冠状动脉CT血管成像对冠心病等危症患者诊断心肌缺血的价值

李建龙; 张 虹; 张变花; 黄晋喜; 曹向红; 孙 帅; 姜 峰

冠状动脉CT血管成像对冠心病等危症患者诊断心肌缺血的价值

Diagnostic value of coronary computed tomographic angiography in detection of myocardial ischemia in patients with coronary heart disease risk equivalents

摘要

摘要: 目的评价冠状动脉CT血管成像（CCTA）对冠心病等危症患者诊断心肌缺血的价值。方法回顾性收集100例均接受了CCTA与负荷核素心肌灌注显像（MPI）的冠心病等危症患者。采用目测直径法对CCTA图像狭窄程度进行判定，冠状动脉狭窄分为<50%,50%~69%和≥70%。相应MPI图像上心肌节段的核素分布分为：灌注正常及灌注异常。结果 400条冠状动脉中，22条冠状动脉狭窄程度≥50%，其中10条（45%）相应的心肌供血区域在MPI图像上出现心肌灌注异常；378条冠脉血管狭窄程度<50%及正常，其中18条（4.8%）冠状动脉的心肌供血区域在MPI图像上出现心肌灌注异常。CCTA对评估心肌缺血诊断的灵敏度、特异度、阳性预测值和阴性预测值分别为36%、97%、45%和95%。结论 CCTA用于诊断冠心病等危症患者心肌缺血时，确定诊断性能较低，排除诊断性能较好。

Abstract: AIM To evaluate the performance of coronary computed tomographic angiography (CCTA) in patients with coronary heart disease risk equivalents for diagnosis of myocardial ischemia. METHODSThis is a retrospective observational study, which included 100 patients with coronary heart disease risk equivalents. CCTA and MPI were conducted. The degree of coronary stenosis is divided by CCTA into the following groups: <50%, 50%-69%, ≥70%. Corresponding myocardial imaging on MPI is divided into normal perfusion and perfusion abnormalities. RESULTSAmong the total 400 coronary vessels, 22 coronary arteries were stenosed ≥50%, including ten with perfusion defect on MPI; 18/378 arteries in which coronary stenosis was<50% showed abnormal imaging on MPI. Sensitivity, specificity, positive predictive value and negative predictive value of CCTA in detecting myocardial ischemia was 36%, 97%, 45%, 95%, respectively. CONCLUSIONCCTA is a useful method for exclusion of myocardial ischemia in patients with coronary heart disease risk equivalents, but with a low diagnostic performance.

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