Diagnostic performance of synchronous 12-lead ambulatory electrocardiogram combined with spiral CT in coronary vascular lesions
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摘要:
目的研究同步12导联动态心电图（AECG）联合螺旋CT对冠脉血管病变程度的诊断效能。 方法选择本院2018年4月~ 2020年8月诊治的90例冠心病患者作为研究对象，均在本院接受螺旋CT和AECG检查，根据患者冠脉血管病变程度将患者分为A组（单支病变）和B组（多支病变）。以冠状动脉造影为金标准，分析比较两种方法联合对冠脉血管病变程度的诊断价值。 结果两组患者心率、房室性早搏、房速、室速比较无统计学意义（P > 0.05），但A组患者ST、ST/HR均显著低于B组（P < 0.05）；A组钙化积分明显低于B组（P < 0.05）；ST、ST/HR以及钙化积分均与冠脉病变程度呈正相关（P < 0.05）；AECG联合螺旋CT诊断冠脉血管的诊断敏感度、特异度、准确率以及阳性、阴性预测值均高于单一诊断（P < 0.05）。 结论ST、ST/HR以及钙化积分变化均与冠脉血管病变密切相关，将同步12导联AECG与螺旋CT联合可提高对冠脉血管病病变程度的诊断效能。 Abstract:ObjectiveTo explore the diagnostic performance of synchronous 12-lead ambulatory electrocardiogram (AECG) combined with spiral CT in coronary vascular lesions. MethodsBetween April 2018 and August 2020, 90 patients with coronary heart disease who were subjected to spiral CT and AECG examinations were enrolled. According to the degree of coronary vascular lesions, the patients were divided into group A and B. Taking coronary angiography as the golden standard, the diagnostic value of the combination of the two methods for coronary vascular lesions was evaluated. ResultsThe differences in HR, atrioventricular premature beats, atrial tachycardia, and ventricular tachycardia between the two groups were not significant (P > 0.05), but the ST and ST/HR of group A were significantly lower than those of group B (P < 0.05). Group A had significantly lower calcification scores than group B (P < 0.05). ST, ST/HR and calcification scores were positively correlated with the degree of coronary artery lesions (P < 0.05). The sensitivity, specificity, accuracy rate, positive and negative predictive values of AECG combined with spiral CT in the diagnosis of coronary vascular lesions were higher than those of single diagnosis (P < 0.05). ConclusionThe changes of ST, ST/HR and calcification scores are closely related to coronary vascular lesions. Combining synchronous 12-lead AECG with spiral CT can improve the diagnostic efficiency. -
Key words:
- 12-lead /
- ambulatory electrocardiogram /
- spiral CT /
- coronary blood vessel /
- severity of lesion
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图 1 ST、ST/HR以及钙化积分与冠脉病变程度的相关性分析
A: ST与冠脉病变程度呈正相关; B: ST/HR与冠脉病变程度呈正相关; C: 钙化积分与冠脉病变程度呈正相关.
Figure 1. Correlation analysis of ST, ST/HR, calcification score and the degree of coronary artery lesions.
图 2 冠心病患者螺旋AECG联合CT检查图像分析
A: VR图像, 冠脉左前降支混合斑并管腔中-重度狭窄; B: 冠状图像, 左前降支多发硬斑致管腔中-重度狭窄; C: 轴位图像, 冠脉左前降支混合斑并管腔中-重度狭窄; D: 冠状图像, 左前降支多发硬斑致管腔中-重度狭窄.
Figure 2. AECG and CT images of patients with CHD.
表 1 多组间AECG指标比较
Table 1. Comparison of AECG indexes between the groups (Mean±SD)
分组 心率（次/min） 房性早搏（ms） 室性早搏（ms） 房速（ms） 室速（ms） ST（mV） ST/HR（μv/bpm） A组（n=41） 68.18±6.83 365.24±132.38 61.27±18.63 5.19±1.84 0.32±0.11 1.05±0.37 1.62±0.58 B组（n=49） 71.06±7.39 318.62±129.48 69.34±30.24 4.52±1.72 0.38±0.20 1.69±0.65 2.37±0.71 t 1.905 1.680 1.488 1.783 1.715 5.589 5.417 P 0.060 0.097 0.140 0.078 0.090 < 0.001 < 0.001 
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表 2 ST、ST/HR以及钙化积分与冠脉病变程度的相关性
Table 2. Correlation between ST, ST/HR, calcification score and the degree of coronary artery lesions
项目 r P ST 0.633 < 0.001 ST/HR 0.543 < 0.001 钙化积分 0.724 < 0.001
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表 3 AECG联合螺旋CT诊断情况
Table 3. Diagnosis by AECG combined with spiral CT
检查方法 冠状动脉造影 单支病变 多支病变 合计 AECG 单支病变 29 28 57 多支病变 12 21 33 合计 41 49 90 螺旋CT 单支病变 25 5 30 多支病变 16 44 60 合计 41 49 90 AECG联合螺旋CT 单支病变 35 3 38 多支病变 6 46 52 合计 41 49 90
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表 4 三种诊断方法的诊断效能比较
Table 4. Comparison of diagnostic efficiency among the three methods (%)
检查方法 敏感度 特异度 准确率 阳性预测值 阴性预测值 AECG 70.73 42.86* 55.56* 50.88* 63.64* 螺旋CT 60.98* 89.80 76.67 83.33 73.33 AECG联合螺旋CT 85.37 93.88 90.00 92.11 88.46 *P < 0.05 vs AECG联合螺旋CT组.
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