Comparative Study Of MSCT Coronary CTA And CAG In Diagnosis Of Coronary Heart Disease In Climacteric Women

Objects:To study the application value of multi-slice spiral CT?MSCT?on the early Diagnosis of Coronary Heart Disease in Menopausal Women.Women menopause syndrome is also called menopausal syndrome,is a common physiological phenomenon in women,its incidence is 10%¹5%,and the peak incidence of the menopause is before and after 40⁶0 years old of middle-aged women.The main clinical manifestations are irritability,insomnia,hot flushes sweat,heart palpitations,chest tightness,chest pain,headache,memory declining,waist pain,etc,and these atypical symptoms of menopause,such as palpitation,chest tightness,chest pain,etc are very similar to the angina pectoris of coronary heart disease,so that the diagnosis of coronary heart disease is very easy to misdiagnosis or missed diagnosis.Coronary atherosclerosis heart disease or coronary heart disease is the most common type,which is organ lesions by atherosclerosis,and that is also a common diseases of serious hazard human health.Coronary heart disease takes at the age of over 40 years,male patient is earlier than female,and high incidence at economically developed countries.Epidemiological studies have shown that the incidence and mortality of coronary heart disease among Perimenopausal and postmenopausal women?that is Menopausal women?are four times higher than that in the premenopausal period.Therefore,The early diagnosis and early treatment of coronary heart disease have important clinical significance in menopausal women,so that seeking a kind of check means that is simple,safe,economic and reliable,which could be acted as the first choice for the screening of coronary heart disease in menopausal women is particularly important.Myocardial ischemic events are mainly caused by coronary artery stenosis that caused by coronary atherosclerosis,and some are caused by myocardial bridge.In recent years,studies have shown that the myocardial bridge?myocardial bridge,MB?can cause serious cardiovascular events,for example,coronary spasm,angina,myocardial infarction,arrhythmia,ventricular septal perforation,and even sudden death,etc.It has changed the traditional view that MB is a benign congenital anatomic variation.Up to now,selective coronary angiography was applied to clinical more than fifty years,which has been still considered as the gold standard for the diagnosis and treatment of coronary artery disease,and that for the evaluation of cardiac function after vascular remodeling,and that for recovery coronary circulation flow,and that for the establishment situation of collateral circulation.But,it is a kind of invasive diagnostic technique,and may inevitably lead to various complications and even death.The most important reasons leading to complications are due to the anatomical characteristics of the patient's coronary artery,as well as the course development.So CAG should not be the first choice for coronary disease.Single row spiral CT cannot be used in cardiac imaging,only Multi-slice spiral CT,that have high volume scanning speed and time resolution,can be used in coronary scanning,Therefore,cardiac imaging has become a common problem in routine clinical diagnosis,and has also been a concern of imaging experts.With the continuous development of imaging and computer technology,multi-slice spiral CT from 4,16,64,128,256 rows to 320 rows received continuous development,it not only had been accelerated the ball tube rotation speed,but also had been significantly improved temporal resolution.Meanwhile,the scanning range being covered by the probe rotating1 week n be reached to 32⁴0 mm,which made heart check can be completed within 5-10s,that greatly improved the success rate of check.Another the applications of powerful post-processing software imaging laid a solid foundation for clinical diagnosis of CTA.Therefore,MSCT had been widely used in clinical,because it had high diagnostic accuracy of coronary artery morphology,repeatability,low cost,short testing time,and the noninvasive operation,which had become the first choice for the exclusion of coronary artery disease.Methods:To choose 60 cases Menopausal Women continuously,who were diagnosed coronary heart disease in the cardiology of Cheng-De central hospital from August 2012 to October 2015,their age were from 45 to 55years old,and they all had symptoms of menopause,such as palpitations,chest tightness,chest pain,discomfort,hot flashes and sweat out,muscle weakness,irritability,etc,and with the exception of the disease of endocrine system and gynaecology,and to be done MSCT coronary angiography examination in a week,and to be had coronary angiography within two week.MSCT coronary angiography:All of patients,who conformed to the conditions of being chose,had sign the informed consent of large