冠状动脉CTA联合动态心电图诊断冠心病心肌缺血价值分析

Exploring the clinical value of combining coronary artery CTA and dynamic electrocardiogram for the diagnosis of myocardial ischemia in coronary heart disease

目的:探讨冠状动脉CT血管造影(CTA)联合动态心电图对冠心病心肌缺血诊断的临床价值。方法:选取2022年1月—2023年2月临沂市中心医院收治的68例高度疑似冠心病心肌缺血患者为研究对象,所有患者均接受冠状动脉CTA和动态心电图检查,并以冠状动脉造影结果作为诊断“金标准”分析冠状动脉CTA和动态心电图单独及联合检查冠心病心肌缺血的诊断效能,比较冠心病心肌缺血和非冠心病心肌缺血患者灌注参数。结果:冠状动脉造影结果显示,68例患者中冠心病心肌缺血42例。以冠状动脉造影结果为金标准,冠状动脉CTA检出冠心病心肌缺血36例、漏诊12例、误诊6例,Kappa值为0.463;动态心电图检出冠心病心肌缺血35例、漏诊11例、误诊4例,Kappa值为0.556;冠状动脉CTA联合动态心电图检出冠心病心肌缺血42例、漏诊3例、误诊3例,Kappa值为0.813,准确率、灵敏度均高于冠状动脉CTA与动态心电图单独检查,差异有统计学意义(P<0.05)。冠心病心肌缺血患者QRS时限低于非冠心病心肌缺血患者,差异有统计学意义(P<0.05)。结论:冠状动脉CTA和动态心电图联合用于冠心病心肌缺血的诊断具有较高的临床价值。

Objective To explore the clinical value of combining coronary angiography(CTA)and dynamic electrocardiogram for the diagnosis of myocardial ischemia in coronary heart disease.Methods A total of 68 patients with highly suspected coronary heart disease and myocardial ischemia admitted to Linyi Central Hospital from January 2022 to February 2023 were selected.All patients received coronary CTA and holter electrocardiogram examination,and coronary angiography results were used as the"gold standard"for diagnosis.To compare the diagnostic efficacy of coronary artery CTA and holter electrocardiogram alone and combined,and compare the parameters of diseased and normal myocardium perfusion.Results Using coronary angiography results as the diagnostic gold standard,a total of 42 cases of coronary heart disease myocardial ischemia were detected in 68 patients;Coronary CTA detected 36 cases of coronary heart disease with myocardial ischemia,12 cases were missed,6 cases were misdiagnosed,and the Kappa value was 0.463.Dynamic electrocardiogram detected 35 cases of coronary heart disease with myocardial ischemia,11 cases were missed,4 cases were misdiagnosed,and the Kappa value was 0.556.Joint examination detected 42 cases of coronary heart disease with myocardial ischemia,3 cases were missed and 3 cases were misdiagnosed,with a Kappa value of 0.813;The accuracy and sensitivity of the combined examination of coronary artery CTA and dynamic electrocardiogram were higher than those of coronary artery CTA and dynamic electrocardiogram(P<0.05).The QRS duration of myocardial ischemia was lower than that of non myocardial ischemia patients(P<0.05).Conclusion The combination of coronary artery CTA and dynamic electrocardiogram examination has good clinical value for the diagnosis of myocardial ischemia in coronary heart disease.