冠状动脉计算机断层血管造影在主动脉瓣置换术前筛查冠心病中的应用

Application of Computed Tomography Angiography in Evaluation of Coronary Heart Disease Before Aortic Valve Replacement

目的探讨主动脉瓣置换术前冠状动脉计算机断层血管造影(computed tomography angiography,CTA)对冠心病诊断的准确性。方法选取2011年1月~2015年12月我院老年主动脉瓣瓣膜病150例,心电图示ST-T改变,均在术前行冠状动脉CTA、冠状动脉造影(coronary angiography,CAG)检查,以CAG结果为标准,分析CTA诊断的敏感性、特异性、阳性预测值及阴性预测值。结果冠状动脉狭窄程度超过50%的患者CTA敏感性、特异性、阳性预测值、阴性预测值分别为97.4%(115/118)、87.5%(28/32)、96.6%(115/119)、90.3%(28/31),以冠状动脉受累数量分析分别为96.7%(323/334)、61.3%(163/266)、75.8%(323/426)、93.7%(163/174)。冠状动脉狭窄程度超过75%的患者CTA敏感性、特异性、阳性预测值、阴性预测值分别为100.0%(52/52)、67.3%(66/98)、61.9%(52/84)、100.0%(66/66),以冠状动脉受累情况分析分别为98.2%(166/169)、64.3%(277/431)、51.9%(166/320)、98.9%(277/280)。结论冠状动脉CTA可用于AVR患者术前筛查,对于CTA未能发现明确冠状动脉狭窄的患者,可不必再行CAG检查。

Objective To discuss the accuracy of computed tomography angiography(CTA)in the diagnosis of coronary heart disease before aortic valve replacement(AVR).Methods A total of150elderly aortic valve disease patients from January2011to December2015were investigated.The ECG showed ST-T changes.All the patients underwent coronary angiography(CAG)and CTA pre-operation.With the results of CAG as a golden standard,the sensitivity,specificity,positive predictive value and negative predictive value of CTA were analyzed.Results In patients with more than50%stenosis,the sensitivity,specificity,positive predictive value,and negative predictive value were97.4%(115/118),87.5%(28/32),96.6%(115/119),and90.3%(28/31),respectively.According to the number of involved coronary artery,the sensitivity,specificity,positive predictive value,and negative predictive value were97.4%(115/118),87.5%(28/32),96.6%(115/119),and90.3%(28/31),respectively.In patients with more than75%stenosis,the sensitivity,specificity,positive predictive value,and negative predictive value were100.0%(52/52),67.3%(66/98),61.9%(52/84),andl100.0%(66/66),respectively.According to the number of involved coronary artery,the sensitivity,specificity,positive predictive value,and negative predictive value were98.2%(166/169),64.3%(277/431),51.9%(166/320),and98.9%(277/280),respectively.Conclusion