三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的对比研究

目的对比研究三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的应用价值。 方法纳入2018年11月至2019年6月就诊于东莞康华医院心血管中心、可疑或确诊冠心病的患者86例,所有患者均行三磷酸腺苷和多巴酚丁胺负荷超声造影连续试验,并进行了冠状动脉造影（CAG）或冠状动脉CT血管造影（CTA）检查。分别以冠状动脉狭窄≥50%、≥75%为冠心病诊断标准,以CAG或CTA结果为对照标准,应用四格表计算三磷酸腺苷和多巴酚丁胺负荷超声造影诊断冠心病的敏感度、特异度和准确性。 结果冠状动脉狭窄≥50%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为56%、96%、77%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为76%、96%、86%。多巴酚丁胺负荷超声造影的诊断敏感度和准确性均高于三磷酸腺苷负荷超声造影。冠状动脉狭窄≥75%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为81%、97%、94%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为88%、98%、95%。多巴酚丁胺负荷超声造影的诊断敏感度、特异度和准确性均高于三磷酸腺苷负荷超声造影。 结论多巴酚丁胺负荷超声造影诊断冠心病的效能优于三磷酸腺苷负荷超声造影,两者联合应用既增加了检查的安全性又提高了诊断阳性率。     

双嘧达莫负荷超声造影在诊断冠心病中的应用价值

目的 探讨双嘧达莫负荷超声造影(DIPSEC)在诊断冠心病(CAD)中的应用价值。方法 选取178例行DIPSEC及冠状动脉造影(CAG)的患者,以冠状动脉狭窄≥50%为诊断CAD标准,CAG的结果为对照标准,应用四格表分别计算DIPSEC判断前降支合并病变、右冠状动脉合并病变及回旋支合并病变的准确度,以及与CAG对照的一致性。结果 冠状动脉狭窄≥50%为CAD诊断标准时,以CAG结果为对照标准,DIPSEC诊断上述3支冠状动脉合并病变的准确度分别为92.6%、80.9%、82.0%,以及样本整体病变的准确度为87.1%;上述3支冠状动脉合并病变一致性检验Kappa值分别为0.840、0.626、0.646,样本整体病变的一致性检验Kappa值为0.630。结论 DIPSEC在诊断冠心病中与冠状动脉造影的结果一致性较好,能早期诊断及指导治疗冠心病,且DIPSEC对前降支合并病变的准确度高于其他两支合并病变。     

多巴酚丁胺心电图负荷试验诊断冠心病的临床价值

目的:评价多巴酚丁胺心电图负荷试验对冠心病的诊断价值。方法:选择96例冠状动脉造影(CAG)检查的 患者,予行多巴酚丁胺心电图负荷试验,并将其结果与CAG结果对比分析。结果:多巴酚丁胺心电图负荷试验诊 断冠心病的敏感性为67.9%、特异性为74.4%、准确性70.8%。结论:多巴酚丁胺心电图负荷试验对冠心病的诊 断具有较高的敏感性和特异性,且费用低,容易开展,是一种安全、有效的无创检查方法。     

定量组织速度成像技术—多巴酚丁胺负荷超声心动图对室壁运动异常的评价

目的 通过定量组织速度成像技术（QTVI）结合多巴酚丁胺负荷超声心动图（DSE）诱导的室壁运动异常与冠状动脉造影结果相对照，分析室壁运动异常与冠脉血供的关系。方法 对68例临床疑诊为冠心病的患者进行定量组织速度成像技术一多巴酚丁胺负荷超声心动图及冠状动脉造影（CAG）检查，判定室壁运动异常的部位、范围及病变血管。结果 本组68例患者中以冠状动脉造影为标准，定量组织速度成像技术—多巴酚丁胺负荷超声心动图诊断冠心病的敏感性85．7％，特异性89．4％，准确性86．7％。结论 应用定量组织速度成像技术—多巴酚丁胺负荷超声心动图能较准确的评价室壁运动异常及对应血供关系，是诊断冠心病的一种安全、简单、经济的有效方法。     

