冠状动脉CT血管成像在老年患者中的应用价值

The application value of coronary computed tomography angiography in elderly patients

目的:评估冠状动脉CT血管成像在75岁以上临床怀疑CAD低中风险的老年患者中的应用价值,以及分析导致其诊断效能降低的相关因素。方法:回顾性研究100例行冠状动脉CT血管成像的临床怀疑冠心病患者(年龄>75岁),评估冠状动脉的图像质量和管腔狭窄程度,分析导致图像不清晰和/或发生任一节段的管腔狭窄程度不确定的相关因素。结果:68例患者纳入可评估组(A组),平均likert评分为(3.1±0.6)分,图像质量优良。32例患者纳入不可评估组(B组),冠状动脉钙化(25例)是最常见的病因,运动伪影5例,另外心脏起搏器伪影1例和造影剂充填不均1例。糖尿病、男性、年龄和心率>60次/min是B组的显著影响因素(P<0.05)。结论:冠状动脉CT血管成像是一种可行的评估老年患者冠状动脉狭窄程度的无创检查,但临床医生在推荐老年患者接受冠状动脉CT血管成像检查时仍应谨慎,糖尿病、男性、78岁以上和心率>60次/min的老年患者的诊断效能显著降低。

Objective:To evaluate the value of coronary CT angiography in elderly patients over 75 years of age with clinically suspected CAD at low or intermediate CAD risk,and to analyze the relevant factors that lead to reduced diagnostic efficacy.Methods:A retrospective study of 100 patients with suspected coronary heart disease(aged>75 years)who underwent coronary CT angiography.The image quality and stenosis of the coronary arteries were evaluated.Related factors of uncertainty of lumen stenosis.Results:Sixty-eight patients were included in the evaluable group(group A).The average likert score was(3.1±0.6)points,and the image quality was excellent.Thirty-two patients were included in the non-evaluable group(group B).Coronary artery calcification(25 cases)was the most common cause,with 5 cases of motion artifacts,1 case of pacemaker artifacts,and 1 case of uneven contrast filling.Diabetes,men,age,and heart rate>60 beats/min were significant influencing factors in group B(P<0.05).Conclusions:Coronary CT angiography is a feasible non-invasive test to assess the degree of coronary artery stenosis in elderly patients.However,clinicians should be cautious when recommending elderly patients to undergo coronary CT angiography.Diabetes,men,78 years old and above the diagnostic efficacy of elderly patients at 60 times/min was significantly reduced.