64层螺旋CT冠状动脉成像诊断心率≥70次/分或心律不齐患者冠状动脉狭窄病变

64-slice spiral computed tomography coronary angiography for detecting coronary artery stenosis in patients with heart rate larger than 70 bpm or arrhythmia

目的评价64层螺旋CT冠状动脉成像(MSCTCA)对心率≥70次/分或心律不齐患者冠状动脉狭窄病变诊断的准确性。方法对临床诊断和疑诊冠心病的心率≥70次/分或心律不齐患者51例(研究组)及窦性心律且心率<70次/分者40例(对照组),在1个月内完成MSCTCA和DSA检查。以DSA为标准,评价MSCTCA对研究组患者冠状动脉狭窄病变诊断的准确性。结果研究组MSCTCA检出冠状动脉轻度狭窄的敏感度、准确率、特异度、阳性预测值及阴性预测值分别为52.73%(29/55)、78.02%(142/182)、88.98%(113/127)、67.44%(29/43)、81.29%(113/139),中度狭窄为62.50%(30/48)、87.82%(137/156)、99.07%(107/108)、96.77%(30/31)、85.60%(107/125),重度狭窄为69.89%(65/93)、90.07%(263/292)、99.50%(198/199)、98.48%(65/66)、87.61%(198/226)。MSCTCA与DSA检出冠状动脉不同狭窄程度的总节段数差异无统计学意义(χ2=0.859,P>0.05);两种方法在检出冠状动脉狭窄方面显著相关(r=0.731,P<0.01)。结论与DSA相比,MSCTCA评价心率较高、心律不齐患者冠状动脉狭窄病变的敏感度虽然偏低,但采用适当的扫描和后处理技术后有较高的准确率和特异度,与DSA相关性较好,能满足临床筛选介入治疗冠状动脉狭窄适应证的需要。

Objective To evaluate the diagnostic accuracy of multi-slice spiral computed tomography coronary angiography （MSCTCA） for detecting coronary artery stenosis in patients with heart rate larger than 70 bpm or arrhythmia. Methods Ninety-one patients, including 51 heart rate ≥70 bpm or arrhythmia （research group）, and 40 heart rate ≥70 bpm with sinus rhythm （control group） underwent MSCTCA and DSA within a time frame of one month. Taking DSA as the standard, the diagnostic accuracy of MSCTCA for detecting coronary artery stenosis in research group was evaluated. Result In research group, the sensitivity, accuracy, specificity, positive predictive value and negative predictive value of MSCTCA for minor, moderate and serious stenosis was 52.73%（29/55）, 78.02%（142/182）, 88.98% （113/127）, 67.44% （29/43）, 81.29% （113/139）, for moderate stenosts was 62.50% （30/48）, 87.82% （137/156）, 99.07% （107/ 108）, 96.77% （30/31）, 85.60% （107/125）, for serious stenosis was 69.89% （65/93）, 90. 07% （263/292）, 99.50% （198/199）, 98.48% （65/66）, 87.61% （198/226）, respectively （X2 =0. 859, P〉0.05）. There was good correlation between MSCTCA and DSA for detecting stenosis （r=0. 731, P〈0.01）. Conclusion Compared with DSA, the sensitivity of MSCTCA for detecting coronary artery stenosis is relatively low. However, with appropriate measures to scanning and processing, MSCTCA has high accuracy and specificity, as well as good correlation with results of DSA, and can content to the needs of clinical diagnosing of coronary artery disease.