Clinical Investigation Of Coronary Artery Disease In Patients With Metbolic Syndrome Evaluated By Dual-source Computed Tomography

Objectives:To evaluate the accurary in diagnosis of coronary artery stenoses in patients with metabolic syndrome by dual-source computed tomography(DSCT) in contrast to selective coronary angiography(SCA) and evaluate the relationship between metabolic syndrome and severity of coronary artery disease by calculating coronary artery calcification calcification score,plaque type and quantity simultaneously.Methods:Seventy-four patients with possible coronary heart disease were divided into two groups :26 patients with metabolic syndrome(MetS),48 patients without metabolic syndrome (Non-MetS). All patients underwent dual-source computed tomography coronary angiography(DSCTA) and SCA.Sensitivity , specificity,positive predictive value,and negative predictive value were calculated for detection of significant stenosis(>50%) on a segmental basis using SCA as reference and gold standard. Then calculated significantly stenosed vessels,coronary artery calcium score,plaque type and quantity for statistical analysis.Results:1.The sensitivity,specificity,positive and negative predictive value of DSCTA to identify coronary significant stenosis(>50%)in 26 patients with MetS,48 patients without MetS and total were 89.01%,98.61%,95.29%,96.60% ,93.52%,97.44%,87.07%,98.79%,and 91.46%,97.83%,90.55%,98.05% ,respectively.58 patients had definite CAD.2. The average number of significantly stenosed vessels and prevalence of multivessel disease in MetS group was significantly higher than in non-MetS group(P<0.05).The prevalence of multivessel disease in definite CAD subgroup with MetS was also significantly higher than without MetS(P<0.05).In the 4 groups classified according to the number of metabolic factors, coronary artery calcification score was generally increased. Nonparametric test showed that the number of calcified and soft plaque between patients with and without MetS had statistical significance (calcified plaque , p<0.05; soft plaque,P<0.05),respectively. Multivariable logistic regression analysis revealed soft plaque was independently associated with MetS after adjusting for risk factors including age,gender,smoking and so on.Conclusions:1.DSCT can display coronary artery images clearly,and can be a potential,noninvasive examination method for excluding coronary artery disease in patients without typical precordial chest pain symptoms. DSCT had high sensitivity and negative predictive value for detection of coronary significant stenosis,and will be a potential,noninvasive method for diagnosing coronary artery disease.DSCT can calculated coronary artery calcium score and detect coronary artery plaque texture ,which is helpful for predicting coronary events in clinical practice.2. MetS can accelerate the occurrence and development of coronary artery disease.Patients with CAD complicated by MetS would have serious and complex coronary artery lesions.Therefore,to recieve DSCT coronary angiography early will help identify initial subclinical coronary atherosclerosis .Meanwhile,risk-reducing medical therapy will decrease the occurrence of CAD and other cardiovascular events,and improve its prognosis.