冠狀動脈CT血管造影在慢性完全閉塞病變中應(yīng)用價值
發(fā)布時間：2018-11-29 12:57
【摘要】：第一部分冠狀動脈CT血管造影對慢性完全閉塞病變的診斷價值目的以冠狀動脈造影(coronary artery angiography,CAG)確診冠狀動脈慢性完全閉塞病變(chronic total occlusion,CTO)為金標(biāo)準(zhǔn),探討冠狀動脈CT血管造影(coronary computed tomography angiography,CCTA)對CTO病變的診斷價值。材料與方法回顧性分析2013年6月至2016年8月就診于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心內(nèi)科一病房經(jīng)CAG確診至少1支冠狀動脈完全閉塞,閉塞時間超過3個月以上患者2089例,且冠狀動脈造影前60天內(nèi)接受CCTA檢查患者231例。根據(jù)入選及排除標(biāo)準(zhǔn),最終入選患者198例。由經(jīng)驗(yàn)豐富的影像科醫(yī)師通過CCTA評價594支主要心外膜冠狀動脈血管是否完全閉塞。以CAG為金標(biāo)準(zhǔn),判斷CCTA診斷CTO病變的敏感性、特異性、準(zhǔn)確性、陰性預(yù)測價值、陽性預(yù)測價值,計(jì)算Kappa系數(shù)衡量CAG及CCTA診斷CTO病變的一致性。結(jié)果共納入分析198例患者共594支主要冠狀動脈血管,男性74.2%,平均年齡(57.5±10.2)歲。CAG共確診221處病變完全閉塞,CCTA診斷CTO的敏感性為88%,特異性為99%,準(zhǔn)確性95%,陽性預(yù)測價值98.0%,陰性預(yù)測價值93.2%。以CAG診斷CTO病變?yōu)榻饦?biāo)準(zhǔn),CCTA與CAG具有較好的診斷一致性,Kappa值為0.89,P0.05。結(jié)論CCTA確診CTO病變方面具有較好的診斷價值,敏感性為88%,特異性為99%,準(zhǔn)確性95%。與CAG診斷CTO病變有較高的一致性。鈣化病變、支架內(nèi)閉塞(支架類型)及病變血管本身細(xì)小等方面存在一定局限性。第二部分冠狀動脈CT腔內(nèi)衰減梯度評價慢性完全閉塞病變側(cè)支循環(huán)及探討其影響因素目的探討冠狀動脈腔內(nèi)衰減梯度(transluminal attenuation gradient,TAG)對冠狀動脈慢性完全閉塞病變(chronic total occlusion,CTO)側(cè)支循環(huán)形成的預(yù)測價值,以及影響CTO病變側(cè)支循環(huán)建立的因素。材料與方法回顧性分析2013年6月至2016年8月就診于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心內(nèi)科一病房經(jīng)CAG確診至少1支冠狀動脈完全閉塞,閉塞時間超過3個月以上患者2089例,且冠狀動脈造影前60天內(nèi)接受CCTA檢查患者231例。根據(jù)入選及排除標(biāo)準(zhǔn),最終入選患者82例,85支主要心外膜冠狀動脈血管。采用冠狀動脈造影Rentrop分級評價側(cè)支循環(huán),定義Rentrop3級為側(cè)支循環(huán)良好組。比較不同側(cè)支循環(huán)等級時TAG差別,采用單因素及多因素Logistic回歸分析影響CTO病變側(cè)支循環(huán)建立的因素。結(jié)果隨著Rentrop分級增加,TAG呈升高趨勢,當(dāng)TAG≥-15.6HU/10mm提示良好側(cè)支循環(huán),ROC曲線下面積0.63(95%CI=0.49-0.77,P=0.04),TAG診斷側(cè)支循環(huán)的敏感性67.9%,特異性69%,準(zhǔn)確性67.4%。側(cè)支循環(huán)良好組與側(cè)支循環(huán)不良組在既往糖尿病病史、心梗病史及TAG方面存在差異,差異有統(tǒng)計(jì)學(xué)意義。經(jīng)多因素Logistic回歸分析,糖尿病病史及心肌梗死病史是CTO病變影響側(cè)支循環(huán)形成的獨(dú)立預(yù)測因素。結(jié)論TAG在評價側(cè)支循環(huán)方面具有一定預(yù)測價值。糖尿病病史是CTO病變側(cè)支循環(huán)形成不良的影響因素,心肌梗死病史有助于預(yù)測良好側(cè)支循環(huán)的形成。第三部分評價冠狀動脈CT血管造影對CTO介入治療的影響目的通過術(shù)前冠狀動脈CT血管造影(coronary computed tomography angiography,CCTA)評估慢性完全閉塞病變(chronic total occlusion,CTO)特征,分析影響CTO病變介入治療的因素。材料與方法回顧性分析2013年6月至2016年8月就診于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心內(nèi)科一病房經(jīng)冠狀動脈造影(coronary artery angiography,CAG)確診至少1支冠狀動脈完全閉塞,閉塞時間超過3個月以上患者2089例,且冠狀動脈造影前60天內(nèi)接受CCTA檢查患者231例。根據(jù)入選及排除標(biāo)準(zhǔn),最終入選82例患者,85支主要心外膜冠狀動脈。將30分鐘內(nèi)導(dǎo)絲通過閉塞段定義為PCI成功,反之為PCI失敗。采集CCTA分析兩組患者的病變特征及臨床資料,利用單因素及多因素Logistic回歸分析影響CTO病變介入手術(shù)成功的因素,利用ROC曲線對比CT-CTO評分和J-CTO評分的診斷效能。結(jié)果共納入82例患者(85支CTO病變血管),男性66例(80.5%),平均年齡57.3±10.4歲,CCTA與CAG檢查時間平均間隔為9.5±12.5天。30分鐘內(nèi)導(dǎo)絲通過閉塞病變47處,PCI成功率為55.3%,最終有61支病變血管成功開通,成功率達(dá)71.8%。閉塞段遠(yuǎn)端纖維帽形態(tài)不清晰,閉塞近段分叉、閉塞長度≥20mm是影響CTO病變介入治療獨(dú)立危險(xiǎn)因素。隨著CT-CTO評分升高,CTO病變介入治療的手術(shù)成功率逐漸減低(85.7%、65.8%、33.3%、0%)。CT-CTO評分預(yù)測30分鐘內(nèi)導(dǎo)絲通過閉塞病變成功率高于J-CTO評分,差異有統(tǒng)計(jì)學(xué)意義(0.734vs 0.726,P0.001)。結(jié)論閉塞段遠(yuǎn)端形態(tài)纖維帽形態(tài)不清晰、閉塞段頭端分叉、閉塞段長度≥20mm是影響CTO病變手術(shù)成功的獨(dú)立危險(xiǎn)因素。與J-CTO評分相比,CT-CTO評分可以較好的預(yù)測30分鐘內(nèi)導(dǎo)絲通過閉塞病變。
[Abstract]:The first part of the study on the diagnostic value of the first part of the coronary artery computed tomography (CT) on the diagnosis of the chronic total occlusion (CAG) was the diagnosis of the coronary chronic total occlusion (CTO) as the gold standard, and the coronary computed tomography (CT) was also discussed. The value of CCTA in the diagnosis of CTO lesions. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by CAG, and the total occlusion time was over 3 months. In the first 60 days of coronary angiography, 231 patients were examined with CCTA. A total of 198 patients were selected according to the inclusion and exclusion criteria. A total of 594 primary epicardial coronary vessels were completely occluded by an experienced Image Section through the CCTA. