EBCT (electron beam CT) による冠動脈石灰化検出と運動負荷心電図の比較, 及び加齢の影響について

冠動脈疾患疑いで冠動脈造影 (以下, CAG) を行った196名につき, EBCT単純撮影による冠動脈石灰化検出とトレッドミル負荷心電図検査 (TM) を行い, 冠動脈疾患に対する診断的有用性及び加齢の影響について検討した. 全症例では, CAGに対するEBCTの sensitivity は88.5%, specificity 76.9%, positive predictive value (PPV) 88.5%, negative predictive value (NPV) 76.9%であり, トレッドミル負荷心電図では, それぞれ66.4%, 72.3%, 82.9%, 51.6%と,...

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Published in日本老年医学会雑誌 Vol. 35; no. 8; pp. 626 - 630
Main Authors 三ツ浪, 健一, 木之下, 正彦, 井上, 慎二
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本老年医学会 25.08.1998
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ISSN0300-9173
DOI10.3143/geriatrics.35.626

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Abstract 冠動脈疾患疑いで冠動脈造影 (以下, CAG) を行った196名につき, EBCT単純撮影による冠動脈石灰化検出とトレッドミル負荷心電図検査 (TM) を行い, 冠動脈疾患に対する診断的有用性及び加齢の影響について検討した. 全症例では, CAGに対するEBCTの sensitivity は88.5%, specificity 76.9%, positive predictive value (PPV) 88.5%, negative predictive value (NPV) 76.9%であり, トレッドミル負荷心電図では, それぞれ66.4%, 72.3%, 82.9%, 51.6%と, EBCTの有用性が高かった. これは, 各年齢層別にみても同様の結果であった. 特に高齢者では運動負荷でのNPVが低下する傾向にあったが, この原因として, 運動負荷終了理由として leg fatigue や dyspnea で終了することが多く十分に負荷がかけられないことや, 内服薬の影響が考えられる. これらのことより, 冠動脈疾患の診断においてはEBCTの方がTMより優れており, 特に高齢者においてその傾向が強いことが示唆される.
AbstractList 冠動脈疾患疑いで冠動脈造影 (以下, CAG) を行った196名につき, EBCT単純撮影による冠動脈石灰化検出とトレッドミル負荷心電図検査 (TM) を行い, 冠動脈疾患に対する診断的有用性及び加齢の影響について検討した. 全症例では, CAGに対するEBCTの sensitivity は88.5%, specificity 76.9%, positive predictive value (PPV) 88.5%, negative predictive value (NPV) 76.9%であり, トレッドミル負荷心電図では, それぞれ66.4%, 72.3%, 82.9%, 51.6%と, EBCTの有用性が高かった. これは, 各年齢層別にみても同様の結果であった. 特に高齢者では運動負荷でのNPVが低下する傾向にあったが, この原因として, 運動負荷終了理由として leg fatigue や dyspnea で終了することが多く十分に負荷がかけられないことや, 内服薬の影響が考えられる. これらのことより, 冠動脈疾患の診断においてはEBCTの方がTMより優れており, 特に高齢者においてその傾向が強いことが示唆される.
Author 三ツ浪, 健一
木之下, 正彦
井上, 慎二
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References 6) John AR Patric FS, Jerome FB, Robert SS: Electron beam computed tomography coronary calciumu score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997; 29: 1542-48.
1) Tanenbaum SR, Kondos GT, Veselic KE, Predergast MR, Brundage BH, Chomka EV: Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol 1989; 63: 870-871.
5) Kajinami K, Seki H, Takekosi N, Mabuchi H: Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. J Am Coll Cardiol 1997; 29: 1549-56.
8) Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Drtrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832.
3) Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al.: Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 1996; 93: 898-904.
4) Manning WJ, Li W, Edelman RR: A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993; 328: 828-832.
11) Frink RJ, Archor RWP, Brown AL, Kincaid OW, Brandenburg RO: Signifisance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241-247.
12) McCarthy JH, Palmar FJ: Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499-506.
10) Bernard RC: Exercise stress testing, Heart disease, Eugene Braunwald (ed), fifth edition, W. B. Saunders company. Philadelphia 1997; 153-176.
15) Kajinami K, Seki H, Takekosi N, Mabuchi H: Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium xercise stress test results. J Am Coll Cardiol 1995; 26: 1209-21.
17) Moshage WEL, Achenbach S, Seese B, Bachmann K, Kirchgeorg M: Coronary artery stenoses: three dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron beam CT. Radiology 1995; 196: 707-714.
9) Fletcher GF, Balady G, Froelicher VF, et al.: Exercise standards. A statement for healthcare professionals from the American Heart Association. Circulation 1995; 91: 580.
