Cademartiri Filippo, Mollet Nico R, Runza Giuseppe, Baks Timo, Midiri Massimo, McFadden Eugene P, Flohr Thomas G, Ohnesorge Bernd, de Feyter Pim J, Krestin Gabriel P
Department of Radiology, Erasmus Medical Center, Dr. Molewaterplein, 40, Rotterdam 3015GD, The Netherlands.
AJR Am J Roentgenol. 2006 Mar;186(3):634-8. doi: 10.2214/AJR.04.1797.
The objective of our study was to compare diagnostic accuracy of MDCT coronary angiography in a population of patients with mild heart rhythm irregularities before and after editing the ECG.
Thirty-eight patients who underwent MDCT coronary angiography and conventional coronary angiography were enrolled in the study. The inclusion criterion was the presence of mild heart rhythm irregularities (i.e., premature beats; atrial fibrillation; mistriggering; or low heart rate, defined as 40 beats per minute or less) during the scan. All patients underwent MDCT with the following parameters: 16 detectors; collimation, 0.75 mm; gantry rotation time, 375 msec; 120 kV; and effective milliampere-second setting, 500-600. Images were reconstructed in two settings: before ECG editing and after ECG editing (i.e., arbitrary modification of temporal windows within the cardiac cycle at the site of mild heart rhythm irregularities). Data sets were scored for the presence of significant stenoses (> or = 50% lumen reduction) in coronary segments > or = 2 mm diameter. The results of the two groups were compared with a McNemar test, and a p value of less than 0.05 was considered significant.
The sensitivity, specificity, and negative and positive predictive values of MDCT coronary angiography for the detection of significant stenoses before and after ECG editing were 63% (41/65) and 92% (78/85); 97% (251/260) and 96% (305/317); 87% (62/71) and 87% (81/93); 91% (251/275) and 97% (305/313), respectively (p < 0.05). The proportion of nonassessable segments was reduced from 17% (70/416) before ECG editing to 2% (10/416) after.
ECG editing significantly improves diagnostic accuracy in a selected population of patients with mild heart rate irregularities.
我们研究的目的是比较在编辑心电图前后，多排螺旋CT冠状动脉造影（MDCT）对轻度心律不齐患者人群的诊断准确性。
38例行MDCT冠状动脉造影和传统冠状动脉造影的患者纳入本研究。纳入标准为扫描期间存在轻度心律不齐（即早搏；心房颤动；误触发；或心率低，定义为每分钟40次或更少）。所有患者均接受MDCT检查，参数如下：16排探测器；准直，0.75毫米；机架旋转时间，375毫秒；120千伏；有效毫安秒设置，500 - 600。图像在两种情况下重建：心电图编辑前和心电图编辑后（即在轻度心律不齐部位任意修改心动周期内的时间窗）。对直径≥2毫米的冠状动脉节段进行评分，以确定是否存在显著狭窄（管腔缩小≥50%）。两组结果采用McNemar检验进行比较，p值小于0.05被认为具有统计学意义。
心电图编辑前后，MDCT冠状动脉造影检测显著狭窄的敏感性、特异性、阴性和阳性预测值分别为63%（41/65）和92%（78/85）；97%（251/260）和96%（305/317）；87%（62/71）和87%（81/93）；91%（251/275）和97%（305/313）（p < 0.05）。不可评估节段的比例从心电图编辑前的17%（70/416）降至编辑后的2%（10/416）。
心电图编辑显著提高了特定轻度心率不齐患者人群的诊断准确性。