instruments and equipment and the examination agreement of coronary angiography before the check.The ventricular rate of all patients were controlled from 65to 70 times every a minute,and they implemented respiratory training before examination.after MSCT completed coronary angiography scan,then choosing the best time phase of the image quality to do multiple planar reconstruction?MPR?,Volume representation?VR?,maximum density projection?MIP?,curved surface reconstruction?CPR?,simulation endoscopy?virtual endoscopy,VE?by the philips EBW workstation.And making analysis of the degree of coronary artery stenosis by the means of blood vessels analysis software post-processing.Two image doctor,whose title were above attending physician,completed imaging diagnosis independently,and obtaining the common results by the way of discussing.Percutaneous selective coronary angiography:three experienced cardiovascular interventional physicians used multifunction catheter to make selective coronary angiography by the way to radial artery,and puncturing catheter by using the Judkin's method.Iodine alcohol injection was injected moderately.There were six standard position on Left coronary artery and two on right coronary artery,increasing position if necessary,and to aim at displaying each branch of coronary artery clearly.The evaluation criterion of the stenosis degree of coronary artery:The result of CAG evaluated by using SA software,Rs software and visual method.Statistical treatment used SPSS19.0 statistical software to Statistical analysis.Count data used rate or constitution ratio to describe and used?²-test.The consistency of diagnosing disease both DSA and CTA analyzed by Kappa-analysis.Kappa index is more than 0.75,that show best consistency.Kappa index is between 0.75 and 0.40,that show better consistency.Kappa index is less than 0.40,that show poor consistency.There is statistical significance when P<0.05.Results:60 cases menopausal women patients all completed CAG and CTA check successfully.Their images were good,and could meet clinical diagnosis.The result of the two check methods followed up:1.The result of CAG:the mild coronary artery stenosis were 32 cases,the moderate stenosis were 19 cases,the severe stenosis were 8 cases,the totally occluded lesion was 1 case.The blood vessels of clinical diagnostic value were 28 cases,among of them,LAD were 13 cases,D₁ was 1 cases,LCX were 9 cases,RCA were 4 cases,LMA were 1 cases.Myocardial bridge were 3 cases;Soft plaque were 80 parts,table 2,table5.2.The result of MSCT-CTA:the mild coronary artery stenosis were 30cases,the moderate stenosis were 20 cases,the severe stenosis were 9 cases,the totally occluded lesion was 1 case.The blood vessels of clinical diagnostic value were 30 cases,among of them,LAD were 14 cases,D₁ was 2 cases,LCX were 8 cases,RCA were 5 cases,LMA were 1 cases.Myocardial bridge were 4 cases;Soft plaque were 75 parts,table 2,table5.3.CAG was acted as the gold standard,on the side of diagnosed the degree of coronary artery stenosis degree by the MSCT-CTA,to calculate the sensitivity,specificity,positive predictive value,negative predictive value separately,the result of the mild stenosis was 81.1%,87.4%,82.1%,80.1%,the result of the moderate stenosis was 93.5%,97.4%,91.2%,94.3%,the result of the severe stenosis was 97.2%,100.0%,100.0%,98.1%,the result of the totally occluded lesion was 100.0%,100.0%,100.0%,100.0%,table 3.4.CAG was acted as the gold standard,on the side of the lesion distribution of each branch of coronary artery stenosis and diagnosing myocardial bridge,to calculate the sensitivity,specificity,positive predictive value,negative predictive value separately,the result of LAD was 92.3%,91.2%,89.7%,93.7%,the result of LCX was 90.3%,96.8%,81.0%,97.3%,the result of LMA was 100.0%,100.0%,100.0%,100.0%,the result of RCA was 92.1%,89.5%,91.2%,96.1%.The result of diagnosing myocardial bridge was 99.2%,98.1%,97.6%,94.2%,table 4.5.On checking the soft plaque of coronary artery by two methods,the result of that,there were 80 soft plaque on the coronary artery segments of the LM,LAD,LCX,RCA by CAG,and 75 parts by MSCT-CTA.Comparing by statistics,the two methods were no statistical different,table 5.6.Comparing the two methods on diagnosing the stenosis degree and myocardial bridge detection,and then to do consistency analysis,it showed that the consistency was very well,and the difference was no statistical significance?Kappa=0.838,P=0.21?,table 1.Conclusion:1.The consistency of the MSCT-CTA and CAG was very well on the side of the stenosis-degree evaluation of coronary artery and the detection rate of soft plaque.2.MSCT-CTA and CAG were consistent in the diagnosis of coronary artery.3.MSCT-CTA could be acted as the preferred noninvasive check method,which could be used to screening coronary heart disease of menopausal women.