冠状动脉CT血管成像和运动平板试验对冠心病患者的诊断比较

目的:评价冠状动脉CT血管成像(CCTA)和运动平板试验(TET)对冠心病的诊断价值。方法:以常规冠状动脉造影(CAG)为诊断冠心病(冠脉狭窄≥50%)的"金标准",对同期先后行TET、CCTA和CAG 3种检查的75例疑似冠心病患者进行回顾性分析,将其TET和CCTA的结果与CAG进行比较。结果:TET和CCTA诊断冠心病的敏感度分别为45.2%和90.5%,特异度为69.7%和93.9%,阳性预测值为65.5%和95.0%,阴性预测值为50.0%和88.6%,准确率为56.0%和92.0%,P<0.01。在冠状动脉血管水平CCTA对右冠状动脉、左主干、前降支、回旋支狭窄诊断的准确率分别为86.7%、100.0%、88.0%和76.0%。冠心病患者中TET诊断阳性率与病变血管支数呈正相关(r=0.440,P=0.004);冠心病患者TET诊断结果阳性与阴性仅与血管狭窄程度≥75%狭窄的节段数目有统计学差异(P=0.016)。结论:CCTA诊断冠心病较TET有更高的诊断准确性和较低的诊断假阳性和假阴性,对有症状的疑诊冠心病患者CCTA的诊断具有更重要作用。

Comparison of coronary computed tomography angiography and treadmill exercise test in patients with suspected coronary artery disease

Objective：To evaluate and compare the diagnostic efficacy of coronary computed tomography angiography （CCTA） versus treadmill exercise test （TET） for diagnosing coronary artery disease （CAD）. Methods：The results of coro nary an~iography （CAG） were set as the ＂gold standard＂ for diagnosing CAD （≥50% luminal stenosis）. All 75 patients with suspected CAD who underwent CAG,CCTA and TET were retrospectively analyzed. The findings of TET and CCTA were compared with that of CAG. Results：The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TET and CCTA in diagnosis of CAD were 45.2% and 90.5% ,69.7% and 93.9% ,65.5% and 95.0% ,50.0% and 88.6%, 56.0 % and 92.0 %, respectively （P0.01）. In vessel level, the diagnostic accuracy of CCTA for evaluating the right coronary artery,left main artery, left anterior descending artery, left circumflex artery were 86.7 %, 100.0 %, 88.0% and 76.0% ,respectively. The results of TET in the patients with CAD were positively related to the number of the diseased vessels （r= 0. 440, P = 0. 004）. The numbers of involved vessels with ≥75% stenosis were found having significant differ ence in positive and negative groups of TET （P= 0. 016）. Conclusion： The diagnostic accuracy of CCTA for diagnosing CAD had significantly higher accuracy and lower false positive and negative diagnosis in comparison with treadmill exercise test. CCTA plays important role in symptomatic patients who were suspected for CAD.