Diagnostic Value and Clinical Application of the Combination of Coronary Artery Calcification and Holter for Coronary Artery Disease_West China Medical Journal

Authors：

HUANG Gang , QIN Juan ,  HE Xiaojun , LUO Guiquan , TANG Chuansu

Department of Cardiology, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding?author：

HE Xiaojun, Email: huanggang_post@yahoo.cn

Keywords：

冠心病; 鈣質沉著癥; 動態心電圖; 螺旋CT; 冠狀動脈造影

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目的　探討冠狀動脈鈣化檢測聯合動態心電圖對冠心病的診斷價值及臨床應用。方法　對2010年5月－2011年8月住院的108例擬診冠心病的患者同期進行128排螺旋CT冠狀動脈鈣化積分檢測、動態心電圖和冠狀動脈造影，對比研究冠狀動脈鈣化檢測聯合動態心電圖預測冠心病的價值。結果　冠狀動脈鈣化陽性預測冠心病的靈敏度、特異度、陽性預測值和陰性預測值分別為75.6%、81.0%、73.9%、82.3%；動態心電圖陽性預測冠心病的靈敏度、特異度、陽性預測值和陰性預測值分別為73.3%、76.2%、68.8%、80.0%；冠狀動脈鈣化檢測聯合動態心電圖的系列實驗的特異度和陽性預測值分別達到96.8%和92.9%，平行試驗的靈敏度和陰性預測值分別達到93.3%和92.7%，均顯著高于單項試驗的相應指標（P＜0.05）。結論　高分辨率螺旋CT冠狀動脈鈣化檢測聯合動態心電圖顯著提高冠心病的診斷價值，可作為老年患者及基層醫院冠心病首選的篩選檢查。

Citation： HUANG Gang,QIN Juan,HE Xiaojun,LUO Guiquan,TANG Chuansu. Diagnostic Value and Clinical Application of the Combination of Coronary Artery Calcification and Holter for Coronary Artery Disease. West China Medical Journal, 2012, 27(9): 1312-1314. doi: Copy

1.	Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association Writing Group[J]. Circulation, 1996, 94(5):1175-1192.
2.	Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force(ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography[J]. J Am Coll Cardiol, 2007, 49(3): 378-402.
3.	Brandes A, Bethge KP. Long term electrocardiography(Holter monitoring)[J]. Herzschrittmacherther Electrophysiol, 2008, 19(3): 107-129.
4.	Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography[J]. J Am Coll Cardiol, 1990, 15(4): 827-832.
5.	張少雄, 戴汝平, 高潤霖. 電子束CT對冠狀動脈鈣化的定量研究[J]. 中華心血管病雜志, 1998, 26(4): 289-292.
6.	杜志民, 羅初凡, 胡承恒, 等. 電子束CT檢測冠狀動脈鈣化對診斷老年冠心病的價值[J]. 中華老年心腦血管病雜志, 2002, 4(1): 27-29.
7.	Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary arteriography[J]. J Am Coll Cardiol, 1996, 27(2): 285-290.
8.	van der Bijl N, Joemai RM, Geleijns J, et al. Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary arteriography[J]. AJR Am J Roentgenol, 2010, 195(6): 1299-1305.
9.	Maffei E, Martini C, Tedeschi C, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularization: registry data on the impact of calcium score[J]. Radiol Med, 2011, 116(7): 1000-1013.
10.	van Werkhoven JM, de Boer SM, Schuijf JD, et al. Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography[J]. Am J Cardiol, 2010, 106(12): 1675-1679.
11.	Ma ES, Yang ZG, Li Y, et al. Correlation of calcium measurement with low dose 64-slice CT and angiographic stenosis in patients with suspected coronary artery disease[J]. Int J cardiol, 2010, 140(2): 249-252.
12.	Kennedy J, Shavelle R, Wang S, et al. Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography[J]. Am Heart J, 1998, 135(4): 696-702.
13.	Paech DC, Weston AR. A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease[J]. BMC Cardiovasc Disord, 2011, 11: 32.

1. 　Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association Writing Group[J]. Circulation, 1996, 94(5):1175-1192.
2. 　Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force(ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography[J]. J Am Coll Cardiol, 2007, 49(3): 378-402.
3. 　Brandes A, Bethge KP. Long term electrocardiography(Holter monitoring)[J]. Herzschrittmacherther Electrophysiol, 2008, 19(3): 107-129.
4. 　Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography[J]. J Am Coll Cardiol, 1990, 15(4): 827-832.
5. 　張少雄, 戴汝平, 高潤霖. 電子束CT對冠狀動脈鈣化的定量研究[J]. 中華心血管病雜志, 1998, 26(4): 289-292.
6. 　杜志民, 羅初凡, 胡承恒, 等. 電子束CT檢測冠狀動脈鈣化對診斷老年冠心病的價值[J]. 中華老年心腦血管病雜志, 2002, 4(1): 27-29.
7. 　Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary arteriography[J]. J Am Coll Cardiol, 1996, 27(2): 285-290.
8. 　van der Bijl N, Joemai RM, Geleijns J, et al. Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary arteriography[J]. AJR Am J Roentgenol, 2010, 195(6): 1299-1305.
9. 　Maffei E, Martini C, Tedeschi C, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularization: registry data on the impact of calcium score[J]. Radiol Med, 2011, 116(7): 1000-1013.
10. 　van Werkhoven JM, de Boer SM, Schuijf JD, et al. Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography[J]. Am J Cardiol, 2010, 106(12): 1675-1679.
11. 　Ma ES, Yang ZG, Li Y, et al. Correlation of calcium measurement with low dose 64-slice CT and angiographic stenosis in patients with suspected coronary artery disease[J]. Int J cardiol, 2010, 140(2): 249-252.
12. 　Kennedy J, Shavelle R, Wang S, et al. Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography[J]. Am Heart J, 1998, 135(4): 696-702.
13. 　Paech DC, Weston AR. A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease[J]. BMC Cardiovasc Disord, 2011, 11: 32.

West China Medical Journal

Diagnostic Value and Clinical Application of the Combination of Coronary Artery Calcification and Holter for Coronary Artery Disease

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