64层CT在对踏车运动试验阴性或未达到诊断标准的胸痛患者诊断分类中的价值  

Usefulness of 64-Slice Multidetector Computed Tomography in Diagnostic Triage of Patients With Chest Pain and Negative or Nondiagnostic Exercise Treadmill Test Result

作　　者：Rubinshtein R. Halon D.A. Gaspar T. B.S. Lewis 黄欣 

机构地区：[1]Dr. Department of Cardiovascular Medicine,Lady Davis Carmel Medical Center, Haifa, Israel

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2007年第8期28-29,共2页

摘　　要：在100例疑似缺血性胸痛而踏车运动试验(ETT)结果阴性或未达到诊断标准的连续患者(年龄55.8±11.6岁,男性57%)中,检测64层多探头计算机断层扫描(MDCT)用于诊断分类的有效性。所有患者均无既往已知的冠状动脉疾病(CAD)。MDCT显示29例患者有阻塞性(≥50%)CAD;其中包括59例ETT结果阴性患者中的13例(22%),41例ETT结果未达到诊断标准患者中的16例(39%)。高危[左主干和(或)3支血管]CAD存在于3.3%的ETT阴性患者和4.9%的ETT结果未达到诊断标准患者中。29例MThe usefulness of 64-slice multidetector coronary computed tomography(MDCT) in a diagnostic triage of 100 consecutive patients(age 55.8± 11.6 years; 57% men) with chest pain suspected to be ischemic in origin and a negative or nondiagnostic exercise treadmill test(ETT) result was examined. None of the patients had previously known coronary artery disease(CAD). MDCT showed obstructive(≥ 50% ) CAD in 29 patients; 13 of 59 patients(22% ) with a negative and 16 of 41 patients(39% ) with a nondiagnostic ETT result. High-risk(left main and/or 3-vessel) CAD was present in 3.3% of patients with a negative and 4.9% with a nondiagnostic ETT result. The 29 patients with obstructive CAD on MDCT had a higher mean Agatston calcium score(221± 402 vs 40± 77 U, p< 0.001). Invasive coronary angiography confirmed MDCT findings in 26 of 29 patients(positive predictive value 90% ) and 45 of 54 stenotic segments(83% ) in a per-segment analysis. For the 71 patients without obstructive CAD on MDCT, clinically driven invasive angiography detected CAD in 1 of 15 patients(1 false-negative MDCT result) and 2 of another 5 patients who were referred for invasive angiography later during a 12-month follow-up period. In the remaining 51 patients, MDCT findings effectively allowed exclusion of obstructive CAD, and there were no major adverse clinical events during follow-up. In conclusion, in patients with chest pain possibly ischemic in origin, no previously known CAD, and a negative or nondiagnostic ETT result, contrast-enhanced 64-slice MDCT scanning was a useful tool to provide direct noninvasive coronary angiography and rapidly advance diagnostic triage.

关 键 词：踏车运动试验 CT 诊断标准 胸痛 支血管 计算机断层扫描 阳性预测值 血管造影 临床事件 无阻塞 

分 类 号：R816.4[医药卫生—放射医学]