螺旋计算机断层扫描在检测二尖瓣环钙化作为冠状动脉疾病标志物中的应用价值。

Usefulness of helical computed tomography in detection of mitral annular calcification as a marker of coronary artery disease.

作者信息

Adler Yehuda, Fisman Enrique Z, Shemesh Joseph, Tanne David, Hovav Boaz, Motro Michael, Schwammenthal Ehud, Tenenbaum Alexander

机构信息

Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.

出版信息

Int J Cardiol. 2005 Jun 8;101(3):371-6. doi: 10.1016/j.ijcard.2004.03.044.

DOI:10.1016/j.ijcard.2004.03.044

PMID:15907403

Abstract

BACKGROUND

Mitral annulus calcification (MAC) may be a form of atherosclerosis. The goal of the present work was to investigate whether helical CT can determine the presence of MAC and to clarify its possible association with coronary artery disease (CAD) in elderly patients.

DESIGN AND METHODS

Three hundred and twenty-nine consecutive elderly patients (165 men and 164 women, age range 60-79 years) underwent double helical CT of the heart to determine MAC and coronary calcifications (CC) according to a previously described protocol.

RESULTS

MAC was documented in 60 patients (25 men, 35 women; mean age 69 +/- 4.5 years, range 60-78 years). The non-MAC group (control) included 269 patients (140 men, 129 women; mean age 67 +/- 4.6 years, range 60-79 years). Age was the only risk factor which had significant association with MAC (p = 0.01). A significant difference was found between MAC and control group for mean total CC score and advanced CC (total CC > 300) (323 +/- 565 vs. 184 +/- 429, p = 0.033 and 30% vs. 16%, p = 0.017, respectively). A significant difference was also found between groups for the prevalent proven CAD (30% vs. 16%, p = 0.008). Stepwise logistic regression analysis identified age [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.7-6.4, p < 0.001)], gender (male) (OR 3.1, 95% CI 1.6-6.0, p = 0.001), and MAC (OR 2.4, 95% CI 1.2-5.0, p = 0.016) as the independent variables significantly associated with CAD. The independent variables significantly associated with advanced CC (TCS > 300) were MAC (OR 2.6, 95% CI 1.3-5.2, p = 0.005), gender (male) (OR 2.3, 95% CI 1.2-4.2, p = 0.012) and age (OR 1.9, 95% CI 1.0-3.7, p = 0.052).

CONCLUSIONS

Our study demonstrated the usefulness of helical computed tomography in the detection of mitral annular calcification as an additional marker of prevalent CAD. However, the diagnostic significance of the MAC detection is relatively minor and should not be considered as a direct proof for coronary atherosclerosis.

摘要

背景

二尖瓣环钙化（MAC）可能是动脉粥样硬化的一种形式。本研究的目的是探讨螺旋CT能否确定MAC的存在，并阐明其与老年患者冠状动脉疾病（CAD）的可能关联。

设计与方法

329例连续的老年患者（165例男性，164例女性，年龄范围60 - 79岁）按照先前描述的方案接受心脏双螺旋CT检查，以确定MAC和冠状动脉钙化（CC）。

结果

60例患者（25例男性，35例女性；平均年龄69±4.5岁，范围60 - 78岁）记录有MAC。非MAC组（对照组）包括269例患者（140例男性，129例女性；平均年龄67±4.6岁，范围60 - 79岁）。年龄是与MAC有显著关联的唯一危险因素（p = 0.01）。MAC组与对照组在平均总CC评分和重度CC（总CC>300）方面存在显著差异（分别为323±565 vs. 184±429，p = 0.033；30% vs. 16%，p = 0.017）。两组在已证实的CAD患病率方面也存在显著差异（30% vs. 16%，p = 0.008）。逐步逻辑回归分析确定年龄[比值比（OR）3.3，95%置信区间（CI）1.7 - 6.4，p < 0.001]、性别（男性）（OR 3.1，95% CI 1.6 - 6.0，p = 0.001）和MAC（OR 2.4，95% CI 1.2 - 5.0，p = 0.016）为与CAD显著相关的独立变量。与重度CC（TCS>300）显著相关的独立变量为MAC（OR 2.6，95% CI 1.3 - 5.2，p = 0.005）、性别（男性）（OR 2.3，95% CI 1.2 - 4.2，p = 0.012）和年龄（OR 1.9，95% CI 1.0 - 3.7，p = 0.052）。