动态心电图联合CT首过灌注成像对冠心病心肌缺血患者的诊断价值

Diagnostic Value of Dynamic Electrocardiogram Combined with CT First-Pass Perfusion Imaging in Patients with Coronary Artery Disease and Myocardial Ischemia

目的探究动态心电图(DCG)联合CT首过灌注成像对冠心病心肌缺血患者的诊断价值。方法选取2016年11月至2018年3月我院心血管内科诊治102例疑似冠心病患者进行研究,均进行DCG、CT、核素心肌灌注成像(MPI)检查,以MPI作为参考标准,观察DCG、CT首过灌注成像诊断敏感性、特异性、阳性预测值、阴性预测值、准确性。结果DCG诊断心肌缺血敏感性70.5%,特异性81.1%,阳性预测值79.6%,阴性预测值62.5%,准确性71.6%,DCG与MPI结果Kappa=0.413(P<0.05);C T首过灌注成像诊断敏感性90.2%,特异性83.8%,阳性预测值84.7%,阴性预测值83.8%,准确性84.3%,C T首过灌注成像与M P I结果Kappa=0.693(P<0.05)。结论CT首过灌注成像在诊断冠心病心肌缺血优于DCG,因此两者联合有利于优势互补,较好检测出心肌灌注缺损,进而评估心肌缺血情况。

Objective To investigate the diagnostic value of dynamic electrocardiogram(DCG)combined with CT first-pass perfusion imaging in patients with coronary artery disease(CAD)and myocardial ischemia.Methods A total of 102 patients with suspected CAD admitted to our vasculocardiology department from April 2017 to June 2018 were enrolled in the study.All patients underwent DCG,CT,myocardial perfusion imaging(MPI),and MPI was used as a reference standard.The sensitivity,specificity,positive predictive value,negative predictive value,the accuracy of CAD and myocardial ischemia between DCG and CT first-pass perfusion imaging were observed and compared.Results DCG diagnosis of myocardial ischemic:sensitivity 70.5%,specificity 81.1%,positive predictive value 79.6%,negative predictive value 62.5%,accuracy 71.6%,and the Kappa=0.413 of DCG and MPI results(P<0.05);CT first-pass perfusion imaging diagnosis:sensitivity 90.2%,specificity 83.8%,positive predictive value 84.7%,negative predictive value 83.8%,accuracy 84.3%,and the consistency Kappa=0.693 of CT firstpass perfusion imaging and MPI(P<0.05).Conclusion CT first-pass perfusion imaging is superior to DCG in the diagnosis of CAD with myocardial ischemia.Therefore,the combination of the two methods is beneficial to complement each other in detecting myocardial perfusion defects and evaluating myocardial ischemia.