冠脉CTA心肌血流指数诊断钙化斑块相关冠心病的临床意义  

Clinical significance of myocardial blood flow index derived from CCTA in the diagnosis of calcified plaque-related coronary artery disease

作　　者：熊青峰[1] 马小静[1] 陈艳[1] 吴洋[1] 许娟[1] 张甜[1] 何俊[1] 刘整 XIONG Qing-feng;MA Xiao-jing;CHEN Yan(Department of Imaging,the Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院影像科

出　　处：《放射学实践》2019年第12期1327-1331,共5页Radiologic Practice

基　　金：武汉市卫健委医学项目(WX18C01);中国临床试验注册中心(ChiCTR1800018376)

摘　　要：目的:评价冠状动脉CT血管成像心肌血流指数(CCTA-MFI)对冠脉钙化斑块相关冠心病的临床诊断价值。方法:回顾性连续搜集2018年2月-2018年12月在本院门诊首诊疑似冠心病、GRACE院内死亡风险评分为低危、行CCTA检查的570例患者的病例资料,从中筛选出图像质量优秀、CCTA检查发现严重的冠状动脉管壁钙化斑块、且随后行侵入性冠状动脉造影(ICA)检查的94例患者作为研究对象。测量每例患者的心率和血压,间隔10分钟,测量3次,取平均值;记录身高、体重并计算体质指数(BMI)。在CCTA图像上测量狭窄血管的直径,计算血管狭窄率(R CCTA);运用CT后处理软件计算左心室心肌容积和MFI值。CCTA图像上按照管腔重度狭窄(R CCTA>70%)或疑似重度狭窄(R CCTA>50%)判为阳性结果,MFI按照其数值小于2倍标准差即为阳性结果(提示心肌缺血)。以ICA为金标准(血管狭窄程度>70%诊断为冠心病),分析R CCTA和CCTA-MFI诊断结果与ICA的一致性,并进行ROC曲线分析,两个指标间诊断效能的比较采用卡方检验。结果:94例患者中,男50例,女44例,年龄(63.3±9.31)岁。ICA诊断62例(65.96%)患者的冠脉狭窄程度>70%,R CCTA和CCTA-MFI与ICA的相关系数分别为0.4854(P<0.05)和-0.4351(P<0.05),截断值分别为40%和0.110,据此两者判断阳性病例分别为85和61例,以ICA为金标准,两者诊断冠心病的敏感度和特异度分别为98.31%、28.57%和81.54%、82.76%,阳性和阴性预测值分别为69.88%、90.91%和91.38%、66.67%,诊断符合率分别为68.09%和81.91%,差异具有统计学意义(χ2=7.262,P=0.0070);ROC曲线下面积分别为0.529和0.732,差异有统计学意义(Z=2.367,P=0.0179)。结论:CCTA检查中测量MFI可明显提高对冠状动脉钙化斑块相关冠心病的诊断准确性,对于冠脉钙化严重且伴有MFI减低的冠心病疑似患者可能临床上应高度重视。Objective:To evaluate the clinical significance of myocardial blood flow index derived from coronary CT angiography(CCTA-MFI)in the diagnosis of calcified plaque-related coronary artery disease.Methods:570 patients with suspected CAD and low GRACE mortality risk score were enrolled in this study in our hospital from February 2018 to December 2018,and then 94 patients(50 males and 44 females with mean age of[(63.3±9.31)years]with excellent image quality of CCTA and severe calcified plaque in the proximal and middle segments of coronary artery were enrolled at last.All underwent invasive coronary angiography(ICA)within one week after the protocol of CCTA.For each patient,the heart rate and the blood pressure were measured three times with a interval of 10 minutes.At the same time,the body mass index(BMI)was calculated according to the height and weight.On CCTA images,the diameter of coronary artery was measured,and the stenosis rate(R CCTA)was calculated.Left ventricular myocardial volume was calculated by post-processing software,and MFI was obtained.On CCTA images,severe stenosis(R CCTA>70%)or suspected severe stenosis(R CCTA>50%)was named positive result;and if MFI was more than 2 times of the standard deviation,the result was positive.According to the gold standard of ICA(the degree of stenosis>70%was diagnosed as CAD),the consistency of the diagnosis results between CCTA and ICA,and CCTA-MFI and ICA,was analyzed,and the ROC curve analysis was made.Chi square test was used to compare the diagnostic efficacy between the two indexes.Results:A total of 62 cases(65.96%,62/94)were diagnosed as CAD by ICA.The correlation coefficients of R CCTA and CCTA-MFI with ICA were 0.4854(P<0.05)and-0.4351(P<0.05),respectively;the cutoff value for diagnosis of CAD was 40%and 0.110,and the corresponding positive result was found in 85 and 61 cases,respectively.The sensitivity and specificity were 98.31%,28.57%and 81.54%,82.76%,respectively;the positive and negative predictive values were 69.88%and 90.91%,and 91.38%and 66.67%,res

关 键 词：冠状动脉疾病 体层摄影术 X线计算机 血管造影 钙化斑块 心肌血流指数 诊断试验 

分 类 号：R543.3[医药卫生—心血管疾病] R814.42[医药卫生—内科学]