The Diagnostic Value Of Treadmill Test,Coronary Computed Tomography Angiogram In Patients With Coronary Heart Disease

Objective: To evaluate the value and analyze factors affecting the accuracy of ETT and CTA for diagnosis of Coronary Artery Disease(CAD).Contents and methods: Take 619 cases who are suspected coronary heart disease patients in our hospital from 2013 January to 2014 December as the objects of this research,in which 330 cases are diagnosed as positive using CAG and 289 cases are negative.Then among these 619 cases,there are 448 cases underwent TET examination(216 are positive and 232 are negative for CAG)and 171 cases underwent CTA examination(114 are positive and 57 are negative for CAG).Here CAG is seen as a gold standard to compare the accuracy of TET and CTA.Analyze the influence of patients ’ personal characteristics(gender),disease(percent stenosis,lesions and myocardial bridge)and patients’ clinical history and risk factors(hypertension,diabetes,hyperlipidemia,smoking history)TET and CTA.Results: TET confirmed 299 cases of coronary heart disease with a sensitivity of 76.9% and a specificity of 42.7%.CTA confirmed 127 cases of coronary heart disease with a sensitivity of 94.7% and a specificity of 66.7%.While different single and multiple-vessel lesions and lesion location(Larger than 50%)has no effect on diagnosis result of TET and CTA(P>0.05),But there is significant difference of detectable rate for percent stenosis and lesion location(Larger than 70%)using TET(P<0.05),and for CTA,it has no difference.(P>0.05).The diagnostic of TET in coronary heart disease with diabetes,hypertension,specificity,positive predictive value,forecast accuracy are greater than non-diabetic,non-hypertensive patients,and there was a statistically significant difference(P<0.05),hyperlipidemia,accompanied by collateral circulation,vessel occlusion is the independent factors to produce false negative results,and history of high blood pressure,smoking is the independent factors to produce false-positive results.While for CTA,there is no difference too.Conclusions: Treadmill exercise test and CTA have a high sensitivity and specificity for diagnosing coronary heart disease,both can be used as a routine examination method for diagnosing coronary heart disease,but considering significant difference of detectable rate for different percent stenosis and lesion location of TET,and when excluding other factors,treadmill exercise test for patients with high blood pressure and smoking history prone to false-positive results,no Vascular Occlusive Disease,hyperlipidemia or existence of collateral are prone to false-negative results,for different patients under different conditions,the most appropriate way should be chosen carefully to enhance diagnosability.