动态心电图结合CT血管造影对无痛性心肌缺血的诊断价值

目的 探讨动态心电图结合CT血管造影(CTA)检查对无痛性心肌缺血的诊断价值.方法 回顾性分析144例有心肌缺血表现患者的24h动态心电图及发生无痛性心肌缺血(SMI)的患者的CT血管造影(CTA)结果.结果 动态心电图检测出ST段压低者120例,ST段抬高者24例;SMI 93例(64.6％),心绞痛48例(33.3％),急性心肌梗死(AMI)3例(2.1％).93例SMI的CTA检查显示71例(76.3％)阳性,其中冠状动脉狭窄＞70％者42例(59.0％).冠状动脉狭窄50％～70％者29例(40.8％).CTA显示病变血管共172支(狭窄＞70％的病变血管69支),单支病变20例,2支病变33例,3支病变18例.累及左主干4支,左回旋支42支,左前降支65支,右冠状动脉61支.22例(23.7％)CTA结果阴性.结论 动态心电图并选择性地结合CTA可提高无痛性心肌缺血的诊断率价值.

Dynamic electrocardiogram combined with the value of coronary CT in the diagnosis of silent myocardial ischemia

Objective To explore the diagnostic value of the dynamic electrocardiogram combined with cor- onary computer tomography angiography （CTA） for patients with suspected silent myocardial ischemia. Methods The 24-hour Holter monitoring electrocardiograms of 144 patients with myocardial ischemia were analyzed retrospec- tively, and were compared with coronary CTA of 122 patients with silent myocardial ischemia （SMI）. Results ST segment depression was detected in 120 cases, ST segment elevation was detected in 24 cases. Among these cases, 93 cases were SMI （64.6%）, 48 cases were painless myocardial infarction（PMI） （33.3%）, 3 cases were acute myocardial infarction（AMI） （2.1% ）. Among 93 SMI, the CTA findings of 71 cases （76.3%） were positive, in- cluding coronary artery stenosis 〉 70% in 42 cases （ 59% ）, coronary artery stenosis 50% - 70% in 29 cases （41%）. In CTA display, 172 stenosis coronary arteries were found （stenosis 〉70% lesion were 69 arteries）, 20 cases had single vessel disease, 33 cases had 2 lesions and 18 cases had 3 lesions. Four cases involved left main coronary artery, 42 cases involved left circumflex artery, 65 cases involved left anterior descending and 61 cases in- volved right coronary artery. CTA findings of 22 cases （23.7%） were negative. Conclusion As a noninvasive, e- conomic and easy method of cardiac examination, dynamic electrocardiography may reduce the probability of AMI and sudden death due to SMI.