房颤患者320排CT冠脉成像的图像质量及诊断准确性研究

Image Quality and Diagnostic Accuracy of 320 Slice CT Coronary Angiography in Patients with Atrial Fibrillation

目的:通过设立窦性心律组为对照,在图像质量与诊断准确性方面探讨320排CTCA在房颤患者中的应用价值。方法:拟于1周内先后行CTCA、CCA检查的受检者进入本研究。CTCA检查采用回顾性心电门控、手动触发。依检查时所记心电情况,29例受检者纳入房颤组,52例受检者纳入窦性心律组。两组间基本资料、图像质量的比较采用Independent-Samples t检验,频数的比较采用Chi-square检验。以CCA作为金标准,绘制两组的ROC曲线,比较两组的AUC值。结果:房颤组与窦律组的平均心率分别为78.9±9.8、72.5±8.3(P=0.010);未显示冠脉节段比例分别为2.5%(11/435)、0.5%(4/780)(P=0.317);可供研究的冠脉节段数分别为424、776;图像质量1～2分、可用于诊断的冠脉节段比例分别为96.0%(407/424)、100%(776/776)(P=0.775);两组图像质量的平均分分别为1.404±0.571、1.178±0.382(P=0.000)。房颤组中,图像质量3分、不可用于诊断的冠脉节段为4.0%(17/424),多分布于LAD7(35.3%,6/17)及RCA2(23.5%,4/17)。房颤组与窦律组的AUC值分别为0.906、0.949。结论:与窦性心律受检者比较,房颤患者320排CTCA的图像质量及诊断准确性均有所降低,但总体图像质量仍可达到诊断要求,检查仍具有较高的准确性。

Purpose： To evaluate the image quality and diagnostic accuracy of 320-MDCT coronary angiography （CTCA） in patients with atrial fibrillation by comparing them with a control group of patients with sinus rhythm. Methods： Patients who would undergo both 320-CTCA and catheter coronary angiography （CCA） in a week were enrolled. CTCA examination adopted retrospective ECG gating and manual trigger. Twenty-nine patients with atrial fibrillation were treated as the test group, while 52 patients with sinus rhythm as the control group. Clinical data and image quality of the two groups of patients were compared by independent-samples t test, and frequencies of the two groups were compared by Chi-square analysis. By using the CCA as the gold standard, areas under the receiver operating characteristic curve （AUC） were compared. Results： For atrial fibrillation group and sinus rhythm group： mean heart rate was 78.9＋9.8 and 72.5＋8.3 respectively （P=0.010） ; proportion of segments that were not displayed were 2.5%（11/435） and 0.5%（4/780） respectively （P=0.317） ; segments that could be evaluated were 424 and 776 respectively ; proportion of segments that could be used for diagnosis with image quality scoring 1-2 was 96.0% （407/424） and 100% （776/776） respectively （P=0.775） ; mean image quality score was 1.404＋0.571 and 1.178＋0.382 respectively （P=0.000）. In the atrial fibrillation group, the 16 segments which could not be used for diagnosis with image aualitv scoring 3 were most freauentlv located in LAD7 （37.5% and6/16RCA2 （25%,4/16） . The AUC value in atrial fibrillation group and sinus rhythm group was 0.906 and 0.949 respectively. Conclusion： When comparing with normal sinus rhythm subjects, the image quality and diagnostic accuracy of 320-CTCA in patients with atrial fibrillation was lower, but the overall image quality was still acceptable for diagnosis and could provide relatively high accuracy of examination.