冠状动脉造影与常规心电图检查比较研究

目的通过比较冠状动脉造影(CAG)与常规心电图检查(ECG)诊断冠心病的效果,探讨冠状动脉造影与常规心电图的临床使用价值.方法选取进行冠状动脉造影的438例住院患者,将其常规心电图检查结果与冠状动脉造影结果进行比较.结果常规心电图诊断冠心病的灵敏性为77.7%,特异性为52.2%,假阳性率为47.8%,假阴性率为22.3%,阳性预测值为64.1%,阴性预测率为68.1%.ECG检查对冠状动脉狭窄单支病变检出率为64.8%,双支病变为87.9%,三支病变率88.7%.结论常规心电图检查是诊断筛选冠心病的首要有效手段,具有实用的临床诊断价值.     

运动平板试验与动态心电图在老年冠心病诊断中的应用

目的探讨运动平板试验与动态心电图在老年冠心病诊断中的应用价值。方法选择2014年1月—2015年1月收治的80例疑诊为老年冠心病患者,分别进行运动平板试验和动态心电图检查,检查的间隔时间为14 d。计数资料比较采用χ~2检验,P0.05为差异有统计学意义。以冠状动脉造影为金标准,对比运动平板试验和动态心电图诊断的准确性。结果运动平板试验诊断灵敏度为96.43%,特异度为58.33%,阳性预测值为84.38%,阴性预测值为87.50%;动态心电图诊断灵敏度为67.86%,特异度为58.33%,阳性预测值为79.17%,阴性预测值为43.75%;二者灵敏度、阳性预测值比较差异有统计学意义(均P0.05)。结论运动平板试验诊断老年冠心病的准确性及灵敏度高于动态心电图。     

盐酸去甲乌药碱负荷心肌灌注显像与负荷心电图对冠心病诊断价值的对比研究

目的：比较盐酸去甲乌药碱（HG）负荷心肌灌注显像（MPI）和负荷心电图（ECG）对冠心病的诊断价值。方法70例患者同时完成HG负荷核素MPI及冠脉造影（CAG）检查,在心肌灌注负荷试验过程中观察ECG变化,并与同期负荷MPI和冠脉造影结果作对比。结果以CAG结果为金标准,HG负荷MPI诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为55.8%、92.6%、92.3%、56.8%、70%,HG负荷ECG诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为74.4%、29.6%、62.7%、42.1%、57.1%。MPI的特异性和阳性预测值明显高于ECG（P＜0.01）,敏感性、阴性预测值、准确性两者统计学差异不大（P＞0.05）。结论 HG可作为负荷MPI和负荷ECG药物来诊断冠心病,且HG负荷MPI的特异性要优于HG负荷ECG。     

心电图运动负荷血清骨保护素变化对冠心病的诊断及预后的评价

目的探讨心电图运动负荷试验中血清缺铁修饰骨保护素(OPG)水平变化对冠心病的诊断及病情预后的评价价值。方法选择2012年5月-2015年9月在本院行心电图运动负荷试验的患者80例,所有患者在运动前和运动后均检测血清OPG水平,运动平板试验(ETT)阳性患者进一步冠状动脉造影(CAG),探讨血清OPG水平与对冠心病的诊断价值,以及与冠心病患者冠状动脉病变程度及患者临床预后的关系。结果 CAG阳性组患者运动最大心率、运动时间明显低于CAG阴性组;运动后各时间点CAG阳性组较阴性组OPG水平升高,病变支数越多,狭窄程度越严重,患者EET后OPG水平越高。EET后6 h血清OPG水平、冠状动脉狭窄程度≥50%、冠状动脉病变支数≥2支是患者心血管事件的独立风险因素。结论心电图运动负荷试验过程中血清骨保护素有助于冠心病的诊断和患者冠状动脉病变程度的评价。     

心电图运动试验ST指标与非ST指标相结合诊断冠心病的临床价值 附168例单光子发射型计算机断层(SPECT)心肌显像对照

本文168例受检者做了活动平板心电图运动试验(EET).综合ST与非ST变化作为分析参数,参照同时进行的~(99m)TC-MIBI心肌断层显像结果,探讨了EET多参数分析在冠心病中的诊断价值.结果表明:随着EET上反映心肌缺血信息量的增多,诊断准确性也相应提高.单项ST指标诊断敏感性、特异性与阳性预测率分别为64.3% 、73.6%和84.9%;三项指标积分法分别为61.7%、90.6%与93.4%;而六项指标积分法分别达78.3%、90.6%和94.6%.以六项指标积分法诊断准确性最高,与单项ST指标相比其阳性预测值差异有显著意义(P<0.01).     

