cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2020-2374cardiovascular-2374Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАCORONARY HEART DISEASEСравнение результатов стресс-эхокардиографии и компьютерной томографической ангиографии в диагностике стабильной ишемической болезни сердца у пациентов >70 летStress echocardiography vs coronary oomputed tomography angiography for the detection of obstructive coronary artery disease in patients aged >70 years with suspected stable coronary artery diseasehttps://orcid.org/0000-0001-8800-1670КозловС. Г.KozlovS. G.

 

Доктор медицинских наук, ведущий научный сотрудник отдела проблем атеросклероза Института клинической кардиологии им. А. Л. Мясникова.

Москва

Sergei Gennadievich Kozlov - Ph.D.

Moscow

bestofall@inbox.ruhttps://orcid.org/0000-0003-4700-9566ЧерноваО. В.ChernovaO. V.

Аспирант отдела.

Москва

Moscow

Glazunova-23@mail.ruhttps://orcid.org/0000-0002-8878-7340ШитовВ. Н.ShitovV. N.

Кандидат медицинских наук, научный сотрудник. Отделения ультразвуковой диагностики.

Москва

Victor Nikolayevich Shitov - Ph.D.

Moscow

vik.schitow@yandex.ruhttps://orcid.org/0000-0001-8319-3714ВеселоваТ. Н.VeselovaT. N.

Доктор медицинских наук, ведущий научный сотрудник отдела томографии.

Москва

  Tatyana Nikolaevna Veselova - Ph.D.

Moscow

tnikveselova@gmail.comhttps://orcid.org/0000-0002-3233-1862СаидоваМ. А.SaidovaM. A.

Доктор медицинских наук, профессор, руководитель отдела, заведующий отделением ультразвуковых методов диагностики.

Москва

Marina Abdulatipovna Saidova - Ph.D. professor.

Moscow

m.saidova@gmail.comhttps://orcid.org/0000-0003-4374-1063ТерновойС. К.TernovoyS. K.

Доктор медицинских наук, профессор, академик РАН, руководитель отдела томографии.

Москва

Sergei Konstantinovich Ternovoy - RAS, M.D., Ph.D., Professor.

Moscow

prof_ternovoy@list.ruФГБУ “Национальный медицинский исследовательский центр кардиологии” Минздрава РоссииNational Medical Research Center of Cardiology20201211202019523742374Copyright © Козлов С.Г., Чернова О.В., Шитов В.Н., Веселова Т.Н., Саидова М.А., Терновой С.К., 20202020Козлов С.Г., Чернова О.В., Шитов В.Н., Веселова Т.Н., Саидова М.А., Терновой С.К.Kozlov S.G., Chernova O.V., Shitov V.N., Veselova T.N., Saidova M.A., Ternovoy S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2374Цель

Цель. Сравнение результатов стресс-эхокардиографии (стресс -ЭхоКГ) с физической нагрузкой и компьютерной томографической ангиографией (КТА) в диагностике стабильной ишемической болезни сердца (ИБС), обусловленной стенозирующим коронарным атеросклерозом (СКА) у пациентов >70 лет с подозрением на наличие стабильной ИБС.

Материал и методы

Материал и методы. В исследование включено 390 пациентов >70 лет, которым в плановом порядке была выполнена коронаро-ангиография (КАГ). На первом этапе определен контингент больных, которым проведение стресс-ЭхоКГ и КТА с целью диагностики ИБС является целесообразным. На втором этапе проведено сопоставление эффективности обоих методов в выявлении СКА у пациентов с атипичной стенокардией и неангинозной болью. Результаты. Из 111 пациентов с атипичной стенокардией и неангинозной болью, у которых стресс-ЭхоКГ была доведена до диагностических критериев, 69 (62%) больных имели СКА. Чувствительность пробы в диагностике СКА равнялась 89%, специфичность — 95%, отношение правдоподобия положительного (ОП+) результата — 17,8, отношение правдоподобия отрицательного (ОП-) результата — 0,1. Положительный результат увеличивал вероятность наличия СКА с 42% до 93%, отрицательный результат уменьшал вероятность до 7%. Из 82 пациентов с атипичной стенокардией и неангинозной болью, которым была проведена КТА, 48 (59%) человек имели СКА. Чувствительность КТА равнялась 100%, специфичность — 88%, ОП+ результата — 8,3, ОП- результата — 0. Положительный результат увеличивал вероятность наличия СКА с 42% до 86%, отрицательный результат уменьшал вероятность до 0%.

Заключение

Заключение. Результаты стресс-ЭхоКГ с физической нагрузкой на велоэргометре сопоставимы с результатами КТА при осуществлении диагностики стабильной ИБС, обусловленной СКА, у пациентов >70 лет с атипичной стенокардией и неангинозной болью. Стресс-ЭхоКГ с физической нагрузкой имеет большую диагностическую ценность положительного результата, КТА — отрицательного результата.

Aim

Aim. To compare stress echocardiography and coronary computed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years.

Materials and methods

Materials and methods. The study included 390 patients aged >70 years with suspected stable CAD, which underwent elective coronary artery angiography (CAG). Initially, patients for whom stress echocardiography and CCTA is appropriate was determined. After that diagnostic accuracy of both methods in the detection of obstructive CAD was evaluated in patients with atypical angina and non-anginal chest pain.

Results

Results. Among 111 patients with atypical angina and non-anginal pain which underwent stress echocardiography and had unequivocal results, 69 (62 %) patients had obstructive CAD. Stress echocardiography has sensitivity of 89%, specificity of 95%, positive likelihood ratio (LR+) of 17,8, and negative likelihood ratio (LR-) of 0,1. Positive result increased probability of obstructive CAD from 62% to 95%, while negative result reduced probability to 16%. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA, 48 (59 %) patients had obstructive CAD. CCTA has sensitivity of 100 %, specificity of 88%, LR+ of 8,3, and LR- of 0,3. Positive result increased post-test probability of obstructive CAD from 59% to 86%, while negative result reduced post-test probability to 0%.

Conclusion

Conclusion. Stress echocardiography and CCTA has comparable diagnostic accuracy in the detection of obstructive CAD in patients aged >70 years with atypical angina and non-anginal pain. Stress echocardiography has a greater diagnostic value of positive result; CCTA has a greater diagnostic value of negative result.

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The authors declare that there are no conflicts of interest present.