AlJaroudi Wael, Mansour Mohamad Jihad, Chedid Maroun, Hamoui Omar, Asmar Joseph, Mansour Layal, Chammas Elie
Division of Cardiovascular Medicine, Clemenceau Medical Center, PO BOX 11-2555, Beirut, Lebanon.
Division of Cardiology, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
Int J Cardiovasc Imaging. 2019 Jun;35(6):1133-1139. doi: 10.1007/s10554-019-01577-x. Epub 2019 Mar 14.
Computed tomography coronary angiography (CTCA) has a higher negative predictive value (NPV) for coronary artery disease (CAD) than stress echocardiography (SE). CT calcium scoring (CTCS) allows detection and quantification of coronary artery calcification (CAC). The NPV of combined SE and CTCS for CAD is not well defined. Consecutive patients from the executive screening program who underwent exercise SE and concomitant CTCA were retrospectively identified between January 2010 and December 2014. Patients with normal SE and CAC score of zero were determined, and the presence or absence of any CAD (obstructive or non-obstructive plaques) on CTCA was confirmed. The NPV of combined SE and CTCS was then re-tested using a validation cohort of subsequent consecutive patients enrolled between January 2015 and July 2018. The initial cohort consisted of 173 patients (19% age > 65 years, 19% diabetic); 40% had normal CTCA, 48% with non-obstructive CTCA (77 with CAC score > 0), and 12% with obstructive CTCA (all with CAC score > 0). There were 16 (9.2%) patients with inducible ischemia on SE. A normal SE had a 93% NPV to exclude obstructive CAD but only 42% NPV to exclude any CAD. A combined normal SE and CTCS had a 100% NPV for obstructive CAD, and 92% for any CAD. In a validation cohort of 111 patients, a normal SE and CAC score of zero had NPV of 100% for obstructive CAD and 92% for any CAD. The combined cohort consisted of predominately low Framingham risk patients; more than 40% (70/181) had CAC score > 0 and 5/70 had obstructive CAD, with the remaining non-obstructive. A concomitant normal SE and CAC score of zero excluded obstructive CAD (NPV 100%) and any CAD in 92% of the testing and validation cohorts. CTCS seems to add incremental risk stratification, particularly for patients with low Framingham score.
计算机断层扫描冠状动脉造影（CTCA）对冠状动脉疾病（CAD）的阴性预测值（NPV）高于负荷超声心动图（SE）。CT钙化评分（CTCS）可用于检测和量化冠状动脉钙化（CAC）。SE和CTCS联合应用对CAD的NPV尚未明确界定。对2010年1月至2014年12月期间接受运动SE及同期CTCA检查的行政筛查项目中的连续患者进行回顾性分析。确定SE正常且CAC评分为零的患者，并确认CTCA上是否存在任何CAD（阻塞性或非阻塞性斑块）。然后使用2015年1月至2018年7月期间纳入的后续连续患者组成的验证队列重新测试SE和CTCS联合应用的NPV。初始队列包括173例患者（19%年龄>65岁，19%患有糖尿病）；40%的患者CTCA正常，48%的患者CTCA为非阻塞性（77例CAC评分>0），12%的患者CTCA为阻塞性（均为CAC评分>0）。有16例（9.2%）患者在SE检查时有可诱导的心肌缺血。SE正常对排除阻塞性CAD的NPV为93%，但对排除任何CAD的NPV仅为42%。SE正常且CTCS联合应用对阻塞性CAD的NPV为100%，对任何CAD的NPV为92%。在111例患者的验证队列中，SE正常且CAC评分为零对阻塞性CAD的NPV为100%，对任何CAD的NPV为92%。联合队列主要由Framingham风险较低的患者组成；超过40%（70/181）的患者CAC评分>0，其中5/70患有阻塞性CAD，其余为非阻塞性。SE正常且CAC评分为零可排除阻塞性CAD（NPV为100%），在92%的测试和验证队列中可排除任何CAD。CTCS似乎能增加风险分层，尤其是对于Framingham评分较低的患者。