多巴酚丁胺负荷组织速度成像与心肌SPECT诊断老年冠心病的对比观察

目的 以CAG为金标准,与ATP负荷^99mTc-MIBI心肌SPECT对比,探讨多巴酚丁胺负荷定量组织速度成像(DSE+QTVI)诊断老年冠心病的临床价值。 方法 98例入选者接受DSE+QTVI,其中40例接受ATP负荷SPECT检查,并均在2周内接受CAG。在DSE+QTVI检查过程中测定不同多巴酚丁胺负荷剂量时各室壁中段收缩期心肌运动峰值速度(Vpeak)。 结果 Vpeak在多巴酚丁胺20 μg/(kg·min)负荷量时其诊断老年冠心病的敏感度和特异度最高,分别为80.43%、81.58%;在多巴酚丁胺40 μg/(kg·min)负荷剂量时,敏感度和特异度最低,分别为52.94%、69.57%。与ATP负荷SPECT相比,Vpeak诊断老年冠心病的敏感度、特异度略低。 结论 DSE+QTVI诊断老年冠心病是安全、有效、无创的方法。     

多巴酚丁胺负荷磁共振成像检测存活心肌的临床研究

目的 评价小剂量多巴酚丁胺(10μg·kg-1·min-1)负荷磁共振成像(MRI)检测存活心肌的临床价值.方法 经彩色多普勒超声检查存在左心室壁节段运动障碍冠心病患者24例,进行MRI、小剂量多巴酚丁胺负荷MRI、冠状动脉造影(CAG)及经皮冠状动脉介入治疗(PCI),所有狭窄病变行完全血运重建.参照美国超声心动图学会16节段划分法,经MRI测得各运动异常节段小剂量多巴酚丁胺负荷前后舒张末期室壁厚度(EDWT),以应用小剂量多巴酚丁胺后室壁增厚为存活心肌标准;术后1、3、6个月时复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准.结果 24例冠心病患者共获得符合条件的室壁运动异常节段170个,根据金标准判断其中115个为存活心肌,55个为非存活心肌;MRI检测存活心肌的敏感度、特异度、准确度分别是76.5%、90.9%、81.2%.结论 小剂量多巴酚丁胺负荷MRI检测存活心肌有较高的临床价值.     

CK—DSE对检测冠脉狭窄部位及程度的诊断价值

目的：评价彩色室壁动力（CK）分析技术多巴酚丁胺负荷超声心动图（CK-DSE）对预测冠状动脉病变（CAD）部位及程度的准确性、安全性及可行性。方法：以冠状动脉造影（CAG）为标准，采用CK-DSE检测了50例可疑CHD患者。结果：CK-DSE对多支病变的敏感性优于单支病变，在三支主要冠脉分支中对识别左前降支（LAD）最敏感。结论：CK-DSE对检测冠脉狭窄部位及程度耐受性好，方便，价廉，具有较高的诊断价值。     

64层螺旋CT冠状动脉成像诊断冠状动脉狭窄价值

目的评价64层螺旋CT冠状动脉成像（CTA）诊断冠状动脉狭窄的准确性与可行性。方法 30例临床拟诊为冠心病的病人行64层螺旋CTA,以选择性冠状动脉DSA造影作为金标准,比较两种检查方法的结果。结果 120段冠状动脉在CTA图像上得到良好显示,达到分析要求。64层螺旋CT诊断冠状动脉狭窄（狭窄程度≥50%）的灵敏度、特异度、阳性预测值和阴性预测值分别为77.8%、85.3%、48.3%和95.6%。结论 64层螺旋CTA显示冠状动脉狭窄具有很高的阴性预测值,可作为一种无创检查技术对冠状动脉狭窄进行筛查。     

多巴酚丁胺负荷定量组织追踪技术诊断老年冠心病的临床研究

目的探讨多巴酚丁胺负荷超声心动图(DSE)与定量组织追踪技术(TT)相结合诊断老年冠心病的临床价值。方法 98例疑似冠心病老年患者行DSE+TT检查,测定不同多巴酚丁胺负荷剂量时各室壁中段收缩期心肌峰值位移(Dpeak),2周内行冠状动脉造影后将所有患者分成冠心病组与正常组,并将两组Dpeak进行比较研究。结果冠心病组在10、20μg·kg-1·min-1这两个负荷剂量时前壁、前间隔、侧壁、后壁Dpeak小于正常组,差异有统计学意义(P<0.05),而两组下壁Dpeak在其他任何负荷剂量时差异均无统计学意义(P>0.05);与冠状动脉造影比较,Dpeak诊断老年人冠心病的敏感度、特异度、准确性分别为82.4%、61.7%、72.4%,Dpeak在多巴酚丁胺40μg·kg-1·min-1负荷剂量时其诊断的敏感度和特异度最高,分别为88.2%、69.5%。结论多巴酚丁胺负荷定量组织追踪成像是一项安全、有效、无创诊断老年冠心病的方法。     

