Service de cardiologie et maladies vasculaires, CCP-CHU de Pontchaillou, 2, rue Le-Guilloux, 35033 Rennes cedex 9, France.
Arch Cardiovasc Dis. 2009 Oct;102(10):685-96. doi: 10.1016/j.acvd.2009.06.004. Epub 2009 Oct 2.
Meta-analyses have confirmed the high performance of multislice computed tomography (MSCT) in coronary stenosis detection. Recent reports have described the study of left ventricular anatomy and function and coronary venous anatomy with MSCT.
We sought to compare, in patients with cardiomyopathy of unknown origin, the performance of MSCT versus angiography for significant coronary artery disease detection and versus transthoracic echocardiography (TTE) for left ventricular anatomy and function evaluation, and to assess its ability to characterize coronary venous anatomy.
Fifty-nine patients with cardiomyopathy (left ventricular ejection fraction [LVEF] less than or equal to 40%) of unknown origin, in sinus rhythm, underwent MSCT, TTE and coronary angiography.
Twenty-four (3%) of 724 analysable coronary segments (97%) and 12 (20%) patients had significant coronary artery disease. MSCT sensitivity, specificity, and positive and negative predictive values for coronary artery disease detection were 87.5%, 98.5%, 67.7% and 99.6% in the per-segment assessment and 100%, 91%, 75% and 100% in the per-patient evaluation, respectively. Statistical analyses showed good agreement between MSCT and TTE in LVEF measurement (33+/-10% vs 32+/-11%, p=0.4, mean difference=0.7%, limits of agreement+/-13.6%) and a small LVED diameter overestimation (65.0+/-9.3mm vs 63.6+/-9.4mm, p=0.03). MSCT allowed detection of the posterolateral vein in 86% of cases.
In selected patients presenting with idiopathic cardiomyopathy, MSCT is accurate for coronary artery disease detection and is a useful coronary venous imaging tool. MSCT studies of left ventricular function and morphology were mostly concordant with TTE measurements.
荟萃分析已经证实多层螺旋 CT（MSCT）在冠状动脉狭窄检测方面的高性能。最近的报告描述了 MSCT 对左心室解剖结构和功能以及冠状静脉解剖结构的研究。
我们旨在比较在原因不明的心肌病患者中，MSCT 对冠状动脉疾病检测的性能与血管造影相比，以及对左心室解剖结构和功能评估的性能与经胸超声心动图（TTE）相比，并评估其对冠状静脉解剖结构的描述能力。
59 例原因不明的心肌病（左心室射血分数[LVEF]≤40%）患者，窦性心律，接受了 MSCT、TTE 和冠状动脉造影。
24 个（3%）724 个可分析的冠状动脉节段（97%）和 12 个（20%）患者有显著的冠状动脉疾病。MSCT 对冠状动脉疾病检测的敏感性、特异性、阳性和阴性预测值在节段评估中分别为 87.5%、98.5%、67.7%和 99.6%，在患者评估中分别为 100%、91%、75%和 100%。统计分析显示，MSCT 与 TTE 在 LVEF 测量方面具有良好的一致性（33±10% vs 32±11%，p=0.4，平均差值=0.7%，+/-13.6%的一致性界限），以及对 LVED 直径的轻微高估（65.0±9.3mm vs 63.6±9.4mm，p=0.03）。MSCT 能够在 86%的病例中检测到后外侧静脉。
在患有特发性心肌病的特定患者中，MSCT 对冠状动脉疾病的检测是准确的，并且是一种有用的冠状静脉成像工具。MSCT 对左心室功能和形态的研究与 TTE 测量结果大多一致。
