平板运动试验与冠状动脉CT血管成像对冠状动脉狭窄诊断的准确度比较

Diagnostic accuracy comparison of treadmill exercise test and coronary CT angiography for coronary artery stenosis

目的探讨平板运动试验(TET)所测得经心率校正ST段变化参数与冠状动脉CT血管成像(CTA)对冠状动脉狭窄诊断的准确度。方法选择2017年11月至2020年3月在浙江省中医院接受冠脉造影(CAG)、TET和CTA检查的患者47例,计算ST/HR指数、最大ST/HR斜率值,以CAG结果为标准,确定ST/HR指数、最大ST/HR斜率值及两者联合诊断的准确度。结果最大ST/HR斜率值诊断冠状动脉狭窄的灵敏度为45.71%,特异度为83.33%(χ^(2)=13.762,P<0.01,Kappa值=0.198);ST/HR指数及最大ST/HR斜率值联合诊断的灵敏度为68.57%,特异度为83.33%(χ^(2)=6.231,P<0.05,Kappa值=0.416);CTA诊断冠状动脉狭窄的灵敏度为78.79%,特异度为72.95%(χ^(2)=7.681,P<0.05,Kappa值=0.485)。结论ST/HR指数结合最大ST/HR斜率值诊断冠脉狭窄的准确度与CTA相近。

Objective To explore the accuracy of heart rate adjustment of ST-segment depression during treadmill exercise and coronary CT angiography(CTA)in the diagnosis of coronary artery stenosis.Methods Forty-seven patients underwent coronary angiography(CAG),treadmill exercise test and CTA in the First Affiliated Hospital of Zhejiang Chinese Medical University from November 2017 to March 2020 were selected.The value of ST/HR index and maximum ST/HR slope were calculated.The diagnostic accuracy of ST/HR index,maximum ST/HR slope and the combination of these two parameters were determined based on the results of CAG.Results The sensitivity and specificity in the diagnosis of coronary artery stenosis were 45.71%and 83.33%,for maximum ST/HR slope(χ^(2)=13.762,P<0.01,Kappa=0.198),68.57%,and 83.33%for the combination of ST/HR index and maximum ST/HR slope(χ^(2)=6.231,P<0.05,Kappa=0.416),78.79%and 72.95%for CTA(χ^(2)=7.681,P<0.05,Kappa=0.485),respectively.Conclusion The diagnostic accuracy of the combination of ST/HR index with maximum ST/HR slope is similar to that of CTA.