冠状动脉CTA对心肌病并发心绞痛患者的诊断价值

Diagnostic value of coronary CTA in patients with cardiomyopathy and angina

目的探讨冠状动脉CTA对心肌病并发心绞痛患者的诊断价值。方法选择2011年10月~2017年10月我院收治的疑似肥厚型心肌病并心绞痛患者36例为研究对象,共540节段冠状动脉,所有患者均通过64排螺旋CT冠状动脉CTA扫描技术和冠状动脉造影技术检查,比较分析两种检查方法对肥厚型心肌病并心绞痛患者的诊断结果。结果冠状动脉CTA和选择性冠状动脉造影诊断血管狭窄程度完全符合的共有384节段,完全相符率为71.1%。通过冠状动脉CTA检查诊断发现,患者血管狭窄程度正常的节段与血管狭窄程度为重度的节段的敏感性高于血管狭窄程度为轻度和中度的节段(P<0.05);但从阳性预测值方面看,血管狭窄程度为轻度的节段的阳性预测值却低于正常、中度、重度的节段(P<0.05)。两种检查方式对非钙化斑块和混合斑块的诊断效果差异无统计学意义(P>0.05)。而钙化斑块诊断率方面,通过冠状动脉CTA的诊断率高于选择性冠状动脉造影(P<0.05)。结论对于患有肥厚型心肌病并心绞痛的病人,可用冠状动脉CTA检查其是否有冠状动脉狭窄。冠状动脉CTA对冠状动脉病变的情况可作出精确的判断,且安全、快速,具有推广价值。

Objective To explore the diagnostic value of coronary CT angiography（CTA） in patients with cardiomyopathy complicated with angina.Methods 36 patients with suspected hypertrophic cardiomyopathy complicated with angina admitted to our hospital from October 2011 to October 2017 were enrolled, with 540 segments of coronary artery in total, and all cases received 64-slice coronary CTA and coronary angiography（CAG）. Results of these two examination methods were compared. Results The degree of coronary stenosis showed in CTA and CAG of 384 segments of coronary artery completely matched, with the complete corresponding rate of 71.1%. CTA results demonstrated that the sensitivity of coronary segments with normal or severe stenosis were significantly higher than that of coronary segments with mild or moderate stenosis（P〈0.05）. However, in terms of positive predictive value, that of coronary segments with mild stenosis was significant lower than that of coronary segments with normal, moderate or severe stenosis（P〈0.05）. There were no significant differences in the diagnosis rate of non-calcified plaques and mixed plaques（P〉0.05）. In terms of the diagnosis rate of calcified plaque, that of coronary CTA was significantly higher than that of CAG（P〈0.05）.Conclusion For patients with hypertrophic cardiomyopathy and angina, coronary CTA can be used to detect the presence of coronary stenosis. Coronary CTA can accurately detect coronary artery lesions, and is safe and fast, thus worthy of clinical application and promotion.