64排螺旋CT在老年冠心病患者中的应用研究

目的:探讨64排螺旋CT在老年冠心病患者中的应用价值方法:选择60例老年冠心病患者行64排螺旋CT冠状动脉成像,并与传统的冠状动脉造影进行比较结论:以冠状动脉造影作为对照,64-MSCTA诊断冠状动脉狭窄的灵敏度为86.41%、特异度为94.01%、阳性预测值为78.26%、阴性预测值为96.52%、诊断符合率为92.49%。研究结果表明对于老年冠心病患者的诊断而言,64排螺旋CT可以作为冠脉动脉造影的有效替代检查。     

冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠状动脉硬化性心脏病的价值研究

摘要 目的：探讨冠状动脉CTA结合动态心电图夜间ST段趋势图对冠状动脉硬化性心脏病（冠心病）的诊断价值。方法：回顾性分析2022年1月-2023年2月在我院疑似冠心病的患者104例,所有患者均行冠状动脉造影、冠状动脉CTA、动态心电图及临床相关实验室检查。以冠状动脉造影结果作为诊断冠心病的金标准,分析比较冠状动脉CTA、动态心电图夜间ST段趋势图及两者联合诊断冠心病的诊断效能和一致性。结果：104例疑似冠心病的患者确诊93例（89.42%）。冠状动脉CTA诊断冠心病的敏感性为90.32%,特异性为72.73%,阳性预测值为96.55%,阴性预测值为47.06%,准确率为88.46%,与冠状动脉造影的Kappa值为0.813,一致性好。动态心电图夜间ST段趋势图诊断冠心病的敏感性为84.95%,特异性为63.64%,阳性预测值为95.18%,阴性预测值为33.33%,准确率为82.69%,与冠状动脉造影的Kappa值为0.724,一致性较好。有夜间ST段动态改变的冠心病检出率（84.95%,79/93）明显高于无夜间ST段动态改变的冠心病检出率（15.05%,14/93）,差异有统计学意义（P＜0.001）。冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的敏感性为96.77%,特异性为90.91%,阳性预测值为98.90%,阴性预测值为76.92%,准确率为96.15%,与冠状动脉造影的Kappa值为0.923,一致性好。结论：冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的临床价值优于冠状动脉CTA或动态心电图夜间ST段趋势图单独检查。     

应用运动后踝臂指数评估冠心病冠脉病变程度的临床研究

目的:探讨运动后踝臂指数(ABI)与冠状动脉病变程度的相关性及对冠状动脉病变的预测价值。方法:选取2012年1月-2012年9月我院收治的冠心病行冠状动脉造影患者117例,根据造影结果分为正常组(38例)、轻中度病变组(45例)和严重病变组(34例),术前所有患者均行静息状态及运动后ABI检查。结果:轻中度病变组和重度病变组运动后ABI下降,各组间运动后ABI差异有显著性(P0.05)。由ROC曲线图可知,运动后ABI诊断冠心病及病变程度的准确性高于静息ABI诊断,差异具有统计学意义(P0.01)。结论:静息ABI和运动后ABI对冠心病均有诊断价值,运动后ABI诊断价值更高。静息下ABI和运动后ABI对冠状动脉严重病变有中等诊断价值,运动后ABI对冠状动脉严重病变诊断价值较高。     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的:探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法:收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影(DSA)检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果:70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论:相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

冠状动脉CTA和DSA对冠心病患者的临床诊断价值比较

目的:比较冠状动脉CT血管成像(CT angiography,CTA)以及数字减影血管造影(digital subtraction angiography,DSA)诊断冠心病的临床价值差异。方法:选择2013年12月至2020年3月安徽医科大学第三附属医院、安徽医科大学第四附属医院收治的60例冠心病患者为研究对象,首先对其实施多排螺旋CT冠状动脉血管造影检测(CTA),而后2 w内再对其实施DSA检测,比较两种检测方式对不同血管狭窄程度、不同性质斑块检出率的差异,最后以DSA检测结果为金标准,评估CTA对冠状动脉狭窄诊断的一致性、灵敏度、特异度、阳性预测值和阴性预测值。结果:(1)CTA检测狭窄血管共计387支,轻度狭窄152支(39.28%),中度狭窄118支(30.49%),重度狭窄105支(27.13%),闭塞12支(3.10%);DSA检测狭窄血管392支,轻度狭窄150支(38.27%),中度狭窄124支(31.63%),重度狭窄112支(28.57%),闭塞6支(1.53%),两组各血管狭窄类型比较差异无统计学意义(P0.05);(2)CTA检测斑块69个,其中钙化斑43个(62.32%),非钙化斑26个(37.68%),DSA检测斑块61个,其中钙化斑33个(54.10%),非钙化斑28个(45.50%),两种检测方式差异无统计学意义(P0.05);(3)以DSA检测为金标准,CTA对重度及以上血管狭窄诊断一致性为99.23%,特异度为98.31%,灵敏度为99.64%,阳性预测值为99.15%,阴性预测值为99.27%。结论:与DSA相比,CTA对冠心病患者血管狭窄的诊断价值相当,且属于无创检测,在冠心病早期筛查中临床应用价值更高。     

