摘要
目的:探讨双源CT冠状动脉血管造影(CCTA)冠状动脉周围脂肪CT密度特征联合心电图对冠心病患者病情严重程度的诊断价值。方法:收集2021年3月至2023年3月山西白求恩医院收治的120例冠心病患者,根据美国纽约心脏协会(NYHA)心功能分级进行分组,其中86例Ⅱ~Ⅲ级患者纳入Ⅱ~Ⅲ级组,34例Ⅳ级患者纳入Ⅳ级组。所有患者均行双源CT和心电图检测。双源CT检测包括冠状动脉左前降支近端(pLAD)、左前降支中段(mLAD)、左回旋支近端(pLCX)、右冠状动脉近端(pRCA)、右冠状动脉中段(mRCA)以及右冠状动脉远段(dRCA)不同分支的平均冠状动脉周围脂肪组织(PCAT)密度。记录患者心电图检查QRS波电压值和时限值以及QTc间期。观察并比较两组pLAD、mLAD、pLCX、pRCA、mRCA及dRCA的平均PCAT密度及心电图检查时的QRS电压和时限,以及QTc间期,采用受试者工作特征(ROC)曲线分析上述指标单独及联合诊断冠心病患者病情严重程度的效能。结果:Ⅱ~Ⅲ级组患者的pLAD、mLAD、pLCX、pRCA、mRCA及d RCA的平均PCAT密度、QRS时限及QTc间期明显低于Ⅳ级组,QRS电压明显高于Ⅳ级组,差异有统计学意义(t=58.681、5.097、5.902、13.513,P<0.05);心电图和冠状动脉CTA冠状动脉周围脂肪CT密度对冠心病患者病情严重程度的ROC曲线下面积(AUC)均>0.5,且联合诊断的AUC最高,为0.966;Pearson线性相关性分析结果显示,平均PCAT密度、QRS电压、QRS时限及QTc间期之间存在相关性,且QRS电压与平均PCAT密度、QRS时限及QTc间期均存在显著负相关关系(r=-0.754,-0.280,-0.452,P<0.05),平均PCAT密度、QRS时限及QTc间期与冠心病患者病情严重程度之间存在显著正相关关系(r=0.983、0.435、0.547,P<0.05),QRS电压与冠心病患者病情严重程度之间存在显著负相关关系(r=-0.776,P<0.05)。结论:冠状动脉CTA冠周脂肪CT密度特征联合心电图QRS波群检测有助于冠心病患者病情严重程度的诊断,可以提高诊断的准确率,具有一定的应用价值。
Objective:To investigate the diagnostic value of density features of computed tomography(CT)of the fat around pericoronary artery of dual-source computer tomography angiography(CTA)combined with electrocardiogram(ECG)on the severity of disease condition in patients with coronary heart disease(CHD).Methods:A total of 120 CHD patients who admitted to Shanxi Bethune Hospital from March 2021 to March 2023 were selected,and they were grouped according to the New York Heart Association(NYHA).Among of them,86 cases at grade II-III were divided into grade II-III group,and 34 cases at grade IV were divided into grade IV group.A dual-source CT was used to detect the densities of different coronary branches of Pericardial Adipose Tissue(PCAT)of average coronary artery of proximal left anterior descending artery(pLAD),mid left anterior descending artery(mLAD),proximal left circumflex artery(pLCX),proximal right coronary artery(pRCA),mid right coronary artery(mRCA)and distal right coronary artery(dRCA)of all patients,and ECG was used to detect and record the value of QRS voltage,QRS time limit value and QTc interval of patients.The mean PCAT densities of pLAD,mLAD,pLCX,pRCA,mRCA and Drca,and the QRS voltage and QRS time limit,as well as QTc interval between the two groups were observed and compared.The receiver operating characteristics(ROC)curve was used to analyze the efficacies of the above indicators in single diagnosis and combined diagnosis for the severity of disease condition of CHD patients.Results:The mean PCAT density of pLAD,mLAD,pLCX,pRCA,mRCA,mRCA and dRCA,and QRS time limit and QTc interval of patients in grade II-III group were significantly lower than those in grade IV group,with statistically significant difference(t=58.681,5.097,5.902,13.513,P<0.05),respectively.The area under curve(AUC)values of ROC curves of ECG and CT density of the fat around pericoronary artery of CTA were larger than 0.5 for the severity of disease condition in CHD patients,and the highest AUC value of combined diagnosis was 0.966.The results of Pearson linear correlation analysis showed that there were correlations among mean PCAT density,QRS voltage,QRS time limit and QTc interval,and there were significantly negative correlations between QRS voltage and mean PCAT density,between QRS time limit and QTc interval(r=-0.754,-0.280,-0.452,P<0.05),and there were significantly positive correlations among mean PCAT density,QRS time limit,QTc interval and the severity of the disease condition of CHD patients(r=0.983,0.435,0.547,P<0.05),respectively.There was a significantly negative correlation between QRS voltage and severity of disease condition of CHD patients(r=-0.776,P<0.05).Conclusion:The combination of CT density features of the fat around pericoronary artery of coronary artery CTA and ECG QRS wave group detection is helpful to the diagnosis for the severity of disease condition of CHD patients,which can improve the accuracy of diagnosis and has a certain of application value.
作者
刘晋文
李学文
吴山
张亚运
张志军
Liu Jinwen;Li Xuewen;Wu Shan;Zhang Yayun;Zhang Zhijun(Department of Interventional Treatment,The Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital(Tongji Shanxi Hospital,Shanxi Academy of Medical Sciences),Taiyuan 030032,China)
出处
《中国医学装备》
2024年第9期47-52,共6页
China Medical Equipment
基金
国家自然科学基金项目(82170398)。
关键词
冠状动脉CTA
冠周脂肪CT密度
心电图
冠心病
病情严重程度
诊断价值
Coronary computed tomography angiography(CCTA)
Pericoronary fat computed tomography(CT)density
Electrocardiogram(ECG)
Coronary heart disease(CHD)
Severity of disease condition
Diagnostic value