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of CCTA in the diagnosis of CTO were determined by CAG as the gold standard. Results A total of 594 main coronary vessels were included in 198 patients. The average age was 72.5%. The sensitivity of CCTA to the diagnosis of CTO was 88%, the specificity was 99%, the accuracy was 95%, the positive predictive value was 98. 0%, and the negative predictive value was 93.2%. The results showed that the value of Kappa was 0.89, P <0.05, and the value of Kappa was 0.89, P <0.05. Conclusion CCTA has good diagnostic value in the diagnosis of CTO, the sensitivity is 88%, the specificity is 99%, and the accuracy is 95%. There was a higher consistency with the CAG in the diagnosis of CTO. There are some limitations in calcified lesion, stent-in-stent occlusion (type of stent), and small lesion vessel. In the second part, the internal attenuation gradient of the coronary artery was evaluated to evaluate the side branch circulation of the chronic total occlusion and to explore the predictive value of the internal attenuation gradient (TAG) of the coronary artery on the collateral circulation of the chronic total occlusion (CTO) of the coronary artery. and the factors that affect the establishment of the side branch of the CTO lesion. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by CAG, and the total occlusion time was over 3 months. In the first 60 days of coronary angiography, 231 patients were examined with CCTA. According to the inclusion and exclusion criteria, 82 patients and 85 main epicardial coronary vessels were selected. The side branch circulation was evaluated by using the Renta grade of the coronary angiography, and the Rentrop3 stage was defined as a good group of the lateral branch. A single factor and a multi-factor logistic regression were used to analyze the factors affecting the establishment of the side branch of CTO. The results showed that with the increasing of Renta, TAG showed a tendency to increase, and the area was 0.63 (95% CI = 0.49-0.77, P = 0.04) under the ROC curve, the sensitivity of the TAG diagnosis side branch was 60.9%, the specificity was 69% and the accuracy was 64.4%. There was a significant difference in the history of previous diabetes, the history of myocardial infarction and the TAG, and there was a significant difference in the history of previous diabetes, the history of myocardial infarction and the TAG. Logistic regression analysis of multiple factors, the history of diabetes and the history of myocardial infarction were independent predictors of the formation of the lateral branch of CTO. Conclusion TAG has a certain predictive value in the evaluation of collateral circulation. The history of diabetes is an adverse factor in the formation of the side branch of the CTO. The medical history of the myocardial infarction can be used to predict the formation of the good collateral circulation. In the third part, the effect of coronary artery CT angiography on the treatment of CTO was evaluated, and the characteristics of chronic total occlusion (CTO) were assessed by coronary computed tomography (CCTA) before and after operation, and the factors influencing the interventional treatment of CTO were analyzed. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by coronary angiography (CAG), and 2089 patients with more than 3 months of occlusion were diagnosed by coronary angiography (CAG). In the first 60 days of coronary angiography, 231 patients were examined with CCTA. According to the inclusion and exclusion criteria, 82 patients and 85 primary epicardial coronary arteries were included. The 30-minute guide wire is defined as PCI success through the block segment, and vice versa. CT-CTO score and J-CTO score were compared by ROC curve. Results There were 82 patients (85 CTO lesions), 66 male (80.5%), mean age of 57. 