64层CT冠状动脉成像、磁共振多技术扫描评价冠心病的对比研究

目的比较64层螺旋CT冠状动脉造影(CTA)和磁共振心脏多技术扫描对冠心病(CHD)的诊断结果。方法28例拟行冠状动脉造影(CAG)的冠心病患者,于术前一周完成64层螺旋CTA及磁共振心脏多技术扫描,分别与CAG进行对照。结果64层螺旋CTA与CAG对各支冠状动脉狭窄程度的显示具有较好的一致性(P<0.05)。64层螺旋CTA判断中、重度狭窄血管(≥50%)的敏感度、特异度、准确度、阳性预测值、阴性预测值为87.88%、98.73%、95.54%、96.67%、95.12%。磁共振多技术扫描左室增大8例,室壁明显变薄7例。在476个节段中,29个节段(6.09%)运动减弱或不运动,9个节段(1.89%)出现矛盾运动或室壁瘤。冠状动脉轻、中、重度狭窄组的心肌磁共振灌注及延迟扫描序列阳性显示率为26.32%、89.47%、100%。MRI间接判断中、重度狭窄血管(≥50%)的敏感度、特异度、准确度、阳性预测值、阴性预测值为93.75%、86.54%、89.29%、81.08%、95.74%。结论64层螺旋CTA和MR心肌灌注显示冠心病中、重度狭窄血管与CAG的结果差异无明显统计学意义;两种方法的准确度无明显差异,对冠心病的诊断各具优势。     

应用全模型迭代重建技术的低剂量冠脉CTA在疑似冠心病患者中诊断价值的初步研究

目的:评估应用全模型迭代重建(IMR)技术的低剂量冠脉CTA显示冠状动脉的图像质量及其对疑似冠心病患者冠脉狭窄的诊断价值。方法:回顾分析我院疑似冠心病并接受冠脉CTA及冠状动脉造影(CAG)检查的患者80例。采用4分法对冠脉各主支进行主观质量评分。以CAG显示冠脉管腔直径缩小超过50%为阳性标准,分别在冠脉节段、主支水平分析冠脉CTA诊断冠脉狭窄的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及准确度,将患者按Agaston积分分成两组(A组<400,B组≥400),比较两组间诊断效能的差异。结果:在节段水平上,98.1%的冠脉图像质量合格,冠脉CTA诊断冠脉狭窄的灵敏度、特异度、PPV、NPV及准确度分别为93.2%、98.0%、91.3%、98.4%、97.1%;在主支水平上,96.6%的冠脉图像质量合格,冠脉CTA诊断冠脉狭窄的灵敏度、特异度、PPV、NPV及准确度分别为84.6%、93.0%、88.9%、90.1%、89.6%;A、B两组之间在特异度、PPV和准确度上存在显著差异(99.2%&91.8%,95.7%&84.2%,97.9%&93.7%,P<0.05)。结论:应用IMR技术的低剂量冠脉CTA检查可获得满意的图像质量,对冠脉狭窄具有较高的诊断准确性,但对严重钙化的血管节段的诊断尚有局限性。     

Simultaneous dobutamine stress echocardiography and dobutamine scintigraphy (99mTc-MIBI-SPET) for assessment of coronary artery disease

Background: Simultaneous dobutamine stress echocardiography (DSE) and^99mTc-MIBI-SPET (DMS) for the evaluation of the presence and the extent of coronary artery disease (CAD) were assessed for a head to head comparison regarding the diagnostic accuracy of the two tests. Methods and Results: Forty-five consecutive patients (33 males and 12 females: 53±6.8 yr.) underwent exercise electrocardiography and simultaneous dobutamine stress echocardiography and MIBI-SPET imaging. Coronary angiography was performed in all patients (significant coronary stenosis > 50%). On the basis of the results of exercise electrocardiogram the pre-test probability for coronary artery disease (Diamond's algorithm) was low (45.6±12.7 %). The overall specificity, sensitivity and predictive accuracy of Echo-dobutamine stress test for diagnosis of the presence or absence of CAD were: specificity 82%, sensitivity 76%, diagnostic accuracy 80%, positive predictive value 90%, negative predictive value 40%. The overall specificity, sensitivity and predictive accuracy of MIBI-SPET-dobutamine test for diagnosis of the presence or absence of CAD were: specificity 86%, sensitivity 87%, diagnostic accuracy 84%, positive predictive value 97%, negative predictive value 54%. MIBI-SPET-dobutamine test showed a significantly higher sensitivity in comparison with ECHO-dobutamine test (P<0.05). Conclusion: Both noninvasive methods for the detection of CAD showed a good diagnostic accuracy. Nevertheless the SPET model showed an higher sensitivity in comparison with DSE model, essentially in the presence of a lower extent of CAD and during submaximal test.     

