冠脉CT与冠脉造影诊断心肌桥的临床价值比较

目的:比较冠脉CT与冠脉造影诊断心肌桥的临床价值。方法:收集2015年7月~2020年7月苏州大学第二附属医院心内科收治的107例疑似冠心病患者临床资料。依次进行冠脉CT和冠脉造影检查，计算壁冠状动脉（MCA）狭窄程度，观察前降支、对角支、钝缘支、后降支和回旋支冠脉分布走行以及与心肌的关系，测量心肌桥长度和厚度。比较两种检查方法图像质量优良率、心肌桥检出率以及心肌桥测量指标。分析两种检查方法显示MCA狭窄程度和诊断心肌桥的一致性。以冠脉造影为金标准，计算敏感度、特异度、准确度、阳性预测值、阴性预测值，评估冠脉CT判断MCA中重度狭窄和诊断心肌桥的价值。结果:两种检查方法图像质量优良率均较好，冠脉CT心肌桥检出率显著高于冠脉造影（25.23% vs 14.02%, P<0.05）；冠脉CT测得心肌桥长度大于冠脉造影，MCA狭窄程度低于冠脉造影，差异具有统计学意义（P<0.05）；冠脉CT和冠脉造影显示MCA狭窄程度的一致性较好（Kappa=0.832, P<0.05）；与冠脉造影比较，冠脉CT判断MCA中重度狭窄的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.63%、86.67%、74.36%、95.59%、87.85%；冠脉CT和冠脉造影诊断心肌桥的一致性较好（Kappa=0.815, P<0.05）；与冠脉造影比较，冠脉CT诊断心肌桥的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为64.29%、73.33%、69.23%、68.75%、68.97%。结论:冠脉CT与冠脉造影对心肌桥诊断均具有一定价值，而冠脉CT具有无创性、图像质量优良率高，且对心肌桥位置及分布显示佳，并对MCA狭窄具有较高敏感度和特异度，更具临床应用优势。

Comparison of clinical value of coronary CT and coronary angiography in diagnosis of myocardial bridge

Abstract: Objective To compare the clinical value of coronary CT and coronary angiography in diagnosing myocardial bridge. Methods The clinical data of 107 patients with suspected coronary heart disease in Department of Cardiology Medicine, the Second Affiliated Hospital of Soochow University were collected. All patients received coronary CT and coronary angiography. The stenosis degree of mural coronary artery (MCA) was calculated the distributions and courses of anterior descending artery, diagonal branch, obtuse marginal branch, posterior descending artery, circumflex artery were observed, and their relationships with myocardium were analyzed and the length and depth of myocardial bridge were measured. The image quality, detection rate for myocardial bridge and measurement indexes of myocardial bridge were compared between two examination methods, and the consistency of two methods in the diagnosis of MCA stenosis degree and myocardial bridge was analyzed. Taking coronary angiography as gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for evaluating the clinical value of coronary CT in the diagnosis of moderate-to-severe MCA stenosis and myocardial bridge. Results The excellent and good rates of the quality of images obtained by two examination methods were satisfactory, but the detection rate of coronary CT for myocardial bridge was higher than that of coronary angiography (25.23% vs 14.02%, P<0.05). The length of myocardial bridge measured by coronary CT was longer than that measured by coronary angiography, and MCA stenosis degree was lower than that measured by coronary angiography, with statistical significance (P<0.05). Coronary CT and coronary angiography showed a good consistency in the diagnosis of MCA stenosis degree (Kappa=0.832, P<0.05). Compared with coronary angiography, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of coronary CT in diagnosing moderate-to-severe MCA stenosis were 90.63%, 86.67%, 74.36%, 95.59% and 87.85%, respectively. Coronary CT and coronary angiography showed a good consistency in the diagnosis of myocardial bridge (Kappa=0.815, P<0.05). Compared with coronary angiography, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of coronary CT in diagnosing myocardial bridge were 64.29%, 73.33%, 69.23%, 68.75% and 68.97%, respectively. Conclusion Both coronary CT and coronary angiography have certain value in the diagnosis of myocardial bridge. However, coronary CT has more advantages in clinical application, such as non-invasion, high image quality, clear display of the location and distribution of myocardial bridge, higher sensitivity and specificity for MCA stenosis.