Diagnostic And Short-term Prognostic Value Of 12-lead Ambulatory Electrocardiography And 64-slice Spiral Computed Tomography In Patients With Coronary Heart Disease

Objective To evaluate the primary diagnostic and prognostic value of 12-lead ambulatory electrocardiography (AECG) and restrospectively elctrocardiographically gated 64-slice spiral computed tomography angiography in patients with coronary heart disease.Methods Eighty-nine patients underwent AECG, 64-slice spiral computed tomography and coronary angiography(CAG). With the CAG as the standard, patients were divided into single-vessel CHD group and multi-vessels CHD group, then it was analyed that the diagnostic value in CHD by AECG, 64-slice spiral computed tomography and combination of them. By visual estimation, coronary artery were classified as evaluable and unevaluable, and in evaluable arteries, the severity of coronary artery stenosis , the score of coronary artery calcium and the characteristics of coronary artery were confirmed by 64-slice spiral computed tomography. Patients with CHD were followed up for the occurrence of major adverse cardiac events (MACE) within 180 days.Results The sensitivity and specificity of AECG in the diagnosis of CHD were 81.6% and 82.5%, respectively . The positive rate of AECG in the multi-vessels CHD group was higher(92.6%) than in the single-vessel CHD (63.6%). To evaluate 330 of 356 coronary arteries, the sensitivity and specificity of 64-slice spiral computed tomography in the diagnosis of CHD were 89.3% and 95.7%,respectively. The sensitivity of diagnosis were 100% in both of left main coronary artery and left anterior descending artery diseases. The sensitivity and negative predictive value wear 93.9% and 89.7%, respectively, in paralled test of AECG and 64-slice spiral computed tomography in the diagnosis of CHD. 95.0% specificity and 94.7% positive predictive value of serial test of AECG and 64-slice spiral computed tomography in the diagnosis of CHD were found. Coronary plaques were detected in 112 coronary arteries including 17 with soft plaques, 41 with mixed plaques and 54 with calcified plaques. Twelve MACE occurred during followed-up of 180 days. The episodes of myocardial ischemia, the score of coronary artery calcium, the number of coronary arteries with calcified plaques, the number of coronary arteries with soft plaques in patients with MACE was more frequent than those without MACE. The result of multivariate analysis suggested that the number of coronary arteries with stenosis and with soft plaques were independent significant predictors of MACE.Conclusion (1) The diagnosis of CHD by AECG is good at the sensitivity and specificity, and the positive rate of it is associated with severity of coronary arteries lesion; (2) The sensitivity and specificity of 64-slice spiral computed tomography in the diagnosis of CHD are higher than 12-lead AECG, and especially, the positive rate of detecting the stenosis of left main coronary artery and left anterior descending artery was satisfactory; (3) The accuracy of diagnosis of CHD was improved when 12-lead AECG and 64-slice spiral computed tomography were joined together; (4) Multi-slice spiral computed tomography coronary angiography provides independent prognostic information in patients with CHD.