Comparison of thallium-201 exercise SPECT and dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch block

The present study assessed and compared the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerised tomography (SPECT) and dobutamine stress echocardiography (DSE) for detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Study population consisted of 26 consecutive patients with permanent LBBB who were suffering from chest pain. Patients (8 women, 18 men mean age = 57 ± 8 years) were studied with DSE, Tl-201 SPECT and coronary angiography (CAG). Three different approaches for diagnosis of CAD were used to identify CAD in left arterial descending (LAD) coronary artery territories in scintigraphic studies: (1) Approach A (conventional approach): involvement of septal, and/or anterior, and/or apical wall. (2) Approach B: involvement of anterior and septal wall irrespective of apical wall. (3) Approach C: involvement of septum, anterior and apical wall. DSE gave a sensitivity of 91%, specificity of 92% and accuracy of 92% for diagnosis of CAD in the LAD coronary artery territory. Tl-201 SPECT (conventional approach) gave a sensitivity of 100%, specificity of 42% and diagnostic accuracy of 69% for diagnosis of CAD in the LAD coronary artery territory. Sensitivity, specificity and diagnostic accuracy of approach C were 33, 85 and 57% respectively. The specificity of Tl-201 SPECT significantly increased in approach C when compared with approach A and B (p < 0.02). However sensitivity of the Tl-201 SPECT with approach C showed significant decrease when compared with DSE and approach A and B (p < 0.005). Specificity of DSE for diagnosis of CAD in LAD were significantly higher than those of Tl-201 SPECT regarding the approach A and B (p < 0.01). In conclusion the use of DSE for diagnosis of CAD in patients with LBBB seems to be more suitable than Tl-201 SPECT.     

双源CT 冠状动脉血管成像对冠状动脉狭窄的诊断价值分析

目的:探讨应用双源CT冠状动脉血管成像(DSCT-CA)的检查方式对诊断冠状动脉狭窄的价值。方法:选取2019年1月—2020年5月期间我院65例疑似冠状动脉狭窄的患者,均接受冠脉造影(CAG)与DSCT-CA检查,以CAG检查为金标准,评价DSCT-CA对狭窄情况的诊断价值,并且以冠状动脉狭窄50%为界限,分析DSCT-CA诊断的准确度、敏感度及特异度。结果:检出595个冠状动脉节段,经CAG检出狭窄节段158个(26.55%),经DSCT-CA检出狭窄节段142个(23.87%);经DSCT-CA对冠状动脉狭窄50%的诊断准确度为96.92%(63/65)、敏感度为100.00%(47/47)、特异度为88.89%(16/18)。结论:应用DSCT-CA可对不同程度的冠状动脉狭窄的诊断价值显著,值得推广。     

Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography

To determine the value of dual-energy CT (DECT) and combined information of perfusion and angiography in diagnosing coronary artery disease (CAD), with single photon emission computed tomography (SPECT) and quantitative coronary angiography (QCA) as a reference standard. Thirty-four patients were enrolled in this study. DECT was used as a contrast-enhanced retrospectively ECG-gated scan protocol during the rest state and tubes were set at 140/100 kV. DECT angiography (DE-CTA) and DECT perfusion (DE-CTP) were calculated from two kV images. DE-CTP results were compared with SPECT and DE-CTA with QCA, respectively. The combined DE-CTP with DE-CTA data were compared to QCA in diagnosis of obstructive CAD (stenosis ≥ 50%). DECT showed diagnostic image quality in 31 patients. Using SPECT as a reference, DE-CTP had sensitivity of 68%, specificity of 93%, and sensitivity of 81%, and specificity of 92% for identifying any type of perfusion deficits on the segment- and territory-based analysis, respectively. Using QCA as a reference standard, DE-CTA showed sensitivity of 82%, specificity of 91% and accuracy of 86% for detecting ≥50% coronary stenosis on the vessel-based analysis, whereas the combination of DE-CTA and DE-CTP gave sensitivity of 90%, specificity of 86% and accuracy of 88% for detecting ≥50% coronary stenosis, respectively. Combination of DE-CTP and DE-CTA may improve diagnostic performance compared to CTA alone for the diagnosis of significant coronary stenosis.     

