平均心率、心率变异性和钙化负荷对双源CT冠状动脉成像诊断准确性的影响

目的 与常规冠状动脉造影(CAG)对照,评价双源CT冠状动脉血管成像(CTCA)诊断冠状动脉狭窄性病变的准确性以及平均心率、心率变异性和钙化负荷对CTCA诊断准确性的影响.资料与方法 2006年12月至2008年9月,113例患者同时进行了CTCA与CAG.以CAG为参照,评价CTCA诊断≥50%和>75%冠状动脉狭窄性病变的准确性.按心率、心率变异性和钙化积分将患者分组,评价不同亚组CTCA的诊断准确性,对敏感性和特异性数据进行χ~2检验.结果 以患者为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为94%、93.3%;88.5%、96.2%;以血管为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为90.0%、98.0%;84.8%、98.5%;而以节段为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为89.9%、99.5%;83.0%、99.7%.平均心率对CTCA诊断冠状动脉狭窄无明显影响,而心率变异性和钙化积分对CTCA诊断冠状动脉狭窄有影响.结论 无论是以患者、血管还是节段为分析单位,CTCA在诊断冠状动脉狭窄方面均有较高的敏感性和特异性,平均心率对CTCA诊断冠状动脉狭窄的准确性无明显影响,而心率变异性和钙化积分对CTCA诊断冠状动脉狭窄的准确性有影响.

The Effect of Average Heart Rate, Heart Rate Variability, and Calcium Score on Diagnostic Accuracy of Dual Source CT Coronary Angiography

Objective To evaluate the accuracy of dual source computed tomography coronary angiography(CTCA) in diagnosing coronary artery stenosis compared with conventional coronary angiography(CAG),and to evaluate the effect of average heart rate,heart rate variability,and calcium score on the accuracy of CTCA.Materials and Methods Between December 2006 and September 2008,113 patients underwent both CTCA and CAG.The results of CTCA and CAG were compared to assess the accuracy of CTCA in diagnosing ≥50% and >75% stenosis of coronary artery.Patients were divided into groups according to their heart rate,heart rate variability,and calcium score.The accuracy of CTCA was further calculated in each group.Chi-square test was used to analyze the difference of sensitivity and specificity among groups.Results On a per-patient analysis,the sensitivity and specificity for diagnosing ≥50% and >75% stenosis were 94%,93.3% and 88.5%,96.2%.On a per-vessel analysis,the sensitivity and specificity were 90.0%,8.0% and 84.8%,98.5%.On a per-segment analysis,the sensitivity and specificity were 89.9%,99.5% and 83.0%,99.7% respectively.Average heart rate had no effect on the sensitivity and specificity of CTCA,whereas heart rate variability and calcium score had some effect on the sensitivity and specificity of CTCA.Conclusion On a per-patient,per-vessel,and per-segment analysis,CTCA has a high sensitivity and specificity for the diagnosis of coronary artery stenosis.Average heart rate has no effect on the accuracy of CTCA,while heart rate variability and calcium score had some effect on the accuracy of CTCA in diagnosing coronary artery disease.