冠状动脉CTA、超声心动图在冠状动脉粥样硬化性心脏病心肌缺血的临床诊断价值

Clinical Diagnostic Value of Coronary CTA and Echocardiography in Myocardial Ischemia of Coronary Atherosclerotic Heart Disease

目的探讨冠状动脉CTA、超声心动图在冠状动脉粥样硬化性心脏病(CHD)心肌缺血的临床诊断价值。方法从2017年3月至2020年3月在本院接受检查的疑似CHD患者中选出100例,所有患者均行冠状动脉CTA、超声心动图检查(TTE),并与冠状动脉造影(CAG)检查“金标准”做对比,比较两种诊断方式的心肌缺血诊断情况。结果100例疑似CHD患者中,发现118支血管病变,分析影像学资料中血管病变特征,冠脉CTA检查狭窄程度>50%共89支显著少于冠脉CTA联合超声心动图检查狭窄程度>50%共101支(75.42%VS 85.59%;P<0.05);CAG检查FFRCT≤0.8血管49支,诊断为心肌缺血患者46例,冠状动脉CTA检查FFRCT≤0.8血管44支,诊断为心肌缺血患者40例,冠状动脉CTA诊断心肌缺血准确率为84.00%,敏感度76.09%,特异性90.74%,阳性预测值87.50%,阴性预测值81.67%,Kappa值为0.675;CTA联合TTE检查诊断为心肌缺血患者42例,冠状动脉CTA诊断心肌缺血准确率为90.00%,敏感度84.78%,特异性94.44%,阳性预测值92.86%,阴性预测值87.93%,Kappa值为0.797。结论CTA联合TTE检查诊断CHD患者心肌缺血的效率明显高于单纯的冠脉CTA检查,且对重度狭窄的诊断准确率也更高,值得临床推广。

Objective To explore the clinical diagnostic value of coronary CTA and echocardiography in myocardial ischemia of coronary atherosclerotic heart disease(CHD).Methods 100 patients with suspicion of CHD who completed examinations in the hospital between March 2017 and March 2020 were enrolled.All of them completed coronary CTA and echocardiography(TTE).With coronary angiography as the golden standard,diagnosis of myocardial ischemia with the two methods was compared.Results A total of 118 blood vessels were found in the 100 patients with suspicion of CHD.Coronary CTA showed a total of 89 blood vessels(75.42%)with stenosis>50%,while coronary CTA combined with echocardiography showed a total of 101 blood vessels(85.59%)with stenosis>50%(P>0.05).CAG showed 49 blood vessels with FFRCT≤0.8,and 46 patients were diagnosed with myocardial ischemia.Coronary CTA showed 44 blood vessels with FFRCT≤0.8,and 40 patients were diagnosed with myocardial ischemia.The accuracy rate,sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of coronary CTA in diagnosis of myocardial ischemia were 84.00%,76.09%,90.74%,87.50%,81.67%and 0.675,respectively.42 patients were diagnosed with myocardial ischemia by CTA combined with TTE.The accuracy rate,sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of coronary CTA in diagnosis of myocardial ischemia were 90.00%,84.78%,94.44%,92.86%,87.93%and 0.797,respectively.Conclusion:The efficiency of CTA combined with TTE in diagnosis of myocardial ischemia in patients with CHD is significantly higher than that of coronary CTA alone,and the diagnostic accuracy of severe stenosis is also higher.