多层螺旋CT血管造影和核素心肌灌注显像在冠状动脉疾病中诊断价值

目的比较多层螺旋CT血管造影(MSCTA)和心肌灌注显像(MPI)在诊断冠状动脉疾病中的价值。方法 52例怀疑或诊断为冠心病的患者,行CAG检查前行MSCTA与MPI检查。评价MSCTA和MPI诊断冠状动脉疾病(CAD)的准确性。结果与CAG结果对比,MSCTA与MPI二者联合诊断CAD的敏感性、特异性、准确性、阳性和阴性预测值分别为96.8%、95.2%、96.2%、96.8%和92.2%。MSCTA与MPI二者联合诊断CAD的特异性及阳性预测值较MSCTA显著提高(p<0.05)。结论 MSCTA结合MPI对疑似冠心病患者有着很高的诊断价值,较CTCA检查明显提高了特异性与阳性预测值。     

十二导联动态心电图加做晨起运动负荷试验诊断冠心病的价值

目的探讨十二导联动态心电图(DCG)加做晨起运动负荷试验对冠心病的诊断价值.方法选择可疑冠心病58例,将DCG加做晨起运动负荷试验和冠脉造影(CAG)检查结果进行对比分析,以CAG为标准计算晨起负荷试验的敏感性、准确性等指标.结果 DCG晨起运动负荷试验检出冠心病敏感性、阳性预测值及准确性高,但特异性差,女性假阳性高.结论 DCG晨起运动负荷试验可提供冠心病诊断及鉴别诊断可靠依据.     

十二导联动态心电图加做晨起运动负荷试验诊断冠心病的价值

目的探讨十二导联动态心电图(DCG)加做晨起运动负荷试验对冠心病的诊断价值。方法选择可疑冠心病58例,将DCG加做晨起运动负荷试验和冠脉造影(CAG)检查结果进行对比分析,以CAG为标准计算晨起负荷试验的敏感性、准确性等指标。结果DCG晨起运动负荷试验检出冠心病敏感性、阳性预测值及准确性高,但特异性差,女性假阳性高。结论DCG晨起运动负荷试验可提供冠心病诊断及鉴别诊断可靠依据。     

ST段延长在冠心病诊断中的价值

目的探讨ST段水平延长≥0.12s在诊断冠心病中的价值及ST段水平延长时间与冠状动脉狭窄程度、ST段延长与冠状动脉狭窄支数的相关性。方法记录80例经冠状动脉造影证实的冠心病患者(冠心病组)和80例正常对照组12导联常规心电图,回顾性分析心电图ST段延长情况。结果两组ST段沿基线水平延长(≥0.12s)发生率有显著性差异(p<0.01)。ST段水平延长诊断冠心病的敏感性为86.25%,特异性为77.50%,准确度为81.88%,阳性预测值为79.31%,阴性预测值84.93%。结论ST段沿基线水平延长≥0.12s提示心肌缺血,对冠心病有较高的诊断价值。     

冠状动脉造影与冠心病临床分析

目的 探讨临床诊断为冠心病患者与冠状动脉造影结果间的关系.方法 选择186例临床诊断为冠心病行冠状动脉造影检查的病例,依据临床表现、心电图有无缺血的改变分为五组,进行回顾性对比分析.结果 Ⅰ组(心绞痛伴心电图提示心肌供血不足)冠状动脉造影病变阳性检出率最高为91%、Ⅱ组(心绞痛伴心电图正常而运动试验阳性)冠状动脉造影病变阳性检出率为67%、Ⅲ组(心绞痛伴心电图及运动试验正常)冠状动脉造影病变阳性检出率为39%、Ⅳ组(无心绞痛伴心电图提示心肌供血不足)冠状动脉造影病变阳性检出率为8%、V组(无心绞痛伴心电图正常而运动试验阳性)冠状动脉造影病变阳性检出率为0.结论 心绞痛伴心电图提示心肌供血不足的改变在冠心病诊断中具有重要价值.     

