冠状动脉CT成像和平板运动试验对冠心病的诊断价值

目的探讨冠状动脉CT成像(CTCA)和平板运动试验(TET)对冠心病的诊断价值。方法选择怀疑冠心病并于2周内分别行CTCA、TET及冠状动脉造影检查的患者共254例,以冠状动脉造影结果为对照指标,分析CTCA、TET及两者联合时对冠心病的诊断价值。结果 TET、CTCA及CTCA联合TET的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为:60.8%、64.7%、82.5%、37.6%和61.8%;84.9%、80.9%、92.4%、66.3%和83.9%;88.3%、86.0%、94.2%、74.0%和87.7%。CTCA对左主干病变的检出率明显高于冠状动脉造影(P<0.01)。结论 CTCA和CTCA联合TET在诊断冠心病时的准确率比单独TET高,CTCA对左主干病变的检出更有一定优势。因此,临床上可将CTCA作为可疑冠心病患者的筛查方法之一。

Value of CT coronary angiography and treadmill exercise test in diagnosis of coronary heart disease

Objective To evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) and treadmill exercise test(TET) for the detection of significant coronary artery stenosis.Methods 254 consecutive patients with suspected coronary heart disease(CHD) were enrolled in the study and underwent CTCA,TET and coronary angiography(CAG) during two weeks.CTCA and TET reports were used to evaluate diagnostic accuracy compared with CAG in the detection of significant stenosis≥50%.Results The diagnostic accuracy of TET was sensitivity 60.8%,specificity 64.7%,positive predictive value(PPV) 82.5%,negative predictive value (NPV) 37.6%and accuracy rate(AR) 61.8%,that of CTCA was sensitivity 84.9%,specificity 80.9%,PPV 92.4%,NPV 66.3%and AR 83.9%.When CTCA combined with TET,sensitivity was 88.3%,specificity 86.0%,PPV 94.2%,NPV 74.0%and AR 87.7%.The difference in diagnostic accuracy between TET and CTCA was significant,that between TET and CTCA combined with TET was also significant(P<0.05).CTCA could detect more plaques in LMCA than CAG (P<0.01).Conclusions CTCA or CTCA combined with TET has significantly higher diagnostic accuracy compared with only TET.CTCA has an advantage in detecting LMCA plaques. CTCA can be used as one of the diagnostic methods in patients with suspected CHD.