3 and 10. 4 years. The average time interval between CCTA and CAG was 9.5 to 12.5 days. The success rate of PCI was 53.3% in 30 minutes, and the success of 61 diseased vessels was successful. The success rate was 71.8%. The shape of the distal fiber cap in the occluded segment is not clear, the proximal segment of the occlusion is bifurcated, and the occlusion length is equal to 20mm, which is an independent risk factor affecting the intervention of the CTO lesion. As the CT-CTO score increased, the success rate of the operation of the CTO lesion was gradually decreased (85.7%, 65.8%, 33.3%, 0%). The success rate of CT-CTO score was higher than that of J-CTO in 30 minutes, and the difference was statistically significant (0.734vs. 0.726, P0.001). Conclusion The shape of the distal end of the occlusion segment is not clear, the tip of the occlusion segment is bifurcated, and the length of the occlusion segment is equal to 20mm, which is an independent risk factor affecting the success of the operation of the CTO lesion. Compared with the J-CTO score, the CT-CTO score can be well predicted for 30-minute lead wire passing through the occlusion lesion.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
本文編號：2365056
[Abstract]:The first part of the study on the diagnostic value of the first part of the coronary artery computed tomography (CT) on the diagnosis of the chronic total occlusion (CAG) was the diagnosis of the coronary chronic total occlusion (CTO) as the gold standard, and the coronary computed tomography (CT) was also discussed. The value of CCTA in the diagnosis of CTO lesions. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by CAG, and the total occlusion time was over 3 months. In the first 60 days of coronary angiography, 231 patients were examined with CCTA. A total of 198 patients were selected according to the inclusion and exclusion criteria. A total of 594 primary epicardial coronary vessels were completely occluded by an experienced Image Section through the CCTA. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of CCTA in the diagnosis of CTO were determined by CAG as the gold standard. Results A total of 594 main coronary vessels were included in 198 patients. The average age was 72.5%. The sensitivity of CCTA to the diagnosis of CTO was 88%, the specificity was 99%, the accuracy was 95%, the positive predictive value was 98. 0%, and the negative predictive value was 93.2%. The results showed that the value of Kappa was 0.89, P <0.05, and the value of Kappa was 0.89, P <0.05. Conclusion CCTA has good diagnostic value in the diagnosis of CTO, the sensitivity is 88%, the specificity is 99%, and the accuracy is 95%. There was a higher consistency with the CAG in the diagnosis of CTO. There are some limitations in calcified lesion, stent-in-stent occlusion (type of stent), and small lesion vessel. In the second part, the internal attenuation gradient of the coronary artery was evaluated to evaluate the side branch circulation of the chronic total occlusion and to explore the predictive value of the internal attenuation gradient (TAG) of the coronary artery on the collateral circulation of the chronic total occlusion (CTO) of the coronary artery. and the factors that affect the establishment of the side branch of the CTO lesion. