心房颤动患者单心动周期绝对时相收缩末期冠状动脉CT成像研究

Coronary Artery CT Imaging on the End of Absolute Phase Systole of a Single Cardiac Cycle in Patients with Atrial Fibrillation

目的探讨心房颤动单心动周期绝对时相收缩末期冠状动脉CT血管成像的可行性。资料与方法前瞻性纳入临床疑似冠心病且心房颤动受检者208例,按照随机数字表法分为两组,两组均行绝对时相冠状动脉CT成像检查。研究组107例,在收缩末期(260360 ms)采集数据;对照组101例,根据心率变化选择采集期相(心率≤65次/分:400750 ms;心率6675次/分:200550 ms;心率7690次/分:200500 ms;心率≥91次/分:200400 ms)。根据美国心脏协会冠状动脉15分段并以4分法进行主观评价,比较两组基本资料及主动脉根部、前降支中段、右冠状动脉中段CT值和SD值、有效辐射剂量(ED)和主观评分。结果两组受检者的年龄、体质量指数、扫描心率、心率波动等差异均无统计学意义(P均>0.05)。研究组绝对期相为(304.7±22.3)ms;对照组绝对期相88.1%(89/101)分布在收缩末期,11.9%(12/101)分布在舒张中晚期,绝对期相分别为(326±48)ms和(690±61)ms。研究组第9段图像主观评分低于对照组(Z=-2.261,P=0.024),其他分段差异无统计学意义(P>0.05)。研究组ED低于对照组[(1.5±0.5)m Sv比(3.2±1.1)m Sv,P<0.01]。结论对于心房颤动受检者单心动周期收缩末期绝对时相冠状动脉CT血管成像可行,且能够有效降低辐射剂量。

Purpose To investigate the feasibility of coronary CT angiography(CCTA) of the end of absolute systolic phase of single cardiac cycle in patients study with atrial fibrillation. Materials and Methods A total of 208 patients with clinically suspected coronary heart disease and atrial fibrillation were prospectively included. According to the digital random grouping method, all patients were divided into two groups, including study group(n=107) and control group(n=101). And absolute time phase coronary CT imaging was further performed on these both two groups. The data of the end absolute systolic phase of study group(260-340 ms) were collected, and all 101 control cases were gathered data according to the change of heart rate(heart rate≤65 beats/min: 400-750 ms, 66-75 beats/min: 200-550 ms, 76-90 beats/min: 200-500 ms, ≥91 beats/min: 200-400 ms). According to the American Heart Association, the coronary artery was divided into 15 segments and subjectively evaluated by 4-point method. The CT values and standard deviation(SD) values of aortic root, middle segment of anterior descending artery, middle segment of right coronary artery, effective radiation dose(ED), and subjective score were compared between these two groups. Results There was no significant difference in age, body mass index, scan heart rate and heart rate fluctuation between these two groups(P>0.05). The mean absolute phase of the study group was(304.7±22.3) ms, and the absolute phase of the control group was concentrated at the end of systole(326±48) ms with 88.1%(89/101) and middle and late diastolic phase(690±61) ms with 11.9%(12/101). There was no statistical difference in the subjective score except for the ninth segment, which was significantly lower than that of control group(Z=-2.261, P=0.024). ED of study group was significantly lower than that of control group [(1.5±0.5) mSv vs.(3.2±1.1) mSv, P<0.01]. Conclusion Absolute phase CCTA imaging at the end of systolic phase of single cardiac cycle is feasible and could effectively reduce the radiation dose in patients with atrial fibrillation.