超声心动图对冠心病诊断的特异性、敏感性和ROC曲线分析

Sensitivity,specificity and ROC curve analysis of echocardiography for diagnosis of coronary artery disease

目的:对超声心动图诊断冠心病的特异性、敏感性和ROC曲线进行分析,评价其诊断价值。方法:对114例临床诊断标准为冠心病的患者进行超声心动图检查,观察有无室壁运动异常及其部位,并测量左室射血分数、左室舒张末期内径、左室收缩末期内径、二尖瓣舒张早期峰值流速(E)和舒张晚期峰值流速(A),计算E/A比值。上述患者进行冠脉造影检查,观察3支冠状动脉有无病变、狭窄及狭窄程度,狭窄≥50%诊断为冠心病。结果:114例中经冠脉造影明确为冠心病患者96例。冠心病超声心动图表现为:节段性室壁运动减弱、消失或矛盾运动。超声心动图诊断冠心病的敏感性为79.2%,定位准确率为75.0%。以左室室壁运动评分≥4为截点,诊断冠心病的敏感性为82.2%,特异性为100%,ROC曲线下面积为0.95(0.89-0.98)。结论:超声心动图是诊断冠心病首选的无创性诊断方法。利用室壁节段性运动评分诊断冠心病具有较高的特异性和敏感性。

AIM：To analyze the sensitivity,specificity and receiver operating characteristic（ROC）curve of echocardiography for diagnosis of coronary artery disease.METHODS;One hundred and fourteen subjects were selected according to the clinical diagnostic criteria of coronary artery disease and echocardiography was performed.The regional ventricular wall motion was observed,and the left ventricular end-diastolic diameter,left ventricular end-systolic diameter, left ventricular ejection fraction and the ratio of early-diastolic peak flow velocity to late-diastolic peak flow velocity were measured in all subjects.The coronary angiography was performed,and the final diagnosis of coronary artery disease was made when the degree of the coronary artery stenosis was≥50%.RESULTS：The final diagnosis of coronary artery disease was confirmed by coronary angiography in 96 cases of the total 114 patients selected.Among them,attenuation, disappearance and paradoxical motion of the regional ventricular wall motion were observed,and a sensitivity of 79.2%and a positioning accuracy of 75.0%were achieved by echocardiography.The sensitivity was 82.2%and the specificity was 100%when the score of the regional left ventricular wall motion was divided into the cut-off point of≥4,and the area under the ROC curve was 0.95（0.89-0.98）.CONCLUSION：Echocardiography is a preferred non-invasive method for diagnosis of coronary artery disease.The score of regional ventricular wall motion has high specificity and sensitivity in the diagnosis of coronary artery disease.