冠脉斑块CT血管造影的定性特征对预测心肌缺血的诊断价值

目的:探讨冠状动脉CT血管成像(CCTA)定性检测斑块特征对预测负荷心肌灌注显像(SPECT-MPI)心肌缺血的诊断价值.方法:本研究纳入了 60例患者,在7天内分别做了 CCTA及SPECT-MPI检查,所有研究对象CCTA检查结果均为阳性.收集患者临床特征资料(性别、高血压、高血脂、吸烟、糖尿病),对冠状动脉狭窄程...

The diagnostic value of the qualitative characteristics of plaque detected by CCTA in predicting myocardial ischemia

Objective: To study the diagnostic value of the qualitative characteristics of plaque detected by coronary-com-puted tomography angiography(CCTA) in predicting myocardial ischemia. Methods: In this study, 60 patients were included.CCTA and SPECT-MPI were performed within 7 days. All the subjects were positive in CCTA. The clinnical features(gender,hypertension, hyperlipidemia, smoking, diabetes) of patients were collected. The severity of coronary artery stenosis(mild steno-sis<50%, moderate stenosis 50% ~<70%, severe stenosis ≥70%) and the characteristics of high-risk plaques(low-density plaques, positive remodeling, spotty calcification, napkin ring sign) were qualitatively evaluated. SPECT-MPI images were qual-itatively analyzed by 17 segment myocardial classification. According to the results of SPECT-MPI, the subjects were divided into two groups: myocardial ischemia positive group and myocardial ischemia negative group. The independent sample Chi-square test was used to compare the classification variables between the two groups. The ROC curve was used to compare the diagnostic efficacy of significant stenosis(≥70%), high-risk plaque and the combination of the two on myocardial ischemia.Results: In the clinical features of the patients, there were significant differences in female and hyperlipidemia between my-ocardial ischemia group and non myocardial ischemia group(P<0.05). According to the results of SPECT-MPI, the qualitative characteristics of coronary artery were statistically analyzed. The results showed that there were significant differences in mod-erate and severe stenosis(≥50%), positive remodeling, napkin ring sign and the characteristics of three or more high-risk plaques between myocardial ischemia group and non myocardial ischemia group(P<0.05). The sensitivity, specificity and accuracy of significant stenosis(≥70%) in predicting myocardial ischemia were 75.4%, 50.9% and 59.5% respectively. The sensitivity, specificity and accuracy of high-risk plaque in predicting myocardial ischemia were 78.7%, 34.8% and 50.3% respective-ly. The sensitivity, specificity and accuracy of the two combined methods in predicting myocardial ischemia were 73.8%,75.0% and 74.6% respectively. The area under the ROC curve of the two combined methods in predicting myocardial is-chemia was 0.728(95%CI:0.649~0.807). Conclusion: Significant stenosis(≥70%) combined with high-risk plaque has higher accuracy in predicting myocardial ischemia, and the combination of the two has better diagnostic efficiency for myocardial ischemia.