Clinical Inquiry: How should we use the coronary artery calcium score to predict cardiovascular risk?

Most atherosclerotic lesions are calcified. The degree of calcification is proportional to the severity of atherosclerosis and can be quantified by the CAC score as measured by electron beam computed tomography (EBCT).     

64层螺旋CT与选择性冠状动脉造影诊断对比研究

目的：探讨64层螺旋CT在冠状动脉疾病检查中的临床应用价值。方法：对23例疑似冠状动脉狭窄的患者采用64层螺旋CT冠状动脉成像,检查结果与导管法选择性冠状动脉造影（CAG）进行比较分析。结果：23例患者共299个节段中,64层螺旋CT冠状动脉成像能满足临床诊断的为291个节段,8个节段因钙化、运动伪影而不能评价。以选择性冠状动脉造影为金标准。64层螺旋CT诊断冠状动脉狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为88．7％、98．2％、94．0％、96．4％。结论：64层螺旋CT虽不能取代选择性冠状动脉造影,但在冠状动脉狭窄的诊断方面还是一种具有潜力的检查方法,具有较好的临床应用价值。     

Detection of subclinical cardiovascular disease: the emerging role of electron beam computed tomography.

BACKGROUND: Although extraordinary advances have been made in the management of advanced coronary artery disease, little progress has been made in its prevention. Traditional screening methods utilizing risk factor profiles and exercise treadmill tests have failed to identify populations who will subsequently have coronary events with a high degree of predictive accuracy. METHODS: We review the pathobiologic basis and clinical utility of electron beam computed tomography (EBCT) to detect coronary artery calcium as a screening tool for subclinical coronary artery disease. Because EBCT is able to perform subsecond imaging of the heart, it can detect and quantitate coronary artery calcium with a high degree of precision. Coronary artery calcium is a marker of complex atherosclerosis. RESULTS: Over 4,000 asymptomatic patients in several series have been studied with EBCT and followed prospectively for an average of 42 months (range 37-72 months). A positive scan is associated with a risk ratio for future coronary events of 8.7 (95% confidence interval 2.67 to 28.13). These data indicate that EBCT has the ability to detect subclinical coronary artery disease and predict future coronary events better than any previous existing method or technology. CONCLUSION: EBCT coronary artery screening may prove to be a valuable adjunct to the traditional methods for the detection of subclinical coronary artery disease and to identify those who would benefit from focused preventive therapies.     

双层螺旋CT血管造影与冠状动脉钙化积分诊断冠心病的临床评价

目的评价双层螺旋CT血管造影(DHCTA)与冠状动脉钙化(CAC)积分诊断冠心病(CHD)的临床价值。方法对52例疑有CHD的患者行冠状动脉造影(CAG)、双层螺旋CT扫描检测CAC积分,并行DHCTA扫描,源像输入HP4.1工作站后作多模式三维重建。以CAG结果为金标准来分析DHCTA和CAC积分对CHD的诊断效能。结果DHCTA和CAC积分诊断CHD的灵敏度、特异性、准确性分别为70%、90.9%、78.8%和93.3%、63.6%、80.8%。二者比较DHCTA的灵敏度低于CAC积分,而特异性明显高于CAC积分,准确性比较差异无统计学意义(P>0.05)。将二者结合起来诊断CHD,则灵敏度、特异性、准确性分别为93.3%、90.9%、92.3%。结论在诊断CHD方面,CAC积分具有较高的灵敏度,DHCTA具有较高的特异性,将二者优势结合运用可进一步提高诊断的准确性。     

Electron-beam computed tomography for identification of high-risk persons in primary prevention of coronary heart disease in the United States and its implication for Japan

