以定量冠状动脉造影为"金标准"评价ATP负荷心肌灌注显像对冠心病的诊断价值  

Diagnostic value of ATP stress myocardial perfusion imaging in detecting coronary artery disease with quantitative coronary angiography as the gold standard

作　　者：杜艳 王雅雯 张海龙 张宗耀 汪蕾 方纬 Du Yan;Wang Yawen;Zhang Hailong;Zhang Zongyao;Wang Lei;Fang Wei(Department of Nuclear Medicine,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen,Shenzhen 518057,China;Department of Nuclear Medicine,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院深圳医院核医学科,深圳518057 [2]中国医学科学院阜外医院核医学科,北京100037

出　　处：《中华核医学与分子影像杂志》2023年第2期70-74,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的以定量冠状动脉造影(QCA)为"金标准",评价ATP负荷心肌灌注显像(MPI)对冠状动脉粥样硬化性心脏病(简称冠心病)的诊断价值。方法前瞻性纳入2018年5月至2018年12月在中国医学科学院阜外医院行ATP负荷/静息MPI并于1个月内行冠状动脉造影(CAG)的连续病例95例[男65例、女30例,年龄(56.2±8.5)岁],观察ATP负荷试验的不良反应,并对MPI结果行半定量分析,获得负荷总积分(SSS)、静息总积分(SRS)及差值总积分(SDS);对CAG图像行定量分析,获得QCA冠状动脉狭窄程度(冠状动脉直径狭窄百分比)。以QCA作为"金标准",计算ATP负荷MPI的诊断效能。采用Pearson相关分析SSS与QCA冠状动脉直径狭窄百分比间的相关性。结果95例患者中,ATP负荷试验不良反应发生率为73.7%(70/95),停药后均能自行缓解。ATP负荷MPI诊断冠状动脉狭窄≥50%的灵敏度为45.3%(24/53),特异性为81.0%(34/42),阳性预测值75.0%(24/32),阴性预测值54.0%(34/63),准确性为61.1%(58/95);ATP负荷MPI诊断冠状动脉狭窄≥70%的灵敏度为15/16,特异性为78.5%(62/79),阳性预测值46.9%(15/32),阴性预测值98.4%(62/63),准确性为81.1%(77/95)。SSS与QCA冠状动脉狭窄程度具有中度相关性(r=0.418,P=0.017)。结论ATP负荷MPI在冠心病心肌缺血诊断中具有一定的临床应用价值。Objective To assess the diagnostic value of ATP stress myocardial perfusion imaging(MPI)in detecting coronary heart disease(CAD)with quantitative coronary angiography(QCA)as the gold standard.Methods A total of 95 consecutive patients(65 males,30 females,age(56.2±8.5)years)who underwent ATP stress/rest MPI and coronary angiography(CAG)within one month in Fuwai Hospital,Chinese Academy of Medical Sciences from May 2018 to December 2018 were enrolled prospectively.The adverse reactions of ATP stress test were observed.Semi-quantitative analysis was performed on MPI results,and the summed stress score(SSS),summed rest score(SRS)and summed difference score(SDS)were obtained.Quantitative analysis was performed on CAG images,and the degree of QCA coronary artery stenosis was analyzed.Using QCA as the gold standard,the diagnostic efficiency of ATP stress MPI was calculated.Pearson correlation analysis was performed to analyzed the relationship between SSS and the degree of QCA coronary artery stenosis.Results In 95 cases,the incidence of adverse reactions in ATP stress test was 73.7%(70/95),which could be relieved automatically after drug withdrawal.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ATP stress MPI in diagnosing coronary artery stenosis≥50%were 45.3%(24/53),81.0%(34/42),75.0%(24/32),54.0%(34/63)and 61.1%(58/95)respectively,which were 15/16,78.5%(62/79),46.9%(15/32),98.4%(62/63),and 81.1%(77/95)respectively in diagnosing coronary artery stenosis≥70%.There was moderate correlation between SSS and the degree of QCA coronary artery stenosis(r=0.418,P=0.017).Conclusion ATP stress MPI has a clinical value in the diagnosis of myocardial ischemia in CAD.

关 键 词：冠心病 心肌灌注显像 冠状血管造影术 腺苷三磷酸 

分 类 号：R541.4[医药卫生—心血管疾病]