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by CAG, and the total occlusion time was over 3 months. In the first 60 days of coronary angiography, 231 patients were examined with CCTA. According to the inclusion and exclusion criteria, 82 patients and 85 main epicardial coronary vessels were selected. The side branch circulation was evaluated by using the Renta grade of the coronary angiography, and the Rentrop3 stage was defined as a good group of the lateral branch. A single factor and a multi-factor logistic regression were used to analyze the factors affecting the establishment of the side branch of CTO. The results showed that with the increasing of Renta, TAG showed a tendency to increase, and the area was 0.63 (95% CI = 0.49-0.77, P = 0.04) under the ROC curve, the sensitivity of the TAG diagnosis side branch was 60.9%, the specificity was 69% and the accuracy was 64.4%. There was a significant difference in the history of previous diabetes, the history of myocardial infarction and the TAG, and there was a significant difference in the history of previous diabetes, the history of myocardial infarction and the TAG. Logistic regression analysis of multiple factors, the history of diabetes and the history of myocardial infarction were independent predictors of the formation of the lateral branch of CTO. Conclusion TAG has a certain predictive value in the evaluation of collateral circulation. The history of diabetes is an adverse factor in the formation of the side branch of the CTO. The medical history of the myocardial infarction can be used to predict the formation of the good collateral circulation. In the third part, the effect of coronary artery CT angiography on the treatment of CTO was evaluated, and the characteristics of chronic total occlusion (CTO) were assessed by coronary computed tomography (CCTA) before and after operation, and the factors influencing the interventional treatment of CTO were analyzed. Materials and Methods From June 2013 to August 2016, at least one coronary artery was completely occluded by coronary angiography (CAG), and 2089 patients with more than 3 months of occlusion were diagnosed by coronary angiography (CAG). In the first 60 days of coronary angiography, 231 patients were examined with CCTA. According to the inclusion and exclusion criteria, 82 patients and 85 primary epicardial coronary arteries were included. The 30-minute guide wire is defined as PCI success through the block segment, and vice versa. CT-CTO score and J-CTO score were compared by ROC curve. Results There were 82 patients (85 CTO lesions), 66 male (80.5%), mean age of 57. 3 and 10. 4 years. The average time interval between CCTA and CAG was 9.5 to 12.5 days. The success rate of PCI was 53.3% in 30 minutes, and the success of 61 diseased vessels was successful. The success rate was 71.8%. The shape of the distal fiber cap in the occluded segment is not clear, the proximal segment of the occlusion is bifurcated, and the occlusion length is equal to 20mm, which is an independent risk factor affecting the intervention of the CTO lesion. As the CT-CTO score increased, the success rate of the operation of the CTO lesion was gradually decreased (85.7%, 65.8%, 33.3%, 0%). The success rate of CT-CTO score was higher than that of J-CTO in 30 minutes, and the difference was statistically significant (0.734vs. 0.726, P0.001). Conclusion The shape of the distal end of the occlusion segment is not clear, the tip of the occlusion segment is bifurcated, and the length of the occlusion segment is equal to 20mm, which is an independent risk factor affecting the success of the operation of the CTO lesion. Compared with the J-CTO score, the CT-CTO score can be well predicted for 30-minute lead wire passing through the occlusion lesion.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
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