van der Zant Friso M, Wondergem Maurits, Lazarenko Sergiy V, Geenen Remy W F, Umans Victor A, Cornel Jan-Hein, Knol Remco J J
Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
J Womens Health (Larchmt). 2015 Jul;24(7):550-6. doi: 10.1089/jwh.2014.4929. Epub 2015 Apr 8.
To assess the presence of coronary artery disease (CAD) in women with atypical chest pain with low or intermediate risk for significant CAD by means of calcium scoring (CaSc) combined with coronary computed tomography angiography (CCTA) and to estimate the equivalent radiation dose in women.
From December 2011 until July 2013, all consecutively performed cardiac CTs in women with atypical chest pain were included prospectively in the present study. Both CaSc and CCTA were obtained by a dual source flying focal spot 2×64 slice Somatom Definition Flash. Absence of CAD was defined as CaSc 0 and absence of noncalcified plaques. Presence of CAD was determined as CaSc>0 and/or presence of noncalcified plaques. The impact on patient management was also scored within our patient cohort.
A total of 1033 procedures in 1014 women (mean age 59±10 years; mean BMI 26±8) were analyzed. In 520 (51%) women, CAD was absent. In 494 (49%) women, CAD was diagnosed, and in this subgroup the mean CaSc was 137±229. Thirty-seven (7%) of 494 women with CAD showed only noncalcified plaques. The mean equivalent radiation dose for the cardiac CTs of 1014 women was 2.2±1.6 mSv.
Combined CaSc and CCTA excludes CAD in approximately 50% of women with atypical chest pain, and delivers a modest radiation dose of 2.2±1.6 mSv. CCTA has a substantial impact on patient management and can thus be advocated as first diagnostic tool in excluding CAD in women with atypical chest pain in terms of latest generation equipment with emphasize on radiation reduction techniques.
通过钙化积分（CaSc）联合冠状动脉计算机断层扫描血管造影（CCTA）评估具有非典型胸痛且患严重冠状动脉疾病（CAD）风险较低或中等的女性是否存在CAD，并估算女性的等效辐射剂量。
从2011年12月至2013年7月，本研究前瞻性纳入了所有连续进行的针对有非典型胸痛女性的心脏CT检查。CaSc和CCTA均通过双源飞焦点2×64层Somatom Definition Flash扫描仪获得。CAD不存在定义为CaSc为0且无非钙化斑块。CAD存在定义为CaSc>0和/或存在非钙化斑块。还对我们患者队列中对患者管理的影响进行了评分。
共分析了1014名女性（平均年龄59±10岁；平均BMI 26±8）的1033例检查。520名（51%）女性不存在CAD。494名（49%）女性被诊断为CAD，在该亚组中平均CaSc为137±229。494名患有CAD的女性中有37名（7%）仅显示非钙化斑块。1014名女性心脏CT的平均等效辐射剂量为2.2±1.6 mSv。
CaSc和CCTA联合使用可排除约一半有非典型胸痛女性的CAD，并提供2.2±1.6 mSv的适度辐射剂量。CCTA对患者管理有重大影响，因此就强调辐射降低技术的最新一代设备而言，可被倡导作为排除有非典型胸痛女性CAD的首选诊断工具。
