| Part Ⅰ Comparative study of cardiodynamicsgram(CDG)and stress SPECT-MPI for diagnosis of myocardial ischemia in patients with coronary heart diseaseObjectiveThe aim of this study was to investigate the agreement of cardi odynami csgram(CDG)and stress SPECT-MPI in diagnosis of myocardial ischemia in patients with coronary heart disease(CAD)and evaluate its feasibility and accuracy of diagnosis of myocardial ischemia.MethodsThis study was performed at General Hospital of Guangzhou Military Command of PLA form March 2014 to January 2017.A total of 88 suspected or confirmed patients with CAD were enrolled.CDG were performed before SPECT-MPI.CDG diagnosis results were divided into 2 types:negative and positive.SPECT-MPI images were analyzed by the American Heart Association 17 segment analysis method.Low or defect perfusion was positive,normal was negative.The evaluation of myocardial perfusion images was performed by 2 physicians with intermediate level.Consistency of the two methods in the diagnosis of myocardial ischemia was analyzed by chi-square test.With SPECT-MPI as the standard,to evaluate the accuracy,sensitivity,specificity,false positive rate,false negative rate,positive predictive value,negative predictive value,Youden index,positive likelihood ratio,negative likelihood ratio,odds product,and kappa coefficient of CDG in the diagnosis of myocardial ischemia.ResultsAmong the 88 cases(average 58.88±14.15),62 male(70.45%),42 cases were positive in CDG with 39 true positive,46 cases were negative with 16 were true negative.With SPECT-MPI as the standard,the sensitivity,specificity,accuracy,false negative rate,false positive rate of CDG were 56.52%,84.211%,62.50%,43.47%,15.79%,respectively.The paired chi square test showed poor consistency of the two detective methods(McNemar=20.48,5,P=0.000<0.05).The positive predictive value was 92.86%,the negative predictive value was 34.780%,Youden index is 0.41,the positive likelihood ratio was 3.58,negative likelihood ratio was 0.52,odds product was 6.93,kappa coefficient was 0.269(0.2<0.269<0.4),showed that the two methods had general consistency.ConclusionsCardiodynamicsgram(CDG)has low consistency with SPECT-MPI in diagnosis of myocardial ischemia in CAD,but the specificity and PPV is high.Therefore,as a convenient and noninvasive diagnostic method,CDG could better detect myocardial ischemia in patients of CAD,and guide clinicians in the next step plan.Part Ⅱ Comparative study of cardiodynamicsgram(CDG)and dual source CT angiography(DSCTA)in diagnosis of myocardial ischemia and artery stenosisObjectiveThe aim of this study was to investigate and compare the correlation of cardiodynamicsgram(CDG)diagnosis of myocardial ischemia and dual source CT coronary angiography(DSCTA)diagnosis of coronary stenosis.And evaluate its feasibility and accuracy of diagnosis of myocardial ischemia of CAD.MethodsThis study was performed at General Hospital of Guangzhou Military Command of PLA form March 2014 to January 2017.A total of 609 suspected or confirmed patients with CAD were enrolled.CDG were performed before DSCTA examination.CDG diagnosis results were divided into 2 types:negative and positive.DSCTA images were analyzed by postprocessing methods such as multi-planar reconstruction(MPR),maximum intensity projection(MIP),volume rendering technique(VRT),Circulation et al.to evaluation of stenosis of coronary arteries.DSCTA showed>1 coronary arteries stenosis were positive,with no coronary arteries stenosis were negative.The evaluation of DSCTA images was performed by 2 physicians with intermediate level.Consistency of the two methods in the diagnosis of myocardial ischemia was analyzed by chi-square test.With DSCTA as the standard,to evaluate the accuracy,sensitivity,specificity,false positive rate,false negative rate,positive predictive value,negative predictive value,Youden index,positive likelihood ratio,negative likelihood ratio,odds product,and kappa coefficient of CDG in the diagnosis of myocardial ischemia.According to the results of DSCTA,the patients were divided into 5 groups:normal group,mild stenosis group,moderate stenosis group,severe stenosis group and simple myocardial bridge group,respectively.and compare the diagnostic accuracy of CDG in every group.ResultsAmong the 609 cases(average 58.17±11.48),385 male(63.22%).368 cases were positive in CDG with 311 true positive,241 cases were negative with 125 were true negative.With DSCTA as the standard,the sensitivity,specificity,accuracy,false negative rate,false positive rate of CDG were 72.83%,68.68%,71.59%,27.17%,31.32%,respectively.The paired chi square test showed poor consistency of the two detection methods(p=0.000<0.05).The positive predictive value was 84.51%,the negative predictive value was 51.87%,Youden index is 0.42,the positive likelihood ratio was 2.33,negative likelihood ratio was 0.40,odds product was 5.88,kappa coefficient was 0.380(0.2<0.380<0.4),showed that the two methods had general consistency.In normal group,CDG false positive rate was 31.32%(57/182).And the positive rate of mild stenosis group,moderate stenosis group,severe stenosis group and simple myocardial bridge group were 73.94%(210/284),68.75%(55/80),73.02%(46/63).In simple myocardial bridge