磁心动图用于识别需要冠状动脉血运重建患者的有效性：一项横断面研究。
Effectiveness of magnetocardiography to identify patients in need of coronary artery revascularization: a cross-sectional study.
作者信息
Huang Xiao, Hua Ning, Tang Fakuan, Zhang Shulin
机构信息
Department of Cardiovascular, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China.
Institute of Microsystem and Information Technology, Chinese Academy of Science, Shanghai, China.
出版信息
Cardiovasc Diagn Ther. 2020 Aug;10(4):831-840. doi: 10.21037/cdt-20-121.
BACKGROUND
Patients with angina-like symptoms need invasive or non-invasive angiography to determine whether revascularization is necessary. For patients in need of revascularization, undergoing coronary computed tomography angiography (CCTA) may delay the treatment of revascularization and increase exposure to contrast agents and radiation. The aim of this cross-sectional study was to accessed the effectiveness of magnetocardiography (MCG) to identify patients who should undergo coronary revascularization.
METHODS
A total of 203 patients who were suffering from angina-like symptoms and underwent percutaneous coronary angiography (PCA) between July 27, 2015 and April 10, 2017 at the 8th Medical Center of Chinese PLA General Hospital, were enrolled in this cross-sectional study. In all patients, 12-lead electrocardiography (ECG) and MCG test were performed before PCA. For each subject. The value at every single sampling point was extracted from T wave of each MCG channel in time sequence. Pearson's correlation coefficients were calculated for each two T-waves. A binary logistic regression diagnosis model of these coefficients was established to identify patients in need of revascularization.
RESULTS
Ten pairings of coefficients were entered into diagnostic regression model as covariates. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.747 (95% CI: 0.680-0.815), and the asymptotic P value was less than 0.001. At the cut-off value of 0.55, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.9%, 65.9%, 74.8%, 63.6% and 69.9%, and the positive and negative post-test probabilities were 65.9% and 25.7%. The accuracy, sensitivity, specificity, PPV and NPV for 12-lead ECG were 67.0%, 62.7%, 63.5%, 70.5% and 55.1%, respectively. However, when those acute myocardial infarction (AMI) patients were ruled out from both groups, the MCG model had an accuracy of 68.2%, a sensitivity of 70.1%, a specificity of 66.3%, a PPV of 68.5% and an NPV of 67.9%. But, the accuracy, sensitivity, specificity, PPV and NPV for 12-lead ECG were 60.0%, 55.2%, 65.1%, 62.3% and 58.1%, respectively.
CONCLUSIONS
Patients suffering from angina-like symptoms, with a logistic regression model value over 0.55, should be recommended for PCA.
背景
有类心绞痛症状的患者需要进行有创或无创血管造影，以确定是否需要血运重建。对于需要血运重建的患者，进行冠状动脉计算机断层扫描血管造影（CCTA）可能会延迟血运重建治疗，并增加造影剂和辐射暴露。这项横断面研究的目的是评估心磁图（MCG）识别应接受冠状动脉血运重建患者的有效性。
方法
2015年7月27日至2017年4月10日在中国人民解放军总医院第八医学中心接受经皮冠状动脉造影（PCA）的203例有类心绞痛症状的患者纳入了这项横断面研究。所有患者在PCA前均进行了12导联心电图（ECG）和MCG检查。对于每个受试者，从每个MCG通道的T波按时间顺序提取每个采样点的值。计算每两个T波之间的Pearson相关系数。建立这些系数的二元逻辑回归诊断模型，以识别需要血运重建的患者。
结果
十对系数作为协变量进入诊断回归模型。受试者工作特征（ROC）曲线下面积（AUC）为0.747（95%CI：0.680-0.815），渐近P值小于0.001。在截断值为0.55时，敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为72.9%、65.9%、74.8%、63.6%和69.9%，阳性和阴性检验后概率分别为65.9%和25.7%。12导联ECG的准确性、敏感性、特异性、PPV和NPV分别为67.0%、62.7%、63.5%、70.5%和55.1%。然而，当两组均排除急性心肌梗死（AMI）患者时，MCG模型的准确性为68.2%，敏感性为70.1%，特异性为66.3%，PPV为68.5%，NPV为67.9%。但是，12导联ECG的准确性、敏感性、特异性、PPV和NPV分别为60.0%、55.2%、65.1%、62.3%和58.1%。
结论
对于有类心绞痛症状且逻辑回归模型值超过0.55的患者，应建议进行PCA。
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