多排螺旋CT评估老年冠心病患者的冠状动脉病变严重性与左心室收缩功能

目的探讨多排螺旋CT（MDCT）在评估老年冠心病中的应用价值。方法选取2018年1月~2020年2月在我院治疗的老年冠心病患者110例，在我院行MDCT、超声心动图及冠状动脉造影（CAG）检查，以CAG为“金标准”，分析MDCT诊断价值，比较MDCT和超声心动图测量左室射血分数（LVEF）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室心肌质量（LVMM）、左室每搏输出量（LVSV）和左室短轴缩短率（LVFS）差异。结果MDCT诊断灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为93.80%、93.49%、93.73%、97.98%和81.77%；与超声心动图比较，MDCT测量LVEF、LVEDV、LVESV、LVMM、LVSV和LVFS差异无统计学意义（P < 0.05）；MDCT测量，高度狭窄患者LVEF、LVSV和LVFS低于轻度狭窄和中度狭窄患者（P < 0.05），而LVEDV、LVESV和LVMM高于轻度狭窄和中度狭窄患者（P < 0.05）；Gensini评分与LVEF、LVSV和LVFS呈负相关（r=-0.433、-0.412、-0.422，P < 0.05），与LVEDV、LVESV和LVMM呈正相关（r=0.410、0.366、0.378，P < 0.05）。结论MDCT在老年冠心病诊断中有较好的价值，其可准确评估左心室功能，与冠状动脉狭窄程度有关。 

Clinical significance of MDCT in evaluating the severity of coronary artery disease and left ventricular systolic function in elderly patients with CHD

ObjectiveToo discuss the application value of multi- slice spiral CT (MDCT) in the evaluation of elderly coronary heart disease (CHD).Methods110 elderly patients with CHD treated in our hospital from January 2018 to February 2020 were selected. Among them, the MDCT, echocardiography and coronary angiography (CAG) were performed in our hospital. The CAG was used as the "gold standard" to analyze the diagnostic value of MDCT. The left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular myocardial mass (LVMM), left ventricular stroke volume (LVSV) and left ventricular short axis shortening rate (LVFS) measured by MDCT and echocardiography were compared.ResultsThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MDCT diagnosis were 93.80%, 93.49%, 93.73%, 97.98% and 81.77%, respectively. Compared with echocardiography, MDCT showed no significant difference in LVEF, LVEDV, LVESV, LVMM, LVSV and LVFS (P < 0.05). MDCT showed that LVEF, LVSV and LVFS in patients with severe stenosis were significantly lower than those in patients with mild and moderate stenosis (P < 0.05), while LVEDV, LVESV and LVMM were significantly higher than those in patients with mild and moderate stenosis (P < 0.05). Gensini score were negatively correlated with LVEF, LVSV and LVFS (r=-0.433, -0.412 and -0.422, P < 0.05), and positively correlated with LVEDV, LVESV and LVMM (r=0.410, 0.366 and 0.378, P < 0.05).ConclusionMDCT has a good value in the diagnosis of CHD in the elderly, which can accurately evaluate left ventricular function and is related to the degree of coronary artery stenosis.