超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响

The clinical value of ultra-high-end spiral CT single-heartbeat cardiac technique in identifying coronary artery stenosis and plaque properties and the influence of underlying diseases on accuracy

目的:研究超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响。方法:本研究采用前瞻性研究方法,以我院2022年7月—2023年1月诊断并进行治疗的冠心病患者96例作为研究对象,根据患者的冠脉狭窄程度,Ⅰ级病变患者33例,Ⅱ级病变患者22例,Ⅲ级病变患者41例。根据斑块性质分析,其中稳定性斑块患者55例,不稳定性斑块患者41例,所有患者入组后均接受256排CT行单心跳心脏冠脉成像、冠脉造影(ICA)和血管内超声(IVUS)检查,比较单心跳心脏冠脉成像诊断冠脉血管狭窄以及不稳定性斑块的诊断效能,研究合并基础疾病对准确性的影响。结果:本研究中,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的灵敏度为80.49%,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的ROC曲线下面积为0.771,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的效能下降。单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的灵敏度为80.21%,单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的ROC曲线下面积为0.775,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的诊断效能下降。结论:超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的灵敏度均超过80%以上,合并高血压、糖尿病以及高脂血症患者,会造成冠脉狭窄和斑块性质的判定准确性以及灵敏度的下降。

Objective:To investigate the clinical value of ultra-high-end spiral CT single-heartbeat cardiac technique in identifying coronary artery stenosis and plaque properties and the influence of underlying disease on accuracy.Methods:Ninety-six patients with coronary heart disease diagnosed and treated in our hospital from July 2022 to January 2023 were selected as research objects.According to the degree of coronary artery stenosis,33 patients with grade Ⅰ disease,22 patients with grade Ⅱ disease,and 41 patients with grade Ⅲ disease were selected.According to the analysis of plaque properties,55 patients with stable plaque and 41 patients with unstable plaque were enrolled.All patients underwent 256-slice CT for single-heartbeat coronary artery imaging,coronary angiography(ICA) and intravascular ultrasound(IVUS).The diagnostic efficacy of single-heartbeat coronary artery imaging in the diagnosis of coronary artery stenosis and unstable plaque was compared.The effect of comorbidities with underlying diseases on accuracy was studied.Result:The sensitivity of single-heartbeat coronary imaging for diagnosing grade Ⅲ coronary stenosis was 80.49%,and the area under ROC curve of single-heartbeat coronary imaging for diagnosing grade Ⅲ coronary stenosis was 0.771,which was complicated with hypertension,diabetes,hyperlipidemia,etc.It can reduce the efficiency of single-heartbeat coronary imaging in diagnosing grade Ⅲ coronary artery stenosis.The sensitivity of single-heartbeat coronary imaging in diagnosing unstable plaque was 80.21%,and the area under ROC curve of single-heartbeat coronary imaging in diagnosing unstable plaque was 0.775.Combined with hypertension,diabetes,hyperlipidemia,etc.,the diagnostic efficiency of single-heartbeat coronary imaging in diagnosing unstable plaque decreased.Conclusion:The sensitivity of ultra-high-end spiral CT single-heartbeat cardiac technology to identify coronary artery stenosis and plaque properties is more than 80%.Patients with hypertension,diabetes and hyperlipidemia will result in the decline of the accuracy and sensitivity of coronary artery stenosis and plaque properties.