心肺运动试验用于冠心病诊断价值的临床研究

目的:评估心肺运动试验(CPET)相关指标对于冠心病的诊断价值。方法:选择156例疑诊为冠心病的患者(病情相对稳定,年龄在18～80岁)行CPET、运动负荷心电图及冠状动脉造影,以冠状动脉造影结果为标准,分析CPET相关指标(峰值摄氧量%预计值Peak O_2%pred、峰值氧脉搏%预计值Peak O_2 pulse%pred、摄氧量对应功率的做功效率(ΔO_2/ΔWR)诊断冠心病的敏感度、特异度及其诊断价值。结果:Peak O_2%pred的最佳截断点是≤69%pred,其诊断冠心病的敏感度为55.1%,特异度为77.0%,AUC为0.698。Peak O_2 pulse%pred最佳截断点诊断冠心病的敏感度为50.7%,特异度为72.4%,AUC为0.58。ΔO_2/ΔWR最佳截断点处其诊断冠心病的敏感度为44.9%,特异度为87.4%,AUC为0.647。Peak O_2%pred及ΔO_2/ΔWR敏感度远高于负荷心电图,差异有统计学意义(P0.01)。结论:CPET部分指标诊断冠心病的敏感度优于运动负荷心电图,最佳截断点处特异度及诊断价值均较高,而且CPET本身也包括连续动态全程心电图分析,不建议各自分割使用,主张所有指标整体整合分析使用。CPET相关指标对冠心病诊断有预测价值,可以早期、较准确的诊断冠心病。     

平板运动试验在冠心病心肌缺血早期诊断中的临床应用

目的:探讨平板运动试验在冠心病心肌缺血早期诊断中的临床应用。方法:选取180例被疑诊为冠心病心肌缺血的患者,其中男性患者136例,女性患者44例,所有患者均进行常规心电图与心脏彩超检查,然后对常规心电图阴性者再进行平板运动试验检查,结果对比分析。结果:平板运动试验的敏感性明显高于普通心电图,两组差异有统计学意义(P0.05)。结论:平板试验是一种灵敏度高,准确度高的辅助诊断技术,弥补了普通心电图的不足,对冠心病心肌缺血的早期检出率高,能为临床诊断心肌缺血提供有力证据,提高早期患者无创诊断率,及早诊断及早治疗。     

冠状动脉造影正常的胸痛患者病因分析

目的:探讨冠状动脉造影正常的胸痛患者的病因及其临床特征.方法:对49例临床拟诊冠心病而冠状动脉造影正常的胸痛患者的临床特征进行回顾性分析,为胸痛的临床诊断提供思路.结果:最后诊断:急性心梗死1例(2.04%);冠心病心绞痛10例(20.45%);高血压病12例(24.49%);心律失常8例(16.33%);糖尿病6例(12.24%);X综合症7例(14.29%);急性胆囊炎2例(4.08%);急性胰腺炎2例(4.08%);反流性食管炎1例(2.04%);颈椎病2例(4.08%).结论:冠状动脉造影正常的胸痛患者并不能完全排除冠心痛,要考虑心外病变、非冠心病性器质性心脏病和X综合症等众多的影响因素.     

运动试验假阴性而冠状动脉造影阳性冠心病的特点分析

目的:探讨平板运动试验(TET)假阴性而冠状动脉造影(CAG)阳性冠心病病例的特点.方法:对同期内(相距时间1周)TET阴性而有心前区不适者进行CAG的冠心病患者60例(男性42例,女性18例,平均年龄66±10.岁)进行回顾性分析.TET以运动中及恢复期R波为主的导联出现ST段水平型下移0.05mV为阴性标准.CAG以冠状动脉狭窄直径≥50%为阳性标准.结果:60例患者CAG共累计病变106处,其中左主干2例2处、左前降支21例30处、左回旋支7例13处、右冠状动脉27例36处、对角支7例10处、间隔支3例3处、钝缘支3例3处、后降支6例6处、中间支2例3处.病变范围在在50%～74%占65处、病变范围在75%～89%占30处、病变范围在90%～95%占11处.冠状动脉单支病变40例(占66.7%),以右冠状动脉及左前降支为多,占70.0%(28/40),双支病变14例(占23.3%),左前降支+右冠状动脉较多,占57.1%(8/14),三支病变6例(占10.0%).60例患者中有侧支循环者31例(51.7%).有16 例(26.7%)试验运动量不足,男性明显多于女性(P<0.05).结论:冠心痛患者TET假阴性的因为可能为冠脉病变小、狭窄程度轻、狭窄病变供血心肌建立了良好的侧支循环以及试验运动量不够.对于有临床症状而TET阴性的患者应行CAG检查,以明确诊断.     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的：探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法：收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影（DSA）检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果：70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论：相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

