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; 钙质沉着症; 动态心电图; 螺旋CT; 冠状动脉造影

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目的　探讨冠状动脉钙化检测联合动态心电图对冠心病的诊断价值及临床应用。方法　对2010年5月－2011年8月住院的108例拟诊冠心病的患者同期进行128排螺旋CT冠状动脉钙化积分检测、动态心电图和冠状动脉造影，对比研究冠状动脉钙化检测联合动态心电图预测冠心病的价值。结果　冠状动脉钙化阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为75.6%、81.0%、73.9%、82.3%；动态心电图阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为73.3%、76.2%、68.8%、80.0%；冠状动脉钙化检测联合动态心电图的系列实验的特异度和阳性预测值分别达到96.8%和92.9%，平行试验的灵敏度和阴性预测值分别达到93.3%和92.7%，均显著高于单项试验的相应指标（P＜0.05）。结论　高分辨率螺旋CT冠状动脉钙化检测联合动态心电图显著提高冠心病的诊断价值，可作为老年患者及基层医院冠心病首选的筛选检查。

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.
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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.	张少雄, 戴汝平, 高润霖. 电子束CT对冠状动脉钙化的定量研究[J]. 中华心血管病杂志, 1998, 26(4): 289-292.
6.	杜志民, 罗初凡, 胡承恒, 等. 电子束CT检测冠状动脉钙化对诊断老年冠心病的价值[J]. 中华老年心脑血管病杂志, 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. 　张少雄, 戴汝平, 高润霖. 电子束CT对冠状动脉钙化的定量研究[J]. 中华心血管病杂志, 1998, 26(4): 289-292.
6. 　杜志民, 罗初凡, 胡承恒, 等. 电子束CT检测冠状动脉钙化对诊断老年冠心病的价值[J]. 中华老年心脑血管病杂志, 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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