双源CT冠状动脉成像结合胸痛表现在冠心病诊断中的应用
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摘要
目的探讨双源CT冠状动脉成像及与典型胸痛临床表现结合在诊断冠状动脉重度狭窄病变中的价值。方法序贯收集2014年1月至2015年12月期间在中国人民解放军南京军区南京总医院行64排或128排双源CT冠状动脉成像检查并同期行经皮冠状动脉造影检查(CAG)的病人410例。收集病人一般临床资料,冠脉CTA及CAG结果。结果双源CT诊断总符合率为94.06%,其中血管狭窄程度>75%的病变诊断敏感性、特异性、阳性预测价值、阴性预测价值分别为86.22%(269/312)、95.90%(1 221/1 272)、84.06%(269/320)、96.60%(1 221/1 264)。结合典型胸痛症状,诊断准确率可提高至96.97%(384/396),诊断冠状动脉重度狭窄的敏感性、特异性、阳性预测价值、阴性预测价值分别为96.92%、97.02%、97.78%、95.88%。结论双源CT冠状动脉成像诊断冠状动脉重度狭窄具有良好的敏感性及特异性,准确率较高,可进一步指导介入或外科冠状动脉搭桥术(CABG)治疗。其与典型胸痛临床表现结合可进一步提高其诊断冠状动脉重度狭窄的敏感性、特异性和准确率。
Objective To explore the value of dual-source CT coronary artery imaging combined with typical chest pain in the diagnosis of severe stenosis of coronary artery lesions.Methods Four hundred and ten cases of patients who underwent 64-row or 128-line dual-source CT coronary artery imaging combined with coronary angiography examination(CAG) in Nanjing General Hospital of the Nanjing Military Region of the Chinese PLA from January 2014 to December 2015 were enrolled.The general clinical data,coronary CTA and CAG results were collected.Results The total coincidence rate of Dual-source CT in the diagnosis was 94.06%,of which the diagnostic sensitivity,specificity,positive predictive value and negative predictive value in the lesions of degree of vascular stenosis >75% was 86.22%(269/312),95.90%(1 221/1 272),84.06%(269/320),96.60%(1 221/1 264),respectively.Combined with typical chest pain symptoms,diagnostic accuracy can be improved to 96.97%(384/396),diagnosis of severe stenosis of coronary artery of sensitivity,specificity,positive predictive value and negative predictive value of 96.92%,97.02%,97.78% and 95.88%,respectively.Conclusions Dual-source CT coronary artery imaging has good sensitivity and specificity,high accuracy in the diagnosis of severe stenosis of coronary artery,and can be the further guidance of PCI or surgical coronary artery bypass grafting(CABG) therapy.The combined with typical clinical manifestations of chest pain can further improve the diagnosis of severe stenosis of coronary artery of sensitivity,specificity and accuracy.
Objective To explore the value of dual-source CT coronary artery imaging combined with typical chest pain in the diagnosis of severe stenosis of coronary artery lesions.Methods Four hundred and ten cases of patients who underwent 64-row or 128-line dual-source CT coronary artery imaging combined with coronary angiography examination(CAG) in Nanjing General Hospital of the Nanjing Military Region of the Chinese PLA from January 2014 to December 2015 were enrolled.The general clinical data,coronary CTA and CAG results were collected.Results The total coincidence rate of Dual-source CT in the diagnosis was 94.06%,of which the diagnostic sensitivity,specificity,positive predictive value and negative predictive value in the lesions of degree of vascular stenosis >75% was 86.22%(269/312),95.90%(1 221/1 272),84.06%(269/320),96.60%(1 221/1 264),respectively.Combined with typical chest pain symptoms,diagnostic accuracy can be improved to 96.97%(384/396),diagnosis of severe stenosis of coronary artery of sensitivity,specificity,positive predictive value and negative predictive value of 96.92%,97.02%,97.78% and 95.88%,respectively.Conclusions Dual-source CT coronary artery imaging has good sensitivity and specificity,high accuracy in the diagnosis of severe stenosis of coronary artery,and can be the further guidance of PCI or surgical coronary artery bypass grafting(CABG) therapy.The combined with typical clinical manifestations of chest pain can further improve the diagnosis of severe stenosis of coronary artery of sensitivity,specificity and accuracy.
引文
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[9] LEE TH,GOLDMAN L.Evaluation of the patient with acute chest pain[J].N Engl J Med,2000,342(16):1187-1195.
[10] 吴贵军,韩雅玲,荆全民,等.胸痛症状及其联合辅助检查在冠心病诊断中的价值分析[J].中国介入心脏病学杂志,2011,19(6):313-317.
[2] ROBERTS WT,BAX JJ,DAVIES LC.Cardiac CT and CT coronary angiograpphy:technology and application [J].Heart,2008,94(6):781-792.
[3] 周跟东,胡永胜,周炳凤,等.双源CT冠状动脉成像与冠状动脉造影的对比研究[J].安徽医药,2013,17(7):1182-1184.
[4] MARUYAMA T,TAKADA M,HASUIKE T,et al.Radiation dose reduction and coronary assessability of prospective electrocardiogram-gated computed tomograpy coronary angiograpy:comparison with retrospective electrocardiogram-gated helical scan [J].Am Coll Cardiol,2008,52(18):1450-1455.
[5] NIKOLAOU K,KNEZ A,RIST C,et al.Accuracy of 64-MDCT in the diagnosis of ischemic heart disease [J].AJR Am J Roentgenol,2006,187(1):111-117.
[6] CHUN AA,MCGEE SR.Bedside diagnosis of coronary artery disease:a systematic review[J].Am J Med,2004,117(5):334-343.
[7] GOLDMAN L,KIRTANE AJ.Triage of patients with acute chest pain and possible cardiac ischemia:the elusive search for diagnostic perfection[J].Ann Intern Med,2003,139(12):987-995.
[8] KONTOS MC,JESSE RL.Evaluation of the emergency department chest pain patient[J].Am J Cardiol,2000,85(5A):32B-39B.
[9] LEE TH,GOLDMAN L.Evaluation of the patient with acute chest pain[J].N Engl J Med,2000,342(16):1187-1195.
[10] 吴贵军,韩雅玲,荆全民,等.胸痛症状及其联合辅助检查在冠心病诊断中的价值分析[J].中国介入心脏病学杂志,2011,19(6):313-317.