CCTA在冠心病诊断及斑块性质评估中的应用

Application of CCTA in the Diagnosis of Coronary Heart Disease and Assessment of Plaque Properties

目的评估冠状动脉CTA(CCTA)在冠心病诊断和冠脉粥样硬化斑块性质评估中的应用价值。方法回顾性分析2022年9月至2024年1月本院收治的83例疑似冠心病患者的临床资料。所有患者均行冠状动脉血管造影(CAG)、血管内超声(IVUS)和CCTA检查。以CAG、IVUS诊断结果为“金标准”进行对比,分析CCTA在冠心病诊断以及斑块性质评估中的应用价值。结果83例受检者经CAG检查共552个冠状动脉节段,诊断狭窄节段共305个,其中轻度狭窄82个(26.89%),中度狭窄146个(47.87%),重度狭窄77个(25.25%);经IVUS检出斑块241个,非钙化斑块80个(33.20%),钙化斑块109例(45.23%),混合斑块52个(21.58%)。与CAG相比,CCTA诊断冠状动脉狭窄的灵敏度为91.80%,特异度为97.17%,准确率为94.20%,与CAG诊断结果几乎完全一致(Kappa值=0.884),其诊断冠脉轻、中、重度狭窄的符合率分别为90.30%、89.25%和85.11%。与IVUS相比,CCTA诊断冠脉粥样硬化斑块的灵敏度为94.19%,特异度为84.76%,准确率为90.37%,与IVUS诊断结果高度一致(Kappa值=0.798),其诊断非钙化斑块、钙化斑块和混合斑块的符合率分别为76.25%、91.74%和90.38%。在冠脉粥样硬化斑块性质诊断上,CCTA诊断钙化斑块的ROC曲线下面积(AUC)最高,为0.942,其次为混合斑块和非钙化斑块,其对应的AUC分别为0.939、0.830,诊断鉴别价值均较高(P均<0.01)。结论CCTA对冠心病诊断及冠脉粥硬化斑块性质的鉴别价值均较高,可获得与金标准较高的一致性。

Objective To evaluate the application value of coronary computed tomography angiography(CCTA)in the diagnosis of coronary heart disease and assessment of coronary atherosclerotic plaque properties.Methods The clinical data of 83 patients who were suspected of coronary heart disease and admitted to the hospital from September 2022 to January 2024 were analyzed retrospectively.All patients underwent coronary angiography(CAG),intravascular ultrasound(IVUS),and CCTA.With CAG and IVUS results as the gold standard,the application value of CCTA in the diagnosis of coronary heart disease and assessment of plaque properties was analyzed.Results A total of 552 coronary segments in the 83 patients were examined by CAG,and 305 segments were diagnosed with stenosis,including 82 mild stenoses(26.89%),146 moderate stenoses(47.87%)and 77 severe stenoses(25.25%).241 plaques were detected by IVUS,including 80 non-calcified plaques(33.20%),109 calcified plaques(45.23%),and 52 mixed plaques(21.58%).Compared with CAG,the sensitivity,specificity and accuracy of CCTA for diagnosing coronary artery stenosis were 91.80%,97.17%and 94.20%,showing high consistency with the diagnostic results of CAG(Kappa value=0.884).Its diagnostic coincidence rates for mild,moderate,and severe coronary artery stenosis were 90.30%,89.25%,and 85.11%,respectively.Compared with IVUS,the sensitivity,specificity and accuracy of CCTA for diagnosing coronary atherosclerotic plaque were 94.19%,84.76%and 90.37%,showing high consistency with the diagnosis results of IVUS(Kappa value=0.798).Its diagnostic coincidence rates for non-calcified plaque,calcified plaque,and mixed plaque were 76.25%,91.74%,and 90.38%,respectively.In the diagnosis of coronary atherosclerotic plaque property,the area under the ROC curve(AUC)of CCTA for diagnosing calcified plaque was the highest(0.942),followed by mixed plaque(0.939)and non-calcified plaque(0.830),showing high diagnostic value(P<0.01).Conclusion CCTA is of high value in the diagnosis of coronary heart disease and the differentiation of coronary atherosclerotic plaque property,with high consistency with the gold standard.