成人瓣膜病患者电子束CT检出冠状动脉钙化

Coronary Calcification Detected by Electron Beam Computed Tomography in Adult Patients With Valvular Heart Disease

评价成年瓣膜病患者电子束CT检查冠状动脉钙化的临床意义。 2 0 8例 42～ 75岁瓣膜病患者换瓣术前行电子束CT及选择性冠状动脉造影检查 ,同时进一步分析患者的冠心病危险因素。结果发现 ,2 0 8例瓣膜病患者中无冠状动脉钙化者 114例 ,造影证实无冠心病者 10 9例 ,占 95 .6% (P <0 .0 0 5 ) ,另 5例合并冠心病 ,其中 4例至少有一项冠心病危险因素。全组瓣膜病患者电子束CT检查既无冠状动脉钙化 ,临床又无冠心病危险因素共 5 8例 ,造影证实仅 1例有冠心病 ,占 1.72 %。结果表明 ,瓣膜病患者以电子束CT检查冠状动脉钙化阴性 ,并且无传统冠心病危险因素者排除冠心病的准确性高于 95 .6%。从而认为电子束CT检出冠状动脉钙化阴性对排除瓣膜病患者合并冠心病有重要的临床意义 ,术前行电子束CT检查 。

Aim To evaluate the clinic value of coronary artery calcification (CAC) detected by EBCT in adult patients with valvular heart disease (VHD). Methods 208 patients including 110 men and 98 women with age ranging from 42～75 years. All patients underwent EBCT examination and coronary angiography within 1 week before surgery. An Imatron C-150 EBCT scanner with scanning protocol of ECG-triggered single-slice mode was used to detect coronary calcification .The quantitative study of coronary calcification was carried out by Agatston method. Selected coronary agiography was performed by the Judkins technique. The five classic risk factors of coronary artery disease (CAD) were analyzed including diabetes mellitus? hypertension? hyperlipemia? smoking and family history of CAD. Results In the 208 patients, no coronary calcification was found in 114 cases detected by EBCT. Among them, 109 cases had no CAD (95.6%, P<0.005) and only 5 cases associated with CAD confirmed by coronary angiography. In the five patients with CAD, 4 case had at least one CAD risk factor. In all of the 208 cases, 58 patients had neither CAC nor CAD risk factor. Among the 58 cases, only one patient had CAD demonstrated by coronary angiography (1.72%). Conclusions Based on this study, the adult patients with valvular heart disease have neither coronary calcification detected by EBCT nor CAD risk factor. The accuracy to exclude CAD is rather high, more than 95.6%. We recommend the patients with VHD taking EBCT examination to detect CAC before surgery, that will markedly reduce application of invasive coronary angiography.