心电图门控胸部 CT 血管造影术在未经心率控制情况下对急性缺血性脑卒中患者检测显著冠状动脉狭窄的诊断准确性：一项对比研究。
Diagnostic Accuracy of Electrocardiogram-Gated Thoracic Computed Tomography Angiography without Heart Rate Control for Detection of Significant Coronary Artery Stenosis in Patients with Acute Ischemic Stroke: A Comparative Study.
机构信息
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.
Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.
出版信息
Korean J Radiol. 2018 Sep-Oct;19(5):905-915. doi: 10.3348/kjr.2018.19.5.905. Epub 2018 Aug 6.
OBJECTIVE
To compare the diagnostic performance of electrocardiogram (ECG)-gated thoracic computed tomography angiography (TCTA) without heart rate (HR) control in ischemic stroke patients with coronary CTA (CCTA) in non-stroke patients for detection of significant coronary artery stenosis.
MATERIALS AND METHODS
From September 2009 through August 2014, we retrospectively enrolled 138 consecutive patients diagnosed with acute ischemic stroke who had undergone ECG-gated TCTA and conventional coronary angiography (CCA). Over the same period, we selected 167 non-stroke patients with suspected or known coronary artery disease who had undergone CCTA and CCA. With CCA as the reference standard, the diagnostic performance of TCTA and CCTA for identification of significant coronary stenosis (diameter reduction ≥ 50%) was calculated.
RESULTS
There was no significant difference in baseline characteristics between TCTA (n = 132) and CCTA (n = 164), except for the higher prevalence of atrial fibrillation in the stroke group. There was significant difference ( < 0.001) between TCTA and CCTA in average HR (68 ± 12 vs. 61 ± 10 beats per minute) and image quality score (1.3 ± 0.6 vs. 1.2 ± 0.6). Significant coronary stenosis was identified in 101 (77%) patients, 179 (45%) vessels, and 293 (15%) segments of stroke patients, and in 136 (83%) patients, 259 (53%) vessels, and 404 (16%) segments of non-stroke patients. Diagnostic performance on a per-vessel and per-patient basis was similar in both TCTA and CCTA groups. There was only significant difference in area under receiver-operating characteristic curve between TCTA and CCTA groups (0.79 vs. 0.87, < 0.001) on per-segment basis.
CONCLUSION
Electrocardiogram-gated TCTA without HR control facilitates the identification of significant coronary stenosis in patients with ischemic stroke.
目的
比较无心率（HR）控制的心电图（ECG）门控胸部计算机断层扫描血管造影（TCTA）与非中风患者冠状动脉 CT 血管造影（CCTA）在检测显著冠状动脉狭窄方面的诊断性能。
材料和方法
从 2009 年 9 月至 2014 年 8 月，我们回顾性纳入了 138 例连续确诊为急性缺血性中风并接受 ECG 门控 TCTA 和常规冠状动脉造影（CCA）的患者。同期，我们选择了 167 例疑似或已知冠状动脉疾病的非中风患者，这些患者接受了 CCTA 和 CCA。以 CCA 为参考标准，计算 TCTA 和 CCTA 对识别显著冠状动脉狭窄（直径减少≥50%）的诊断性能。
结果
TCTA（n=132）和 CCTA（n=164）组之间的基线特征除了中风组心房颤动的患病率较高外，没有显著差异。TCTA 和 CCTA 之间的平均 HR（68±12 与 61±10 次/分钟）和图像质量评分（1.3±0.6 与 1.2±0.6）有显著差异（<0.001）。在中风患者中，101 例（77%）患者、179 个（45%）血管和 293 个（15%）节段存在显著冠状动脉狭窄，而非中风患者中，136 例（83%）患者、259 个（53%）血管和 404 个（16%）节段存在显著冠状动脉狭窄。在每个血管和每个患者的基础上，TCTA 和 CCTA 组的诊断性能相似。仅在基于节段的基础上，TCTA 和 CCTA 组之间的受试者工作特征曲线下面积有显著差异（0.79 与 0.87，<0.001）。
结论
无 HR 控制的 ECG 门控 TCTA 有助于识别缺血性中风患者的显著冠状动脉狭窄。
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