group,The paired chi square test showed good consistency of the two detective methods(p=1.00>0.05).The.sensitivity,specificity,accuracy,false negative rate,false positive rate of CDG were 92.31%,81.25%,89.09%,7.69%,18.57%,respectively.The positive predictive value was 92.31%,the negative predictive value was 81.25%,Youden index is 0.736,the positive likelihood ratio was 4.92,negative likelihood ratio was 0.095,odds product was 52,kappa coefficient was 0.736(0.6<0.736<0.8),showed that the two methods had substantial consistency.ConclusionsCardiodynamicsgram(CDG)diagnosis of myocardial ischemia and DSCTA diagnosis of coronary stenosis had low consistency.But the sensitivity,specificity,accuracy and PPV were high.As a rapid,noninvasive,convenient examination method,CDG can detect myocardial ischemia,especially in finding simple myocardial bridge discovery and having good consistency.Part Ⅲ further exploration of cardiodynamicsgram(CDG)in diagnosis of myocardial ischemia in patients with coronary heart diseaseObjectiveThe aim of this study was to investigate the agreement of cardiodynamicsgram(CDG)and treadmill exercise test(TET)in diagnosis of myocardial ischemia in patients with coronary heart disease(CAD)and evaluate its feasibility and accuracy of diagnosis of myocardial ischemia.To evaluate the myocardial ischemia and mental stress detected by cardiodynamicsgram(CDG)and Psychology and spiritual analysis(PSA),then explore the correlation between them.MethodsThis study was performed at General Hospital of Guangzhou Military Command of PLA form January 2017 to February 2017.A total of 101 suspected or confirmed patients with CAD were enrolled.CDG were performed after TET.CDG diagnosis results were divided into 2 types:negative and positive.TET using standard Bruce program,achieving the submaximal heart rate was as the standard.Severe arrhythmia or atypical angina pectoris occurred;or ST segment depression more than 0.lmv in or after exercise,or ST segment elevation were positive.A total of 23 suspected or confirmed patients with CAD were enrolled in General Hospital of Guangzhou Military Command of PLA form April 2017 to May 2017.All patients underwent CDG and PSA examinations before CAG.A positive CAG was confirmed if at least 50%stenosis existed in 1 of the 3 main coronary arteries:left anterior descending artery,circumflex artery,and right coronary artery.Consistency of the two methods in the diagnosis of myocardial ischemia was analyzed by chi-square test.With TET as the standard,to evaluate the accuracy,sensitivity,specificity,false positive rate,false negative rate,positive predictive value,negative predictive value,Youden index,positive likelihood ratio,negative likelihood ratio,odds product,and kappa coefficient of CDG in the diagnosis of myocardial ischemia.The correlation of myocardial ischemia and mental stress detected by CDG and PSA was analyzed with Pearson,s correlation.The paired sample t-test was used to analyze whether the changes in myocardial ischemia and mental stress before and after CAG had statistically significant difference in patients who underwent CDG and PSA examinations before and after CAG.ResultsAmong the 101 cases(average 51.03±11.61),69 male(68.320%),56 cases were positive in CDG with 17 true positive,45 cases were negative with 38 were true negative.With TET as the standard,the sensitivity,specificity,accuracy,false negative,false positive rate rate of CDG were70.83%,49.35%,54.46%,29.17%,50.56%,respectively.The paired chi square test showed poor consistency of the two detection methods(P=0.000<0.05).The positive predictive value was 30.36%,the negative predictive value was 84.44%,Youden index is 0.20,the positive likelihood ratio was-i.40,negative likelihood ratio was 0.59,odds product was 2.37,kappa coefficient was 0.138(0.138<0.2),which showed that the two methods had slight consistency.11 cases of the 23 suspected coronary heart disease patients was correct diagnosis of myocardial ischemia by CDG,in the 11 cases,which showed no correlation between myocardial ischemia and mental stress detected by CDG and PSA(p=0.376>0.05).8 of the 11case underwent CDG and PSA examination before and after CAG showed that CDG value decreased,and mental stress value increased.The t-test showed that the changes of myocardial ischemia and mental stress before and after CAG had no statistically significant difference(t=0.710,p=0.501>0.05,t=-0.198 p=0.848>0.05).ConclusionsCardiodynamicsgram(CDG)had slight consistency with TET in diagnosis of myocardial ischemia in CAD,The sensitivity,specificity,accuracy,and PPV were poor.The reason might be that TET wasn’ t gold standard in diagnosis of myocardial ischemia of coronary heart disease and TET had lower accuracy,sensitivity,specificity,high false positive rate.There was no correlation between myocardial ischemia and mental stress detected by CDG and PSA in patients with coronary heart disease,and the changes of myocardial ischemia and mental stress before and after CAG had no statistically significant difference,which was not in accordance with the relevant literature reports.It may probably due to the fact that the sample size was too small in quanlity. |
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