静息超声心动图对冠心病及相关病变血管的临床诊断价值

目的评估静息超声心动图对冠心病及相关病变血管的临床诊断价值。方法对165例临床拟诊为冠心病的患者均行静息超声心动图和冠脉造影检查,以冠脉造影结果为标准,评估静息超声心动图诊断冠心病的准确性,通过室壁节段性运动异常推测相关病变血管,并比较心绞痛组和心肌梗死组超声心动图诊断的准确性及与不同病变血管的关系。结果①静息超声心动图诊断冠心病的敏感性为46.4%,特异性为92.5%,阳性预测值95.08%,阴性预测值35.57%,对于心肌梗死组及相关病变血管诊断的敏感性均显著高于心绞痛组,差异有统计学意义(P<0.05);②随着病变支数的增加,诊断的敏感性有所增加,但差异无统计学意义(P>0.05);③超声心动图对于推测LAD病变的敏感性和特异性高于LCX和RCA,但差异无统计学意义(P>0.05);④超声心动图阳性组中严重狭窄的冠状动脉(≥90%)所占的比例显著高于超声心动图阴性组,差异有统计学意义(P<0.05)。结论静息超声心动图对于诊断冠心病心绞痛有一定的局限性,但对于诊断心肌梗死有重要的定性和定位价值,且对冠脉病变范围和严重程度的评价有一定意义。

Clinical value of echocardiography at rest in the diagnosis of coronary heart disease and the related lesion artery

Objective To evaluate the clinical value of echocardiography at rest in the diagnosis of coronary heart disease(CHD)and the related lesion artery.Methods A total of 165 patients with suspected CHD were examined with both echocardiography at rest and coronary angiography(CAG).With the CAG results as the diagnostic standard,the diagnostic accuracy was evaluated.The related lesion artery was concluded according to the regional wall motion abnormality(RWMA).The patients with CHD were divided into two groups;myocardial infarction group and angina pectoris group.The diagnostic accuracy and its relationship with the different lesion artery were compared between two groups.Results①The sensitivity,specificity,positive predictive value and negatitve predictive value of echocardiography at rest in the diagnosis of CHD were 46.4%,92.5%,95.08%and 35.57%,respectively.The sensitivities in the diagnosis of myocardial infarction and its related lesion artery were significantly higher than those of angina pectoris(P<0.05).②The sensitivity had a tendency to increase with the increased number of lesion artery,but there was no significant difference(P> 0.05).③The sensitivity and the specificity for the left anterior descending(LAD)lesion tended to be higher than those for the left circumflex (LCX)and the right coronary artery(RCA),but there was no significant difference(P>0.05).④The proportion of severe lesion coronary artery(>90%)in abnormal echocardiography group was significantly higher than that in normal group(P<0.05). Conclusion Although echocardiography at rest has its limitations in the diagnosis of angina pectoris,it plays a very important role in the qualitative analysis and positioning diagnosis for myocardial infarction,and its value in evaluating the extent and severe degree of coronary artery lesion has to be paid more attention to.