冠脉CTA对于评估STEMI后心肌存活性的诊断效力分析

Analysis of the Diagnostic Efficacy of Coronary CTA for Evaluating Myocardial Viability after STEMI

目的冠脉CT血管造影(CT angiography,CTA)对于评估急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction,STEMI)后心肌存活性的诊断效力进行分析。方法该研究选取兰州市第一人民医院心内科2016年1月—2018年1月就诊的STEMI患者201例纳入研究,所有患者均接受CTA和核素心肌显像(emission computed tomography,ECT)检查,并分别评估心肌存活性情况,并针对冠脉CTA的评估效力进行分析。结果冠脉CTA检查显示存活心肌131例,失活心肌70例,ECT显示存活心肌138例,失活心肌63例。两种方法筛查诊断出的存活与失活心肌组患者的差异无统计学意义(χ^(2)=2.769,P=0.092)。心肌存活组与心肌失活组患者的年龄和左室射血分数差异有统计学意义(P<0.05),两种方法筛查诊断出的存活心肌及失活心肌组患者的性别、心率、血压和左室舒张末容积差异无统计学意义(P>0.05)。冠脉CTA评估心肌失活的灵敏度为92.75%(128/138),假阴性概率(漏诊率)为7.25%(10/138),特异度为95.24%(60/63),假阳性概率为4.76%(3/63)。ROC曲线的曲线下面积为0.847,约登指数为0.88。结论冠脉CTA评估STEMI后心肌存活性具有优良的灵敏度和特异度,可供临床参考使用。

Objective Coronary CT angiography(CT angiography,CTA)evaluates the diagnostic efficacy of myocardial viability after acute ST-segment elevated myocardial infarction(STEMI).Methods In this study,201 STEMI patients who visited the Department of Cardiology,Lanzhou First People’s Hospital from January 2016 to January 2018 were selected for inclusion in the study.All patients received coronary CT angiography(CT angiography,CTA)and radionuclide myocardial imaging(emission computed tomography,ECT)examination and assessment of myocardial viability,and analysis of the effectiveness of coronary CTA assessment.Results Coronary CTA examination showed 131 cases of viable myocardium,70 cases of inactivated myocardium,ECT showed 138 cases of viable myocardium,and 63 cases of inactivated myocardium.The difference between the survival and inactivated myocardial groups diagnosed by the two methods was not statistically significant(χ^(2)=2.769,P=0.092).The difference in age and left ventricular ejection fraction of patients in the myocardial viability group and myocardial inactivation group was statistically significant(P<0.05).The two methods were used to screen the diagnosed viable myocardium and the inactivated myocardium group by the gender,heart rate,and blood pressure.There was no statistically significant difference between and left ventricular end-diastolic volume(P>0.05).The sensitivity of coronary CTA to assess myocardial inactivation was 92.75%(128/138),the false negative probability(missed diagnosis rate)was 7.25%(10/138),the specificity was 95.24%(60/63),and the false positive probability was 4.76%(3/63).The area under the curve of the ROC curve was 0.847,and the Youden index was 0.88.Conclusion Coronary CTA has excellent sensitivity and specificity in evaluating myocardial viability after STEMI,which can be used for clinical reference.