Coronary heart disease (CHD) is the leading cause of death in the United States (US). Approximately half of deaths from (CHD) occur out of hospital, most being sudden. The majority of sudden cardiac deaths occur in asymptomatic subjects. Recent lipid-lowering trials in asymptomatic subjects have demonstrated the potential for risk reduction for CHD events by primary prevention. It is, however, generally acknowledged that risk will be underestimated in asymptomatic subjects who fall into the category of intermediate risk by the traditional risk factors. Non-invasive measurements of subclinical atherosclerosis, which is the end result of risk-factor exposure, have the possibility of improving the risk stratification of asymptomatic subjects in intermediate-risk. Electron-beam computed tomography (EBCT) is a non-invasive and highly sensitive means to detect calcification within coronary arterial wall. Coronary artery calcification (CAC) is a recognized marker of atherosclerosis. Atherosclerotic burden of coronary arteries correlates strongly with the amount of CAC measured by EBCT. Studies examining the predictive value of CAC among asymptomatic subjects consistently reported that CAC is a risk for CHD. Two studies reported that unadjusted odds ratios of CAC for CHD were over 20. Incremental value of EBCT over the traditional risk assessment models, however, has not been established. Although CHD mortality in Japan remains uniquely low in industrialized countries, among men aged 30-49, risk factor profiles for CHD are similar between men in the US and Japan, except higher prevalence of cigarette smoking in Japan and higher prevalence of obesity in the US. It is reported that the declining trend in CHD mortality in Japan has recently slowed down in metropolitan areas, especially in men aged 30-49, and that the incidence has increased in middle-aged workers in a metropolitan area. A mortality validation study reported that the differences in CHD mortality between the US and Japan were not as large as suggested by vital statistics. It is, therefore, important to evaluate subclinical atherosclerosis measured by EBCT in men in recent birth cohorts in Japan and compare it to that in men in the US in order to predict future trend in CHD in Japan.     

Expert review on coronary calcium

While there is no doubt that high risk patients (those with >20% ten year risk of future cardiovascular event) need more aggressive preventive therapy, a majority of cardiovascular events occur in individuals at intermediate risk (10%-20% ten year risk). Accurate risk assessment may be helpful in decreasing cardiovascular events through more appropriate targeting of preventive measures. It has been suggested that traditional risk assessment may be refined with the selective use of coronary artery calcium (CAC) or other methods of subclinical atherosclerosis measurement. Coronary calcification is a marker of atherosclerosis that can be quantified with the use of cardiac CT and it is proportional to the extent and severity of atherosclerotic disease. The published studies demonstrate a high sensitivity of CAC for the presence of coronary artery disease but a lower specificity for obstructive CAD depending on the magnitude of the CAC. Several large clinical trials found clear, incremental predictive value of CAC over the Framingham risk score when used in asymptomatic patients. Based on multiple observational studies, patients with increased plaque burdens (increased CAC) are approximately ten times more likely to suffer a cardiac event over the next 3-5 years. Coronary calcium scores have outperformed conventional risk factors, highly sensitive C-reactive protein (CRP) and carotid intima media thickness (IMT) as a predictor of cardiovascular events. The relevant prognostic information obtained may be useful to initiate or intensify appropriate treatment strategies to slow the progression of atherosclerotic vascular disease. Current data suggests intermediate risk patients may benefit most from further risk stratification with cardiac CT, as CAC testing is effective at identifying increased risk and in motivating effective behavioral changes. This article reviews information pertaining to the clinical use of CAC for assessing coronary atherosclerosis as a useful predictor of coronary artery disease (CAD) in certain population of patients.     