The Diagnostic Value of Treadmill Exercise Test Parameters for Coronary Artery Disease

The aim of this study was to determine the diagnostic value of treadmill exercise test (TET) in patients with coronary heart disease (CHD) by comparing the diagnostic conclusions with coronary angiography (CAG). Patients (445) with CHD and suspected CHD underwent TET and CAG, and the corresponding diagnostic conclusions were compared. (1) Out of the 200 cases that had the positive result with TET, 150 cases had been diagnosed CHD by means of CAG; Out of the 245 cases that had the negative result during TET, only 39 cases had been diagnosed CHD by means of CAG. The sensitivity, specificity, positive predictive value, negative predictive value, the false positive incidence, the false negative incidence, and agreement rate in diagnosis of CHD by TET were 79.36, 80.40, 75.00, 84.08, 25.00, 15.92, and 80.00 %, respectively. The patients with multi-vessel disease had a higher positive rate of TET as compared with those with single-vessel disease (P < 0.05). (2) The parameters for 189 cases positive CAG (patients diagnosed CHD by CAG) and 256 cases negative CAG (the control group), including the general exercise time, peak heart rate, and the beginning time of ST depression, were lower than that of control group (P < 0.05). However, the extent of ST depression and duration of ST depression were higher in these patients than in the control group (P < 0.05). (3) 189 cases positive CAG, include 87 cases of single coronary artery and 102 cases of binary or more coronary arteries (the control group). The parameters, including the general exercise time, peak heart rate, and the beginning time of ST depression, were lower than the control group (P < 0.05). However, the extent of ST depression and duration of ST depression were higher in these patients than the control group (P < 0.05). The TET is valuable for noninvasive diagnosis of CHD, especially for patients with multi-vessel disease.     

Elderly Patients and Coronary Heart Disease on Response to Treadmill Exercise Test

To study the response of the cardiovascular system, to exercise tolerance in-patients over 75 years old with coronary heart disease (CHD), and to evaluate the significance of the parameters of the treadmill exercise test (TET). 110 patients received TET and coronary artery angiography. They were divided into two groups: the elderly patients group included 50 patients over 75 years old, and the control group included 60 patients under 60 years old. (1) With aging, there were much more CHD patients in the positive TET (P < 0.05) than in the negative TET (P > 0.05). (2) The parameters of TET for the elderly CHD patients group, included exercise time, peak heart rate, and the onset of ST depression, were lower than the control group (P < 0.05). There was no statistical significance between the two groups in the extent and duration of ST depression (P < 0.05). (1) In TET, the elderly patients had the higher diagnostic value on CHD. (2) The elderly patients with CHD had the lower endurance to exercise test.     

Coronary heart disease diagnosis bases on the change of different parts in treadmill exercise test ECG

Summarize the value of the change of different parts in treadmill exercise test (TET) ECG to coronary heart disease (CHD) diagnosis. Four hundred and forty-five cases have been included in this investigation, which stayed in our hospital from January of 2006 to March of 2011 and underwent TET and coronary arteriography (CAG). The change of different parts in TET ECG in these patients had been retrospective summarized to determine its diagnosis value to CHD. (1) In the 445 cases of TET testers, 200 cases showed positive in TET with 150 cases of positive CAG, and 50 cases of negative CAG; 245 cases showed negative in TET with 206 cases of negative CAG, and 39 cases of positive CAG. The diagnosis sensitivity of CHD was 79.36 % (150/189), the specificity was 80.47 % (206/256), positive prediction value was 75.00 % (150/200), negative prediction value was 84.08 % (206/245), and false-positive rate was 25.00 % (50/200) with prediction accuracy of 80.00 % (356/445). (2) In the 200 cases with positive TET: 51 cases were in the limb lead group; 73 cases were in the chest lead group; and 76 cases were in the limb lead + chest lead group. There were 150 cases showing positive in CAG: 22 cases were in the limb lead group; 58 cases were in the chest lead group; and 70 cases were in the limb lead + chest lead group. The positive diagnosis rate of ST change in the chest lead was obviously higher than that of simple limb lead group (P < 0.05). (3) People with healthy coronary artery will have decreased amplitude of R wave while patients with coronary stenosis have elevated amplitude of R wave. (4) As for the T wave, the positive CAG had no statistical significance between normal T wave group and TET positive group (P > 0.05); CAG results had statistical significance between normal T wave group and TET negative group (P < 0.05). (5) Positive CAG results had no statistical significance between U-wave inversion group and TET positive group (P > 0.05); positive CAG results has statistical significance when TET negative group compared with U-wave inversion group or TET positive group (P < 0.05). TET is a relatively idea invasive diagnosis method for coronary disease, which can be utilized to evaluate the stage of CHD when integrating with the change of TET ECG.     

