-dong

doi:10.3969/j.issn.1672-5301.2025.08.015

Abstract：Objective To explore the diagnostic value of coronary CT fractional flow reserve(FFR)combined with serum Krüppel like factor 2(KLF2)and soluble tumor necrosis factor receptor 1(sTNFR1)for ischemic cardiomyopathy.Methods Two hundred patients with coronary heart disease admitted to Emergency General Hospital from January 2022 to May 2024 were regarded as the study subjects.They were separated into ischemic cardiomyopathy group(n=96)and non ischemic cardiomyopathy group(n=104)based on the presence or absence of myocardial ischemiamyocard(MI)myocardial ischemiamyocard symptoms.The serum levels of KLF2 and sTNFR1 were measured using an ELISA kit.Clinical data was collected,and patients underwent coronary angiography to measure FFR value.Four grid table method was applied to analyze the diagnostic efficacy of FFR and serum KLF2 and sTNFR1 for ischemic cardiomyopathy.The consistency Kappa test was applied to compare the consistency between FFR and serum alone and in combination for the diagnosis of ischemic cardiomyopathy and clinical examination results.ROC curve was applied to analyze the value of FFR and serum KLF2 and sTNFR1 in diagnosing ischemic cardiomyopathy.Results The serum KLF2 level in the ischemic cardiomyopathy group was lower than that in the non ischemic cardiomyopathy group[(5.16±0.72)pg/ml vs.(5.91±0.79)pg/ml,P<0.05],while the sTNFR1 level was higher[(255.89±35.57)ng/ml vs.(225.25±31.64)ng/ml,P<0.05].The AUC of serum KLF2 for diagnosing ischemic cardiomyopathy was 0.775,with a sensitivity of 89.58%and a specificity of 61.92%.The AUC of serum sTNFR1 for diagnosing ischemic cardiomyopathy was 0.763,with a sensitivity of 78.13%and a specificity of 83.65%.The FFR diagnostic results showed 14 false positives and 30 false negatives,which were consistent with the pathological examination results,the Kappa value was 0.556(P<0.05),the diagnostic AUC was 0.776(95%CI 0.712-0.832),the sensitivity was 68.75%,and the specificity was 86.54%.The diagnostic results of FFR combined with serum KLF2 and sTNFR1 showed 1 false positive and 19 false negative cases,with high consistency compared to pathological examination results,the Kappa value was 0.798(P<0.05),the AUC was 0.896(95%CI 0.845-0.935),with a specificity of 99.04%and a sensitivity of 80.21%.The combined diagnosis of FFR,serum KLF2,and sTNFR1 showed increased specificity and accuracy compared to single indicator diagnosis(P<0.05).Conclusion The expression level of serum KLF2 decreases and the expression level of sTNFR1 increases in patients with ischemic cardiomyopathy.The combined diagnosis of FFR and serum KLF2 and sTNFR1 increases the specificity and accuracy of ischemic cardiomyopathy.