经胸超声心动图及多层螺旋CT对诊断冠状动脉瘘患者的临床价值

摘要

目的：以血管造影为“金标准”,评价经胸超声心动图( transthoracic echocardiography,TTE)和多层螺旋CT( multi-slice spiral CT,MSCT)筛查冠状动脉瘘及估算瘘口直径的能力,并分析其各自的影响因素。方法回顾性分析北京安贞医院接受封堵术治疗并经血管造影确诊为冠状动脉瘘的患者,所有患者均于术前1个月内接受TTE及MSCT辅助检查。结果以血管造影结果为金标准,MSCT及TTE对冠状动脉瘘患者的明确诊断准确度为96.7%及90.0%。针对瘘口直径的测定,血管造影对瘘口直径的平均测定值为(8.70±3.50)mm,MSCT及TTE的平均估算值分别为(8.86±3.71)mm及(7.50±5.90)mm,经配对t检验,P值均>0.05。但MSCT估测值较TTE的估算值与血管造影结果的相关性更好( r值分别为0.913及0.778,P值均<0.001)；经Bland-Altman一致性分析发现,当瘘口直径<10.5mm时,TTE低估瘘口直径,当瘘口直径>10.5mm时,TTE高估瘘口直径；MSCT估测结果则与血管造影间的吻合性良好。结论 TTE和MSCT对冠状动脉瘘患者的筛查准确度均较高。但是,对于瘘口直径的判断,MSCT的稳定性较TTE更佳,其术前应用可以进一步提高诊断的准确性。%Objective Angiography as a reference to evaluate the clinical value of transthoracic echocardiography ( TTE) and multi – slice apiral CT ( MSCT) for evaluation of fistula diameters in patients with coronary artery fis-tula( CAF) ,and to investigate their influencing factors. Method Thirty consecutive patients who had coronary artery fistula were revealed by angiography through the interventional operation in Anzhen Hospital. Result Accuracy of MSCT and TTE for diagnosis of CAF are 96. 7% and 90. 0% ,with angiography as reference. For CAF patients, di-ameter of fistula determined by MSCT ,TTE and Angiography were (8. 86 ± 3. 71) mm,(7. 50 ± 5. 90) mm and (8. 70 ± 3. 50)mm (all P>0. 05). But, fistula diameter revealed by MSCT was better related with angiography re-sult than that revealed by TTE (r=0. 913 and 0. 778,P<0. 001). And through Bland-Altman analyze, fistula diam-eter was underestimated by TTE when the diameter was less than 10. 5mm ,and it was overestimated when the diam-eter was more than 10. 5mm. Conclusion Both TTE and MSCT could accurately diagnose CAF patients. However, on an individual patient level, compared with MSCT, fistula diameters determined by TTE were unstable, and pre-operative application of MSCT might improve the accuracy of CAF diagnosis.