320排CT用于风湿性左房室瓣病变伴房颤患者术前筛查冠心病

目的 探讨风湿性二尖瓣病变伴房颤患者术前320排CT冠脉成像检查（CTCA）诊断冠心病准确性，探索其运用于心脏瓣膜病术前筛查冠心病的可行性。方法 选取35例风湿性二尖瓣病变伴持续性房颤患者，瓣膜术前先后接受320排CT冠脉成像检查和选择性冠状动脉造影检查(CCA)。通过Pearson积差相关系数评价CT图像质量与平均心率的相关性。以冠脉造影为对照，从节段、血管及患者3方面计算CT诊断冠脉管腔内狭窄≥50%的灵敏度、特异度、阳性预测值、阴性预测值。采用Kappa值评价CTCA与CCA诊断冠心病的一致性。结果 35位患者平均心率94.7±21.4次/分，右冠状动脉中段与平均心率相关系数r=0.554、P=0.002，回旋支中段与平均心率相关系数r=0.558，P=0.016。在节段水平CT诊断冠心病的灵敏度，特异度、阳性预测值及阴性预测值分别为：87.5%、99.4%、82.4%和 99.6%；血管水平：87.5%、97.6% 、82.4%和98.4%；患者水平：84.6%, 86.3%,78.6%和90.5%。Kappa值分别为0.843、0.828及0.699。结论 320排CT冠脉成像检查诊断冠心病准确性较高，可运用于风湿性心脏病二尖瓣病变伴房颤患者术前筛查。

320-detector row CT coronary angiography in pre-operation screening of coronary artery disease in patients with rheumatic left artrioventricular valve disease and atrial fibrillation

Objective To evaluate the diagnostic accuracy of 320-detector row CT coronary angiography(CTCA)in detecting preoperative coronary artery disease(CAD) in patients with atrial fibrillation(AF) and rheumatic left artrioventricular valve disease(RMVD),so as to assess its feasibility in screening CAD before operation for RMVD.Methods Thirty-five RMVD patients with persistent CAD were enrolled in the present study.All the patients underwent both CTCA and conventional coronary angiography(CCA) before operation.The relationship between mean heart rate and CT image quality was evaluated by Pearson’s correlation coefficient.The sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) of CTCA in diagnosis of stenosis(≥50%) were calculated using the conventional coronary angiography as the reference.Kappa statistics was used to assess the agreement between 320-detector CTCA and CCA in detecting CAD.Results The mean heart rate was 94.7±21.4 beats/min in the 35 patients.There was a significant correlation between the mean heart rate and image quality,especially for middle segment of right coronary artery(r=0.554,P=0.002) and middle segment of the circumflex artery(r=0.559,P=0.016).The sensitivity,specificity,PPV and NPV of CTCA in diagnosing CAD were 87.5%,99.4%,82.4% and 99.6% in segment-based analysis,87.5%,97.6%,82.4% and 98.4% in vessel-based analysis,and 84.6%,86.3%,78.6% and 90.5% in patient-based analysis,respectively.The kappa statistics were 0.843,0.828 and 0.699,respectively.Conclusion CTCA has a high accuracy in diagnosing CAD,and it can be used for preoperation screening of patients with AF and RMVD.