Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
Int J Cardiovasc Imaging. 2012 Jun;28(5):1173-80. doi: 10.1007/s10554-011-9907-1. Epub 2011 Jun 19.
It has been previously reported that the sensitivity and specificity of multislice CT for detecting significant CAD (coronary artery disease) is high. Chest pain is a common presentation in patients with uncontrolled hypertension. We investigated the sensitivity and specificity of dual-source CT to detect and rule out significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. 260 consecutive patients presenting with acute chest pain in the context of stage 2 hypertension (systolic pressure ≥160 and/or diastolic pressure ≥100) were enrolled in the study. After admission, control of blood pressure and risk stratification, 82 patients were excluded due to renal insufficiency, prior coronary revascularisation or refused participation in the study. 90 further patients with low pre-test probability of CAD were also excluded. 88 remaining patients were subjected to CT coronary angiography using dual-source CT (Definition, Siemens Medical Solutions, Forchheim, Germany) within 24 h before invasive coronary angiography. A contrast-enhanced volume dataset was acquired (120 kV, 400 mAs/rot, collimation 2 × 64 × 0.6 mm, retrospective ECG gating). Data sets were evaluated concerning the presence or absence of significant coronary stenoses and validated against invasive coronary angiography. A significant stenosis was assumed if the diameter reduction was ≥50%. 88 patients (mean age 66 ± 11 years, mean heart rate 61 ± 9 bpm) were evaluated regarding the presence or absence of significant CAD (at least one stenosis ≥50% diameter reduction). Mean systolic blood pressure on presentation was 203 ± 20 mmHg and mean diastolic blood pressure was 103 ± 13 mmHg. On a per patient basis, the sensitivity and specificity for dual-source CT to detect significant CAD in vessels >1.5 mm diameter was 100% (36/36, 95% CI 90-100) and 90% (47/52, 95% CI 79-97), respectively with a negative predictive value (NPV) of 100% (47/47, 95% CI 92-100) and a positive predictive value (PPV) of 88% (36/41, 95% CI 74-96). On a per artery basis, 352 vessels were evaluated (left main, left anterior descending, left circumflex and right coronary artery in 88 patients, 12 vessels could not be assessed due to either motion artefacts or heavy calcification and were considered positive for stenoses) with a sensitivity of 84% (54/64, 95% CI 72-95) and specificity of 94% (272/288, 95% CI 88-100); NPV was 96% (272/282, 95% CI 90-100) and PPV was 77% (54/70, 95% CI 62-91). Our study demonstrates high sensitivity, specificity and negative predictive value of dual-source CT to detect significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. Dual-source CT angiography may be useful to safely rule out coronary artery stenoses and avoid invasive angiograms in these patients.
先前有报道称，多层 CT 检测显著 CAD（冠状动脉疾病）的敏感性和特异性较高。胸痛是高血压未控制患者的常见表现。我们研究了双源 CT 检测和排除胸痛伴未控制高血压患者中显著 CAD 的敏感性和特异性。研究纳入了 260 例因 stage 2 高血压（收缩压≥160mmHg 和/或舒张压≥100mmHg）而出现急性胸痛的连续患者。入院后，进行血压控制和风险分层，由于肾功能不全、先前的冠状动脉血运重建或拒绝参与研究，82 例患者被排除。90 例低 CAD 术前概率的患者也被排除。88 例剩余患者在侵入性冠状动脉造影前 24 小时内接受双源 CT（Definition，Siemens Medical Solutions，Forchheim，德国）冠状动脉造影。采集对比增强的容积数据集（120kV，400mA/旋转，准直 2×64×0.6mm，回顾性 ECG 门控）。根据存在或不存在显著冠状动脉狭窄对数据集进行评估，并与侵入性冠状动脉造影进行验证。如果直径减少≥50%，则认为存在显著狭窄。88 例患者（平均年龄 66±11 岁，平均心率 61±9bpm）评估了是否存在显著 CAD（至少一条狭窄≥50%的直径减少）。入院时平均收缩压为 203±20mmHg，平均舒张压为 103±13mmHg。基于每位患者，双源 CT 检测直径>1.5mm 的血管中显著 CAD 的敏感性和特异性分别为 100%（36/36，95%CI 90-100）和 90%（47/52，95%CI 79-97），阴性预测值（NPV）为 100%（47/47，95%CI 92-100），阳性预测值（PPV）为 88%（36/41，95%CI 74-96）。基于每条动脉，评估了 352 条血管（88 例患者的左主干、左前降支、左回旋支和右冠状动脉，由于运动伪影或重度钙化，12 条血管无法评估，被认为存在狭窄），敏感性为 84%（54/64，95%CI 72-95），特异性为 94%（272/288，95%CI 88-100）；NPV 为 96%（272/282，95%CI 90-100），PPV 为 77%（54/70，95%CI 62-91）。我们的研究表明，双源 CT 检测胸痛伴未控制高血压患者中显著 CAD 的敏感性、特异性和阴性预测值均较高。双源 CT 血管造影术可能有助于安全排除这些患者的冠状动脉狭窄，并避免进行有创血管造影。
