ECHO、DCG及MSCT冠脉成像在无症状心肌缺血临床诊断中的应用

Application of ECHO, DCG and MSCT Coronary Angiography in Clinical Diagnosis of Silent Myocardial Ischemia

目的分析超声心动图(ECHO)、动态心电图(DCG)、多排螺旋电子计算机断层扫描(MDCT)冠脉成像在无症状心肌缺血(SMI)临床诊断中的应用效果。方法回顾性分析我院84例疑似SMI患者临床资料,所有患者均行ECHO、DCG、MSCT冠脉成像及冠状动脉造影(CAG)检查,并以CAG诊断结果作为金标准,比较ECHO、DCG、MSCT冠脉成像对SMI的诊断价值。结果 84例疑似SMI患者中,经CAG确诊SMI有69例(82.14%)。MSCT冠脉成像诊断SMI准确77例(91.67%),漏诊5例(7.25%),误诊2例(13.33%),Kappa值为0.737;DCG诊断SMI准确73例(86.90%),漏诊8例(11.59%),误诊3例(20.00%),Kappa值为0.605;ECHO诊断SMI准确66例(78.57%),漏诊14例(20.29%),误诊4例(26.67%),Kappa值为0.421。3种检查方法Kappa值以MSCT冠脉成像最高;3种检查方法特异度、阳性预测值、阴性预测值比较,差异无统计学意义(P>0.05);MSCT冠脉成像灵敏度、准确率均高于ECHO(P<0.05);但MSCT冠脉成像与DCG灵敏度、准确率比较,差异无统计学意义(P>0.05);ECHO与DCG灵敏度、准确率比较,差异亦无统计学意义(P>0.05)。结论 ECHO、DCG及MSCT冠脉成像在SMI临床诊断中具有一定作用,但MSCT冠脉成像准确性更高,临床实用价值较高。

Objective To analyze the application effects of echocardiography(ECHO),dynamic electrocardiogram(DCG)and multi-slice spiral computed tomography(MDCT)coronary angiography in the clinical diagnosis of silent myocardial ischemia(SMI).Methods The clinical data of 84 patients suspected as SMI were analyzed retrospectively.All patients were given ECHO,DCG,MSCT coronary angiography and coronary arteriography(CAG).The results of CAG diagnosis were used as the gold standard to compare the diagnostic value of ECHO,DCG and MSCT coronary angiography for SMI.Results Among 84 patients suspected as SMI,69 cases(82.14%)were diagnosed by CAG.MSCT coronary angiography in the diagnosis of SMI showed there were 77 cases(91.67%)of accurate diagnosis,5 cases(7.25%)of missed diagnosis and 2 cases(13.33%)of misdiagnosis,and the Kappa value was 0.737.DCG in the diagnosis of SMI showed there were 73 cases(86.90%)of accurate diagnosis,8 cases(11.59%)of missed diagnosis and 3 cases(20.00%)of misdiagnosis,and the Kappa value was 0.605.ECHO in the diagnosis of SMI showed there were 66 cases(78.57%)of accurate diagnosis,14 cases(20.29%)of missed diagnosis and 4 cases(26.67%)of misdiagnosis,and the Kappa value was 0.421.The Kappa value of three examination method was the highest in MSCT coronary angiography.There were no significant differences in the specificity,positive predictive value and negative predictive value among the three examination methods(P>0.05).The sensitivity and accuracy of MSCT coronary angiography were higher than those of ECHO(P<0.05).However,there were no significant differences in the sensitivity and accuracy between MSCT coronary angiography and DCG(P>0.05).There were no significant differences in the sensitivity and accuracy between ECHO and DCG(P>0.05).Conclusion ECHO,DCG and MSCT coronary angiography have a certain role in the clinical diagnosis of SMI,but MSCT coronary angiography has higher accuracy and higher clinical value.