| Background:Diagnose of coronary heart disease(CHD) mainly depend on typical clinical situation and coherent auxiliary examination of patients.All kinds of new methods about CHD were applying to clinic in recent years.Duke treadmill score(DTS) is one of the most effective and important non-invasive diagnostic techniques of diagnosis,risk stratification and prognostic assessment to CHD.In recent years,coronary angiography(CAG) is a traumatic technique which was widely used in clinical diagnosis of CHD,and was recognized as the "gold standard" of diagnosis of CHD.But it is also an invasive technique.64-slice siral CT allows the non-invasive angiography diagnosis of anatomic structure and pathological changes with quick movement organs such as arteria coranaria and heart to become possible.DTS,CAG and 64-slice siral CT are the current research focus in the assessment of diagnostic value for CHD.Objective:To evaluation the diagnostic value for CHD through the application of DTS, CAG and 64-slice spiral CT in the diagnosis of CHD,then provide experimental basis for clinical diagnostic methods.Method: Collected 89 patients continuously from May 2007 to April 2008 witch ECG exercise stress test(exercise treadmill test) were positive in our hospital. Duke score was given respective.61 patients were scaned by 64-slice spiral CT in a week and 65 patients were detected by CAG.61 patients were bring into research object according to including and excluding standard.1.All the selected research objects stop taking drugs witch could impact the heart rate,antianginal drugs and digitaloid drugs before treadmill exercise test at least three days.Submaximal exercise test was practised according to standard Bruce scheme.ECG with 12 leads was recorded before and after movement and every 1-2min.Duke score=exercise time-5×ST-segment depression extent-4×angina index.2.All patients were operated with CAG through 6F visualization ductus. And image was gathered through siemens C arm digital subtraction radiography AXIMO Artis,speed was 12.5 frame/s.The degree of coronary artery stenosis was evaluated by two veteran intervention doctors.3.Post-electro cardio-gating cardiac scanner mode and Intell fan- shaped selective scanner mode were provided to all patients.Scan range was from windpipe eminence to diaphragmatic surface of heart.Taking diagnosis by traditional CAG as reference standard,to evaluate the diagnosis accuracy of≥50%and≥70%coronary artery stenosis result from affection of coronary artery calcified plaque,blending plaque and non- calcified plaque by 64-slice siral CT respectively.Taking the extent of coronary artery stenosis±10%by CAG as eference standard,to evaluate the coincidence of the diagnosis of coronary artery stenosis by 64-slice spiral CT.Result:1.Difference of patients who belong to low-risk group(DTS≥5) and belong to mod or high-risk group(DTS＜5) in sex composition and in percentage of HBP and DM complication were not statistically significant(P＞0.05).Mean age of patients who belong to mod or high-risk group was older than that of patients belong to low-risk group,and the difference was statistically significant (P＜0.05).2.To test affection instances of aeteria coronaria by CAG of patients who belong to low-risk group(DTS≥5) and belong to mod or high-risk group (DTS＜5).It was shown that affection instances of three aeteria coronaria of patients who belong to low-risk group were obvious fewer than that of patients who belong to mod or high-risk group.3.Diagnosis of affection of aeteria coronaria in different location by 64-slice spiral CT was not statistically significant than that by CAG.4.Taken CAG as the gold standard in diagnosing CHD,the diagnosis sensitivity of CHD by 64-slice spiral CT was 96.8%,secificity was 88.9%, accuracy rating was 95.8%,positive predictive value was 98.4%and negative predictive value was 80.1%in our studies.5.Plaque display in aeteria coronaria by 64-slice spiral CT was not statistically significant than that by CAG. Conclusion:1.Risk layer by DTS after CAG was definitive significant in diagnosis of different ramus affection of aeteria coronaria.2.Coincidence between the diagnosis of coronary artery stenosis by 64-slice spiral CT and the reference standard which come from the extent of coronary artery stenosis±10%by CAG was good.3.CAG was still the gold standard as coronary artery stenosis.4.Clinically taking DTS association with one of CAG and 64-slice spiral CT as the method of the diagnosis of CHD shew satisfactory specificity and accuracy rating.
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