64排螺旋CT冠状动脉造影在心瓣膜置换术前的应用

Application of Coronary Angiography with 64-Slice Spiral Computed Tomography before Cardiac Valve Replacement

目的探讨无创64排螺旋CT冠状动脉造影(CTA)在心瓣膜置换术前诊断冠状动脉病变的敏感性、特异性。方法50岁以上的心脏瓣膜疾病患者152例,其中单纯二尖瓣病变78例,单纯主动脉瓣病变49例,联合瓣膜病变25例,合并心房颤动93例。所有患者均行CTA和有创冠状动脉造影(CAG)检查,根据两者的检查结果计算CTA诊断冠状动脉病变的敏感性、特异性。结果直径>1mm的冠状动脉、窦性心律、心率≤70次/分患者的CTA显像清晰,诊断冠状动脉病变的敏感性和特异性均为100%;合并心房颤动或心率控制不佳患者的CTA显像诊断冠状动脉病变的敏感性和特异性明显降低,且因冠状动脉病变的部位不同,其诊断的敏感性和特异性亦不相同,对左主干、左前降支、对角支病变诊断的敏感性和特异性分别为87%、89%,右冠状动脉、后降支为80%、76%,回旋支、钝缘支为67%、71%。对直径≤1mm的冠状动脉,CTA尚难成像。结论CTA作为无创、快速和价廉的检查方法,在心脏瓣膜置换术前对冠状动脉病变有一定的诊断价值,但目前尚不能完全替代有创CAG检查。

Objective To investigate the sensitivity and specificity of non-invasive 64-slice spiral computed tomography a.ngiography （CTA） in diagnosis of coronary artery disease. Methods One hundred and fifty-two cases of cardiac valvular diseases, with the age more than 50 years old were included. There were 78 cases of single mitral valve diseases, 49 cases of single aortic valve diseases, 25 cases of combined heart valve disease, and 93 cases combined with atrial fibrillation among them. All cases were undertaken CTA and conventional invasive coronary angiography：（CAG） in routinely. The sensitivity and specificity of CTA in diagnosis of coronary artery disease were calculated on the basis of the results of both processes. Results With the coronary artery diameter more than 1 millimeter, patients with sinus rhythm, heart rates less than 70 beats per minute, the results of CTA showed wonderful picture. The sensitivity and specificity were 100% in diagnosis of coronary artery disease. For patients with atria fibrillation or poor heart rate control, the sensitivity and specificity of the CTA for coronary artery diseases decreased obviously, and were not same for different parts of coronary artery lesion. For left main artery, anterior descending branch and diagonal branch, the sensitivity and specificity were 87% and 89% respectively, For left circumflex branch and obtuse marginal branch they were 67% and 71% respectively. For right coronary artery and posterior descending branch they were 80% and 76% respectively. For the coronary arteries diameter less than 1 millimeter, CTA could not provide good image. Conclusion As a rapid non-invasive and cheap method, CTA could provide some value in diagnosis of coronary artery disease before cardiac valve replacement, but could not substitute conventional invasive coronary angiography completely.