动态心电图与 MSCT 心肌灌注成像在冠心病心肌缺血诊断中的应用价值。

Application value between dynamic electrocardiogram and MSCT myocardial perfusion imaging in the diagnosis of myocardial ischemia in coronary heart disease.

机构信息

Department of Geriatric Cardiovascular, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.

Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China; Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

出版信息

Ann Palliat Med. 2021 Oct;10(10):10720-10725. doi: 10.21037/apm-21-2481.

DOI:10.21037/apm-21-2481

PMID:34763433

Abstract

BACKGROUND

Dynamic electrocardiogram and multi-spiral computed tomography (MSCT) myocardial perfusion imaging are commonly used in clinical examination methods, which can provide important reference for the diagnosis of myocardial ischemia in coronary heart disease. To analyze and compare the application value of dynamic electrocardiogram and MSCT myocardial perfusion imaging in the diagnosis of myocardial ischemia in coronary heart disease.

METHODS

The clinical data of 79 patients diagnosed with coronary heart disease admitted in our hospital from October 2017 to October 2019 were retrospectively collected. Exercise load/rest myocardial perfusion imaging (MPI) confirmed the presence of myocardial ischemia, and the patients were all examined by dynamic electrocardiogram and MSCT. The diagnosis of exercise load/resting MPI was used as a benchmark to compare the sensitivity, specificity, and accuracy of the different tests in the diagnosis of myocardial ischemia in coronary heart disease.

RESULTS

As confirmed by the exercise load/rest MPI, the 79 included patients had myocardial ischemia. Fifty-five cases of myocardial ischemia were detected by dynamic electrocardiogram, of which 33 cases showed horizontal depression of the ST segment. Also, 15 cases exhibited downward oblique depression, and seven cases showed upward oblique depression. MSCT examination showed that 78 patients had myocardial ischemia, of which 74 showed abnormal myocardial perfusion when contracted. Of these patients, 47 showed reversible perfusion filling, 20 exhibited partially reversible perfusion filling, and seven showed fixed perfusion defects. The sensitivity, specificity, and accuracy of dynamic electrocardiogram in the diagnosis of myocardial ischemia in coronary heart disease were 60.76%, 72.15%, 69.62%, respectively, while those of MSCT were 91.14%, 75.94%, and 86.07%, respectively. The sensitivity and accuracy of MSCT examination were significantly higher than those of dynamic electrocardiogram examination (P<0.05), and the specificity was slightly higher than that of dynamic electrocardiogram examination, but this difference was not statistically significant (P>0.05).

CONCLUSIONS

Compared to dynamic electrocardiogram examination, MSCT myocardial perfusion imaging has superior sensitivity and accuracy in the diagnosis of myocardial ischemia in coronary heart disease, and can provide a reference for clinical diagnosis and treatment.

摘要

背景

动态心电图和多层螺旋 CT（MSCT）心肌灌注成像都是临床常用的检查方法，可为冠心病心肌缺血的诊断提供重要参考。分析比较动态心电图与 MSCT 心肌灌注成像在冠心病心肌缺血诊断中的应用价值。

方法

回顾性收集 2017 年 10 月至 2019 年 10 月我院收治的 79 例冠心病患者的临床资料，运动负荷/静息心肌灌注成像（MPI）证实存在心肌缺血，患者均行动态心电图和 MSCT 检查。以运动负荷/静息 MPI 检查结果为诊断金标准，比较不同检查方法诊断冠心病心肌缺血的灵敏度、特异度和准确度。

结果

运动负荷/静息 MPI 检查证实 79 例患者存在心肌缺血。其中 55 例患者经动态心电图检查发现心肌缺血，其中 33 例表现为 ST 段水平型压低，15 例呈下斜型压低，7 例呈上斜型压低。MSCT 检查发现 78 例患者存在心肌缺血，其中 74 例收缩期心肌显影异常，表现为灌注缺损，其中 47 例为可逆性灌注充盈，20 例为部分可逆性灌注充盈，7 例为固定性灌注缺损。动态心电图诊断冠心病心肌缺血的灵敏度、特异度、准确度分别为 60.76%、72.15%、69.62%，MSCT 分别为 91.14%、75.94%、86.07%。MSCT 检查的灵敏度和准确度均明显高于动态心电图检查（P<0.05），特异度稍高于动态心电图检查，但差异无统计学意义（P>0.05）。