Статья
Перфузионная компьютерная томография миокарда с чреспищеводной электрокардиостимуляцией в качестве стресс-теста у больных с пограничными стенозами в коронарных артериях: сравнение с измерениями фракционного резерва кровотока
Цель Оценка диагностической точности перфузионной компьютерной томографии (ПКТ) миокарда с чреспищеводной электрокардиостимуляцией (ЧП-ЭКС) в выявлении ишемии у больных с пограничными стенозами (50–75 %) в коронарных артериях по сравнению с измерениями фракционного резерва кровотока (ФРК).Материал и методы В исследование были включены 25 больных с пограничными (50–75 %) стенозами по данным компьютерной томографической ангиографии (КТА) или коронарной ангиографии (КАГ). Впоследствии им были выполнены инвазивное измерение ФРК и ПКТ миокарда на томографе с 320‑рядным детектором в сочетании со стресс-тестом ЧП-ЭКС. Значение показателя ФРК <0,8 указывало на гемодинамическую значимость стеноза. Перфузию миокарда оценивали визуально, путем согласованного заключения двух специалистов.Результаты Все пациенты прошли полный протокол исследования. Продолжительность навязывания искусственного ритма у всех пациентов составила 6 мин. Внутривенное введение атропина сульфата потребовалось 4 пациентам. ПКТ с ЧП-ЭКС выявила значимые для ФРК стенозы с чувствительностью, специфичностью, прогностической ценностью положительного результата и прогностической ценностью отрицательного результата 47, 90, 87 и 53 % соответственно.Заключение ПКТ с ЧП-ЭКС в комбинации с КТА можно рассматривать как информативный метод обследования для одновременной оценки состояния коронарных артерий и выявления ишемии миокарда. Данная методика особенно актуальна для анализа гемодинамической значимости пограничных стенозов в коронарных артериях.
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