摘要
目的探讨不同类型心律失常患者CT冠状动脉造影(CTCA)图像质量和检查成功率的差异。方法前瞻性连续纳入符合入选和排除标准的心律失常患者795例(实验组),并按心律失常类型分为窦性、房性、房室交界性、室性、混合性5个亚组。另随机选择心律规整患者100例作为对照组。比较不同类型心律失常组患者的平均心室率、心率变异、需心电编辑比例、CTCA图像质量、可诊断节段、可诊断例数以及辐射剂量等的差异。结果窦性、房性、房室交界性、室性、混合性心律失常分别为59、246、110、222、158例。5个亚组与对照组之间在心率变异、需多期相重建、需心电编辑、可诊断节段、可诊断例数等的差异均有统计学意义(P<0.05)。5亚组之间的比较显示,窦性心律不齐的检查成功率最高,混合性心律失常则最低,后者与房性、交界性、室性三组之间差异均有统计学意义(可诊断节段,χ~2=27.47,P=0.000;χ~2=63.27,P=0.000;χ~2=57.86,P=0.000)。结论心律失常类型对CTCA成功率有明显影响,混合性心律失常CTCA成功率最低,有必要对混合性心律失常患者进行CTCA检查前筛选或预治疗。
Objective To investigate the relationship between CTCA image quality and types of arrhythmia. Methods A prospectively continuous 795 cases with arrhythmia（ study group） underwent CTCA in our hospital, then those patients enrolled in the study group were divided into five subgroups according to different types of arrhythmia. Another 100 eases with regular heart rhythm were randomly selected as a control group. All patients performed CTCA using conventional retrospective ECG-gated helical scan mode. All patients＇CTCA image quality was evaluated. The proportion of heart rate variability, the need of multi-phase reconstruction and ECG edit, number of diagnosable segments, and number of diagnosable patients were compared between study group and control group, and compared among sub-study groups. Results Among 795 cases of arrhythmia patients in the study group, there was sinus arrhythmia （59 cases） , atrial arrhythmia （246）, atrioventricular junctional arrhythmias （110） , ventricular arrhythmias （222 cases） , mixed type of arrhythmia （ 158 cases ）.There were statistically significant differences between five study subgroups and control study in heart rate variability, the need for multiphase reconstruction and ECG edit, number of diagnosable segments, and number of diagnosable patients （P 〈 0.05 ）. Comparison within the sub-study group showed that the rates of diaguosable segments and diagnosable patients of sinus arrhythmia sub-group were maximum（93.8% ,88.1% respectively）. On the contrary, the rates of diagnosable segments and diagnosable patients of mixed type of arrhythmia subgroup were minimum（ only 78.7%, 56.3% respectively）, there were statistically significant differences between mixed type of arrhythmia subgroup and other three subgroups （ atrial arrhythmia, atrioventricular junctional arrhythmias, ventricular arrhythmias） in the rate of diagnosable segments （χ2 = 27.47, P = 0.000 ; χ2 = 63.27, P = 0. 000 ; χ2 = 57.86, P = 0. 000 respectively）. Average effective radiation dose in the study group （11.4 ±4.7 mSv） was higher than that in the control group （4.1 ± 1.5 mSv） with a statistically significant difference （t = 15.43 ,P = 0. 000）. Conclusion Although assisted by ECG-edit technology, the successful rates of CT- CA for patients with arrhythmia were less than those with regular rhythm. Patients with different types of arrhythmias, had different success rates of CTCA under the retrospective ECG-gated cardio helical scan and ECG-edit technology. The successful rate of CTCA of the mixed type of arrhythmia patients were minimum among the five types arrhythmia, which suggested that there was necessity of screening out or prior treatment before CTCA exam to reduce unsuccessful rate of CTCA.
出处
《临床放射学杂志》
CSCD
北大核心
2017年第5期648-653,共6页
Journal of Clinical Radiology
基金
国家自然科学基金面上项目(编号:81271629)
