应用超声心动图左室壁运动异常节段推测冠心病相关狭窄血管——与冠脉造影对比研究

Conjecturing the CHD Related Stenotic Artery from Abnormal Segmentation of Ventricle Wall Motion by Echocardiography—A Comparative Study with CAG

目的:探讨二维心超(2DE)对冠心病的诊断价值及对相关狭窄血管推测的准确性。材料和方法:200例临床初步诊断为冠心病的患者同期进行2DE及导管法冠脉造影(CAG)检查(2DE在先,CAG在后),以CAG为标准,统计分析根据节段性室壁运动异常推测冠脉相关狭窄血管的准确性。结果:对狭窄冠脉具体血管数的检出两种方法比较,LAD、LCX、多支病变两者无明显差异(P>0.05),以CAG为标准,2DE推测冠心病相关狭窄血管的特异性较高,敏感性较低,约登指数<0.5;当冠状动脉的某一支狭窄≥90%或次全闭塞时,2DE推测冠心病的准确性明显提高,对LAD、LCX、RCA的判断敏感性均>70%,特异性均>85%,约登指数均>0.6。结论:2DE是一种简便、无创、良好辅助冠脉造影的方法,当血管狭窄≥90%或次全闭塞时准确性较高,当血管狭窄<90%时准确性欠佳。

To investigate the diagnostic value of 2DE （two - dimensional echocardiography）, which was used to examine 200 patients who were diagnosed as CHD（coronary heart disease）, and the conjecturing accuracy for the related stenotic Artery, against CAG（coronary angiography）. Materials and Methods： 200 cases of patients , who were clinically diagnosed as CHD, were examined with both 2DE and CAG at the same period respectively （2DE followed by CAG） . With CAG as a standard, the positive rate of the two methods was comparatively analyzed and the accuracy of the conjecturing, according to the abnormal segmentation of ventricle wall motion , was statistically analyzed. Results： With the same group of patients, in the comparison of the number of stenotic arteries found, both methods indicated P〉0.05, there were no significant differences between the two methods in judging all of the LAD, LCX and multiple branches of arteries. With CAG as a standard, the specificity of 2DE conjecturing the CHD related stenotic Artery was comparatively high, the sensitivity was comparatively low and the Youden＇ s index was 〈0.5. When one of the coronary arteries stenosed ≥90% or severely stenosis, the conjecturing accuracy of CHD was improved obviously. It had the sensitivity of 〉 70% in judging all of the LAD, LCX and RCA, specificity 〉 85%, Youden＇ s index 〉 0.6. Conclusion： The statistical analysis of this group data shows that the conjecturing accuracy for the related stenotic Artery by 2DE is comparatively high when the coronary arteries stenosed ≥90% or severely stenosis. The accuracy is not so high when the arteries stenosed 〈 90%. Indication： 2DE is a method of convenience, noninvasive and practical implementation assisting CAG. The value is very high for evaluating the severe extent of CHD.