多种无创检查组合在冠心病诊断中的价值

目的：评价多种无创辅助检查组合对冠状动脉粥样硬化性心脏病（冠心病）辅助诊断价值,筛选有效的冠心病确诊和排除指标,初步确定优化的冠心病早期诊断策略。方法：回顾性分析6419例冠心病患者多项无创辅助检查结果（包括静息心电图、24小时动态心电图、负荷心电图、负荷核素心肌显像、16或64排CT冠状动脉成像）,以冠状动脉造影阳性（至少一支主要冠状动脉或其主要分支的内径有≥50％的狭窄）为金标准,观察各种无创辅助检查组合对冠心病诊断的特异性、敏感性、误诊率、漏诊率、阳性预测值和阴性预测值。结果：多项无创辅助检查组合在冠心病的诊断中敏感性56．02-87．43％,特异36．13-87．61％,阳性预测值58．83．97．16％,阴性预测值30．21．73．36％,非介入手段中,敏感性和阴性预测值以动态心电图联合核素心肌灌注显像组最高,特异性和阳性预测值以动态心电图联合冠脉CT成像组最高。结论：辅助检查组合可作为无创性诊断、评价冠心病的重要方法,动态心电图可作为各级别医院冠心病筛查的基本及重要手段。     

ZUNG 抑郁量表在冠心病诊断中的作用

目的：研究ZUNG量表在冠心病中的诊断作用。方法：对临床上所有怀疑冠心病的患者并行冠状动脉造影检查,术前给予ZUNG量表进行评价,同时对40健康人进行ZUNG量表评价,所有住院患者同时进行ECG,HOLTER检查及病史方面评价。结果：①在无高危因素和ECG客观检查正常的患者中ZUNG量表积分明显增高,且抑郁症的检出率高于其他各组,而冠心病检出率却低于除健康对照组的其他各组。②相关性分析：ZUNG量表积分与冠脉病变积分无相关关系。冠心病的患者中抑郁的检出率高于非冠心病组。存在高危因素的患者的抑郁检出率高于健康对照组。结论：ZUNG量表在冠心病的鉴别诊断,尤其排除抑郁导致胸痛,是一项比较有意义的检查手段。     

Reciprocal change in ST segment in acute myocardial infarction: correlation with findings on exercise electrocardiography and coronary angiography.

The clinical relevance of reciprocal changes in the ST segment occurring at the time of acute myocardial infarction was studied prospectively in 85 consecutive uncomplicated cases. Reciprocal depression of the ST segment was defined as depression of 1 mm or more in electrocardiogram leads other than those reflecting the infarct. All patients underwent maximal, symptom limited treadmill stress testing two weeks after the infarct and coronary angiography six weeks after infarction. Forty six patients had inferior, 34 anterior, and five true posterior infarction. Of the 51 patients with reciprocal changes, 45 (88%) developed exercise induced ST segment depression in areas remote from the infarction zone. At angiography all 45 patients were shown to have stenoses greater than 70% in at least two major vessels. Four patients had negative exercise electrocardiograms and were sequently shown to have single vessel disease subtending their infarct, and the remaining two patients had a false negative treadmill test result. Of the 27 patients without reciprocal changes, 21 (78%) had negative treadmill stress test results associated with single vessel coronary disease. Five had positive stress test results and multivessel coronary disease, and one had a false negative stress test result. The remaining seven patients had ST segment elevation without Q wave formation in the reciprocal areas and were assessed separately. Of these, six had positive stress test results and multivessel coronary disease and one had a negative stress test result and single vessel coronary disease to the infarct area. Twenty one patients with anterior infarcts (62%) and 27 with inferior infarcts (59%) had reciprocal changes. No differences emerged in the relation between infarct site, reciprocal change, and presence of additional coronary disease. At follow up of the 51 patients with reciprocal changes in the ST segment 36 had become symptomatic, of whom 29 had undergone coronary artery bypass surgery. By contrast, only four of the 27 patients without reciprocal changes in the ST segment had developed symptoms, and two of these had undergone coronary revascularisation. Reciprocal ST segment depression at the time of acute myocardial infarction may identify patients with severe coronary disease who are at risk of subsequent cardiac events and appears to be as reliable as results of early postinfarction treadmill stress testing in predicting the underlying coronary anatomy. When the electrocardiogram does not show reciprocal changes treadmill testing provides valuable additional information.