冠状动脉CT血管成像联合动态心电图在诊断冠心病心肌缺血中的应用

Application of Coronary CT Angiography Combined with Dynamic Electrocardiogram in Diagnosis of Myocardial Ischemia in Coronary Heart Disease

目的研究冠状动脉CT血管成像(CCTA)联合动态心电图(DCG)在诊断冠心病(CHD)心肌缺血价值。方法 300例疑似CHD患者行CCTA、DCG检测,并将核素心肌灌注显像(MPI)结果作为金标准,评估CCTA联合DCG诊断价值。结果 MPI诊断CHD心肌缺血率61.67%,有204个心肌灌注异常区域,其中固定性灌注缺损区29个,可逆性灌注减低区175个;CCTA诊断心肌缺血率63.67%,有224个收缩期心肌灌注异常区,其中固定性灌注缺损27个,部分可逆性灌注填充66个,可逆性灌注填充131个;DCG诊断心肌缺血率52.67%,其中ST段上斜型压低11例,下斜型压低33例,水平型压低114例;CCTA联合DCG诊断心肌缺血率66%;CCTA灵敏度83.78%,特异度68.70%,阳性预测值81.15%,准确性78%,Kappa值53%,DCG为71.35%、77.39%、83.54%、62.68%、73.67%、46.68%,CCTA联合DCG为94.59%、80%、88.38%、90.20%、89%、79.23%。结论CCTA和DCG用于冠心病心肌缺血诊断,均有较佳诊断效能,但CCTA联合DCG诊断,识别效果更佳,可提高诊断检出率。

Objective To study the value of coronary CT angiography （CCTA） and dynamic electrocardiogram （DCG） in the diagnosis of myocardial ischemia in coronary heart disease （CHD）. Methods 300 cases of suspected CHD patients were given CCTA and DCG detection, and the results of radionuclide myocardial perfusion imaging （MPI） were taken as a gold standard to assess the diagnostic value of CCTA combined with DCG.Results CHD myocardial ischemic rate in MPI detection was 61.67% and there were 204 myocardial perfusion abnormal areas, including 29 fixed perfusion defect areas and 175 reversible perfusion reduction areas. Myocardial ischemic rate in CCTA diagnosis was 63.67% and there were 224 systolic myocardial perfusion abnormal areas, including 27 fixed perfusion defect areas, 66 partially reversible perfusion filling areas and 131 reversible perfusion filling areas. Myocardial ischenfic rate in DCG diagnosis was 52.67%, and 11 cases upward sloping ST segment depression, 33 cases downward sloping depression and 114 cases horizontal depression were shown by DCG diagnosis. Myocardial ischemia rate in CCTA combined with DCG diagnosis was 66%. The rates of sensitivity, specificity, positive predictive value, accuracy, Kappa value were 83.78%, 68.70%, 81.15%, 78%, 53% in CCTA respectively and were 71.35%, 77.39%, 83.54%, 62.68%, 73.67%, 46.68% in DCG respectively, and were 94.59%, 80%, 88.38%, 90.20%,89%, 79.23% in CCTA combined DCG.Conclusion Both CCTA and DCG have good diagnostic efficacy in the diagnosis of myocardial ischemia in coronary heart disease, but CCTA combined with DCG diagnosis is better for recognition and can improve the diagnostic detection rate.