320排容积CT评估冠心病患者左心室射血分数和局部室壁运动的初步研究

Assessment of Left Ventricular Ejection Fraction and Regional Wall Motion with 320-Detector Volume Computed Tomography in Patients with Coronary Artery Disease: A Preliminary Study

目的探讨320排容积CT定量评估冠心病患者左心室射血分数(EF)和室壁运动的临床价值。方法将52例拟诊冠心病患者CT冠状动脉成像数据用以心功能分析,测量左心室EF和室壁收缩增厚率(WT%)。以高级职称医师二维超声心动图(2DE)结果为参考标准,采用配对t检验及Pearson检验分析320排容积CT和2DE测量EF结果的一致性和相关性;以WT%<30%为CT诊断室壁运动异常标准,计算320排容积CT评价室壁运动异常的敏感性、特异性和准确性,采用Kappa检验分析两种方法的一致性。结果 320排CT测得52例受检者EF平均值(61.8±13.4)%,2DE测得EF平均值(61.1±12.4)%,两者差异无显著统计学意义(P=0.486>0.05),两者相关性好(r=0.868,P<0.01)。320排容积CT诊断中间段及心尖段室壁运动异常的敏感性、特异性、准确性分别为81%、96%、94%,一致性良好(K=0.72,P<0.01);诊断基底段壁运动异常的敏感性、特异性、准确性分别为84%、61%、63%,一致性较低(K=0.15,P<0.01)。结论 320排容积CT在冠状动脉造影的同时评价左心室EF准确性高且与2DE相关性好;通过320排容积CT测量WT%评价中间段及心尖段室壁运动有重要临床价值,但对于评价基底部室壁运动价值有限。

Objective To explore the clinical value of 320 detector computed tomogramphy （320DCT） in the quantita tive assessment of left ventricular ejection fraction and regional wall motion in patients with coronary artery disease. Meth ods 52 cases suspected or diagnosed of coronary artery disease underwent CT coronary angiography, and the data were used to assess the ejection fraction （EF） and wall thickening（ WT% ）. Using 2Dechocardiography （2DE） as the reference standard. Results The values of mean EF and 2DE were（61.8 ± 13.4）% and （61.1 ± 12.4）%. There was no signifi cant difference of the left ventricular EF measured by DCT and 2DE （ P 〉 0.05 ）, and the correlation was exceUent （ r = 0. 868, P 〈 0.01 ）. The sensitivity, specificity and agreement of DCT for the diagnosis of regional wall motion abnormality ofcardiac apical and mid section were 81% ,96% and 94%, and the agreement was high （K = 0. 72 ,P 〈 0.01 ）, while of cardi ac basal section were 83 % ,61% and 63 %, and the agreement was low （K = 0. 15, P 〈 0.01 ）. Conclusion The accuracy of 320detector volume computed tomogramphy coronary angiography in the assessment of left ventricular ejection fraction is high, and the correlation is also excellent between 320DCT and 2DE. Analyzing WT% with 320DCT is useful to evaluate the wall motion of cardiac apical and mid section, but little significance in the cardiac basal section.