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目的探讨风湿性左房室瓣病变伴房颤患者术前320排CT冠脉成像检查(CTCA)诊断冠心病的准确性,探索其运用于心脏瓣膜病术前筛查冠心病的可行性。方法选取35例风湿性左房室瓣病变伴持续性房颤患者,瓣膜术前先后接受CTCA检查和选择性冠状动脉造影检查(CCA)。通过Pearson积差相关系数评价CTCA图像质量与平均心率的相关性。以CCA为对照,从节段、血管及患者3方面计算CTCA诊断冠脉管腔内狭窄≥50%的灵敏度、特异度、阳性预测值、阴性预测值。采用Kappa值评价CTCA与CCA诊断冠心病的一致性。结果35例患者平均心率(94.7±21.4)次/min。CTCA图像质量评分中,右冠状动脉中段与平均心率相关系数r=0.554、P=0.002,回旋支中段与平均心率相关系数r=0.559、P=0.016。在节段水平CT(A)诊断冠心病的灵敏度、特异度、阳性预测值及阴性预测值分别为87.5%、99.4%、82.4%和99.6%;血管水平分别为87.5%、97.6%、82.4%和98.4%;患者水平分别为84.6%、86.3%、78.6%和90.5%。3个水平的Kappa值分别为0.843、0.828及0.699。结论CTCA检查诊断冠心病准确性较高,可运用于风湿性心脏病左房室瓣病变伴房颤患者术前筛查。
Objective To investigate the accuracy of coronary angiography (CTA) using 320-slice CT coronary angiography (CTCA) in patients with rheumatic left atrial valvulopathy and atrial fibrillation and to explore the feasibility of screening coronary heart disease before surgery for valvular heart disease. Methods Thirty-five patients with rheumatic left atrial valvular disease and persistent atrial fibrillation were selected. CTCA and selective coronary angiography (CCA) were performed before and after valve surgery. The correlation between CTCA image quality and mean heart rate was evaluated by Pearson’s product-of-difference correlation coefficient. The sensitivity, specificity, positive predictive value and negative predictive value of CTCA in diagnosing coronary stenosis ≥50% were calculated from the three aspects of CCA as control. The Kappa value was used to evaluate the consistency between CTCA and CCA in the diagnosis of coronary heart disease. Results The average heart rate of 35 patients was 94.7 ± 21.4 times / min. In the CTCA image quality score, the correlation coefficient between the middle segment of the right coronary artery and the average heart rate was 0.554, P = 0.002. The correlation coefficient between the middle segment of the circumflex artery and the average heart rate was 0.559, P = 0.016. The sensitivity, specificity, positive predictive value and negative predictive value of CT (A) in diagnosis of coronary artery disease were 87.5%, 99.4%, 82.4% and 99.6% respectively. The blood vessel levels were 87.5%, 97.6% and 82.4% And 98.4% respectively; patient levels were 84.6%, 86.3%, 78.6% and 90.5% respectively. The Kappa values of the three levels were 0.843, 0.828 and 0.699 respectively. Conclusion CTCA can diagnose coronary heart disease with high accuracy and can be applied to preoperative screening of left atrioventricular valve lesion with atrial fibrillation in patients with rheumatic heart disease.