Zhou Bi, Tang Zhuoyue, Huang Xianlong, Zhu Hongzhang, Li Xiaojiao, Xiong Hua, Yu Jiayi, Liao Ruikun, Zhang Dan
Department of Radiology, Chongqing General Hospital, Chongqing, China.
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Acta Cardiol. 2023 Feb;78(1):99-108. doi: 10.1080/00015385.2022.2061111. Epub 2022 Apr 6.
All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA ( < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR.
既往所有的冠状动脉CT血管造影（CCTA）减影技术都有严格的心率（HR）纳入标准。在本研究中，一种新的减影方法应用于不同心率的患者。在升主动脉峰值强化后，当心率>80次/分钟时，造影剂注射后扫描时间为3.5秒；当65≤心率≤80次/分钟时，扫描时间为4秒；当心率<65次/分钟时，扫描时间为4.5秒。46例行新减影方案的患者被纳入研究，并被分为高心率组（≥70次/分钟）和低心率组（<70次/分钟）。18例患者有15个严重钙化节段和25个支架节段，进一步接受了有创冠状动脉造影（ICA）。在所有纳入的患者中，比较了高心率组和低心率组之间的冠状动脉强化情况。在接受ICA检查的患者中，分别比较了传统CCTA与减影CCTA之间以及高心率组和低心率组之间图像质量的改善情况和对显著冠状动脉节段狭窄（>50%）的诊断效能。所有纳入患者均获得了足够的冠状动脉强化。在接受ICA检查的患者中，受试者操作特征（ROC）曲线分析显示，减影CCTA诊断显著狭窄的曲线下面积（AUC）为0.93，传统CCTA为0.73（<0.0�）。此外，高心率组和低心率组在图像质量改善、特异性、阳性预测值和准确性方面无显著差异。新的减影CCTA方法拓宽了高心率患者的临床应用范围。