Relation of retinopathy to coronary artery calcification: the multi-ethnic study of atherosclerosis

Microvascular disease, reflected by retinal vascular changes, has been shown to predict clinical coronary heart disease. Whether retinal vascular changes are associated with subclinical coronary artery disease is unclear and was examined in this study. The authors conducted a multiethnic, population-based study of 6,147 persons aged 45-84 years, sampled from six US communities in 2002-2004, who were free of clinical cardiovascular disease. Coronary artery calcification (CAC), a noninvasive measure of subclinical coronary artery disease, was assessed by cardiac computed tomography scanning and categorized into three groups of increasing severity: none (average CAC score = 0), mild (1-100), and moderate-to-severe (>100). Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols. After adjustment for age, gender, race/ethnicity, blood pressure, diabetes, lipid profile, smoking, and other risk factors, retinopathy was associated with having a moderate-to-severe CAC score (odds ratio = 1.43, 95% confidence interval: 1.18, 1.75). This association remained significant in both men and women and in persons with and without diabetes or hypertension. Variations in retinal vascular caliber were not significantly associated with CAC score. This study shows that retinopathy signs are independently associated with CAC, supporting the concept that common pathophysiologic processes may underlie both micro- and macrovascular disease.     

冠状动脉CT造影在2型糖尿病合并冠心病患者诊断中的应用价值研究

目的:探讨冠状动脉CT造影(CCTA)在2型糖尿病合并冠心病(CHD)患者诊断中的应用价值。方法:选取126例2型糖尿病疑似合并CHD患者,分别进行常规心电图和CCTA检查。以冠状动脉血管造影(CAG)为标准,对比两种检查方法诊断结果的准确性。结果:经CAG检查和诊断分析,126例2型糖尿病患者诊断为CHD阳性71例,阴性55例,CCTA检查诊断的灵敏度、特异度、阳性预测值及阴性预测值和诊断准确率均高于心电图诊断,其差异有统计学意义(χ²=23.698,χ²=5.939,χ²=15.930,χ²=11.870;P<0.05);CCTA诊断2型糖尿病合并CHD的受试者工作特征(ROC)曲线下面积(AUC)值为0.921。结论:CCTA有效地提高2型糖尿病合并CHD患者的冠状动脉清晰度,对血管狭窄位置和狭窄程度的识别准确率较高,在临床疾病诊断中具有较高的应用价值。     

320排螺旋CT冠脉成像评估冠脉病变的临床应用价值

目的通过对比320排螺旋CT冠脉成像(冠脉CTA)与冠脉造影(CAG)的结果,探讨其评估冠脉病变的临床应用价值。方法对229例可疑冠心病患者先行冠脉CTA筛查,经其诊断为重度狭窄或闭塞的31例患者在1个月内行CAG检查,分析比较冠脉CTA对冠脉不同狭窄程度的敏感性、特异性、阳性预测值和阴性预测值,并评估其精确率。结果所有患者均成功行320排螺旋CT冠状动脉成像,获得良好的三维重建。冠脉CTA对于评估正常或重度狭窄的冠脉有较高的敏感性、特异性、阳性预测值及阴性预测值。冠脉CTA对冠脉不同狭窄程度判断的精确率达73.4%。结论 320排螺旋CT冠脉成像是一种比较可靠、简便而且安全的冠脉病变无创检查手段,对冠脉病变的评估较准确,可以作为可疑冠心病患者的一种筛查与诊断手段。     

64排冠脉CT和冠脉造影对冠心病诊断的对比研究

目的 以冠状动脉造影(CAG)为参照,评价64排冠脉CT (CTCA),即64排多层螺旋CT (MSCT)在冠心病诊断中的价值.方法 选取本院临床46例疑似冠心病的患者分别进行CAG和MSCT检查,以CAG为参照标准,对MSCT诊断价值进行分析.结果 46例患者中CAG发现狭窄92支,其中轻度狭窄6支,中度狭窄38支,重度狭窄34支,闭塞病变14支;MSCT发现狭窄116支,其中轻度狭窄52支,中度狭窄24支,重度狭窄38支,闭塞病变2支.MSCT诊断冠脉狭窄病变的敏感度,特异度,阴性预测值,阳性预测值及准确度分别为82.8％,82.5％,88.7％,74.2％,82.6％,与冠脉造影结果相比较,无明显统计学差异.MSCT检出软斑块32处、混合斑块42处、钙化斑块30处.结论 MSCT诊断冠心病有较高的敏感度和特异度,特别是阴性预测值较高,可作为冠心病高危人群的一种无创筛查手段:同时可以准确显示各种粥样斑块的病理性质,并对斑块的稳定性做出判断,评估急性冠脉事件的发生,具有较高的临床应用价值.