13) Bartel AG, Chen JT, Peter RH, Behar VS, Hong Y, Lester RG: The significance of coronary calcification detected by fluoroscopy. Circulation 1974; 49: 1247-1253.
2) Breen JF, Sheedy PF, Schwartz RS, et al.: Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992; 185: 435-439.
16) Barrtt-Connor E, Bush TL: Estrogen and coronary heart disease in women. JAMA 1991; 265: 1861-1867.
14) 浜田星紀, 高宮誠, 斎藤春夫: 超高速CTによる冠動脈石灰化の評価. 日本医放会誌1991; 51: 1299-1305.
7) Dietrich B, Axel S, Guenter G, et al.: Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57-64.
References_xml – reference: 12) McCarthy JH, Palmar FJ: Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499-506.
– reference: 4) Manning WJ, Li W, Edelman RR: A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993; 328: 828-832.
– reference: 3) Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al.: Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 1996; 93: 898-904.
– reference: 16) Barrtt-Connor E, Bush TL: Estrogen and coronary heart disease in women. JAMA 1991; 265: 1861-1867.
– reference: 5) Kajinami K, Seki H, Takekosi N, Mabuchi H: Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. J Am Coll Cardiol 1997; 29: 1549-56.
– reference: 8) Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Drtrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832.
– reference: 9) Fletcher GF, Balady G, Froelicher VF, et al.: Exercise standards. A statement for healthcare professionals from the American Heart Association. Circulation 1995; 91: 580.
– reference: 14) 浜田星紀, 高宮誠, 斎藤春夫: 超高速CTによる冠動脈石灰化の評価. 日本医放会誌1991; 51: 1299-1305.
– reference: 1) Tanenbaum SR, Kondos GT, Veselic KE, Predergast MR, Brundage BH, Chomka EV: Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol 1989; 63: 870-871.
– reference: 7) Dietrich B, Axel S, Guenter G, et al.: Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57-64.
– reference: 15) Kajinami K, Seki H, Takekosi N, Mabuchi H: Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium xercise stress test results. J Am Coll Cardiol 1995; 26: 1209-21.
– reference: 17) Moshage WEL, Achenbach S, Seese B, Bachmann K, Kirchgeorg M: Coronary artery stenoses: three dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron beam CT. Radiology 1995; 196: 707-714.
– reference: 6) John AR Patric FS, Jerome FB, Robert SS: Electron beam computed tomography coronary calciumu score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997; 29: 1542-48.
– reference: 13) Bartel AG, Chen JT, Peter RH, Behar VS, Hong Y, Lester RG: The significance of coronary calcification detected by fluoroscopy. Circulation 1974; 49: 1247-1253.
– reference: 10) Bernard RC: Exercise stress testing, Heart disease, Eugene Braunwald (ed), fifth edition, W. B. Saunders company. Philadelphia 1997; 153-176.
– reference: 11) Frink RJ, Archor RWP, Brown AL, Kincaid OW, Brandenburg RO: Signifisance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241-247.
– reference: 2) Breen JF, Sheedy PF, Schwartz RS, et al.: Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992; 185: 435-439.
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Snippet 冠動脈疾患疑いで冠動脈造影 (以下, CAG) を行った196名につき, EBCT単純撮影による冠動脈石灰化検出とトレッドミル負荷心電図検査 (TM) を行い, 冠動脈疾患に対する診断...
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StartPage 626
SubjectTerms トレッドミル負荷心電図
冠動脈疾患
冠動脈石灰化
加齢
Title EBCT (electron beam CT) による冠動脈石灰化検出と運動負荷心電図の比較, 及び加齢の影響について
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