多巴酚丁胺负荷超声心动图结合舒张功能应变率评价冠心病的临床研究

目的探讨多巴酚丁胺负荷超声心动图(DSE)结合应变率显像(SRI)技术中舒张功能参数变化诊断冠心病的临床价值。方法28例临床疑诊为冠心病的患者接受DSE试验并行舒张期SRI参数分析,以冠状动脉造影结果为金标准,比较DSE负荷下二维目测法及SRI检出冠心病患者舒张功能异常的敏感性及特异性。结果狭窄冠状动脉供应心肌节段在峰值剂量(40μg·kg-1·min-1)DSE负荷下与静息状态及小剂量(10~20μg·kg-1·min-1)DSE负荷相比,舒张早期应变率显著降低,舒张开始时间显著延长。DSE检出冠心病患者舒张功能异常的敏感性、特异性、准确率分别为84%、86%及86%,DSE-舒张早期应变率和舒张开始时间检出冠心病患者舒张功能异常的敏感性分别为91%和93%,特异性分别为87%和85%,准确率分别为89%和90%。结论DSE结合SRI中舒张功能参数变化可提高DSE检出冠心病患者舒张功能异常的敏感性,能定量评价冠心病患者DSE状态下的心肌舒张运动状态,具有一定的临床价值。     

Which is the better method in detecting significant left anterior descending coronary artery stenosis during contrast-enhanced dobutamine stress echocardiography: coronary flow velocity reserve or wall-motion assessment?

The diagnostic accuracy of dobutamine stress echocardiography (DSE) depends on wall-motion assessment. Coronary flow velocity reserve (CFVR) during DSE can be measured by transthoracic Doppler echocardiography. To investigate comparative diagnostic accuracy between wall-motion and CFVR assessment in the detection of significant left anterior descending coronary artery (LAD) stenosis, 274 patients underwent both contrast-enhanced DSE and coronary angiography. Intravenous contrast agent, Levovist, was injected to enhance left ventricular endocardial border delineation and coronary flow velocity in the LAD. Wall motion was assessed by standard technique, and CFVR was calculated as coronary flow velocity at peak dobutamine stress divided by baseline coronary flow velocity by transthoracic Doppler echocardiography. CFVR could be successfully obtained in 232 patients (feasibility, 85%). After excluding 14 patients with isolated diagonal stenosis, CFVR was significantly lower in 65 patients with significant LAD stenosis than it was in 153 patients without stenosis (1.62 +/- 0.56 vs 2.72 +/- 0.94, P <.001). CFVR < or = 2.0 had a 75% sensitivity, a 81% specificity, and a 79% diagnostic accuracy for detecting significant LAD stenosis, and these values were comparable with those by wall-motion analysis (sensitivity, 78%; specificity, 89%; and diagnostic accuracy, 86%). The measurement of CFVR in the LAD during DSE was feasible and the diagnostic accuracy of CFVR was equivalent to wall-motion assessment in the detection of LAD stenosis.     

彩色室壁动力技术多巴酚丁胺负荷试验在冠心病诊断中的应用

目的⑶探讨彩色室壁动力技术超声心动图对冠心病⒉ Ｃ Ａ Ｄ⒕患者室壁缺血部位检测的准确性和可靠性⒚方法⑶对拟诊或疑为冠心病者及正常人 ４０ 例全部进行 Ｃ Ｋ 超声心动图多巴酚丁胺负荷试验 ⒉ Ｃ Ｋ Ｄ Ｅｃｈ ｏ⒕⒙然后再与冠脉造影结果进行对照⒚结果⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 对于冠脉造影阳性、阴性组患者的诊断预测值分别为 ９１３０％ 、１００％ ⒙总预测值为 ９３９４％ ⒚其诊断 Ｃ Ａ Ｄ 的敏感性、特异性和准确性分别为 １００ ％ 、８３３３％ 和 ９３９４％ ⒚通过对心室壁缺血部位的观察⒙应用 Ｃ Ｋ 技术能够提高心内膜的显示率⒙避免人为因素⒙客观地做出室壁位移的时间值定量⒙明显优于二维超声法⒚结论⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 为 Ｃ Ａ Ｄ 诊断提供了一种安全、可靠的方法⒚