心磁图对于冠心病诊断价值的探讨

Clinical value of helium-free magnetocardiography in diagnosis of coronary heart disease

目的探讨心磁图对冠心病的诊断价值。方法该研究为诊断性试验。连续纳入2022年12月到2023年3月就诊于首都医科大学附属北京安贞医院心内科疑诊冠心病的患者。通过电子病历系统收集入选者的一般临床资料。所有入选者在入院前48 h内接受心磁图检查,入院前、后完成冠状动脉CT血管成像(CCTA)/冠状动脉造影(ICA)。以CCTA/ICA的诊断结果为标准,评价心磁图对冠心病的诊断价值。出现下列情况之一即为心磁图阳性(可诊断冠心病):①磁场多极化;②磁场单极化;③T波低平;④TT段磁场分布变化;⑤T峰最大最小比异常;⑥极点明显移动;⑦磁场角度偏转;⑧正极分布异常。计算心磁图诊断结果与CCTA/ICA诊断结果的总符合率,以及心磁图诊断冠心病的敏感度、特异度、阳性预测值和阴性预测值。结果入选患者193例,其中男性131例(67.9%),年龄(57.3±12.2)岁。通过CCTA/ICA诊断冠心病患者135例,其中心磁图诊断阳性者121例,阴性者14例;无冠心病的患者58例,其中心磁图诊断阴性者50例,阳性者8例。心磁图诊断冠心病的总符合率为88.60%(95%CI:83.25%~92.72%),敏感度为89.63%(95%CI:83.21%~94.21%),特异度为88.23%(95%CI:78.12%~94.78%),阳性预测值为93.80%(95%CI:88.72%~96.68%),阴性预测值为81.08%(95%CI:72.15%~87.64%)。结论心磁图对冠心病的诊断价值较高,具有潜在的临床推广价值。

Objective To assess the clinical value of helium-free magnetocardiography(MCG)in the diagnosis of coronary artery disease(CAD).Methods A total of 213 patients with suspected CAD undergoing MCG in Beijing Anzhen Hospital were enrolled in the study.All patients underwent coronary CT angiography/invasive coronary angiography(CCTA/ICA)within 48 hours after MCG scanning.The parameters of MCG,including magnetic field multipolarization,magnetic field unipolarization,T-wave flattened,change in magnetic field distribution at TT segment,abnormal T-peak amplitude ration of maximum to minimum,significant movement of poles,magnetic field angle deviation and abnormal distribution of positive pole were used for the evaluation of the stenosis of coronary arteries.Results Among 213 patients,MCG scanning was completed in 193 cases(90.6%),while 20 cases were excluded for various reasons.The CCTA/ICA results were taken as gold standard,the total coincidence rate of MCG with the degree of stenosis was 88.60%(95%CI:83.25%-92.72%),the sensitivity and specificity of MCG in the diagnosis of CAD was 89.63%(95%CI:83.21%-94.21%)and 88.23%(95%CI:78.12%-94.78%),respectively;the positive and negative predictive value were 93.80%(95%CI:88.72%-96.68%)and 81.08%(95%CI:72.15%-87.64%),respectively.Conclusion MCG is highly accurate in the diagnosis of CAD,it may be widely used clinically as an non-invasive method free of radiation or contrast agent.