目的 探讨多层CT冠脉成像检查 对风湿性左房室瓣病变术前冠心病(CAD) 筛查的应用价值。方法 42例风湿性左房 室瓣病变患者在接受瓣膜术前，依次接受 CT冠脉成像检查和选择性冠脉造影术检 查，以冠脉造影结果为对照，以节段、血 管及患者水平评价冠脉成像诊断CAD的灵 敏度、特异度、阳性预测值、阴性预测 值、准确率，采用Kappa值评价冠脉成像 和冠脉造影诊断CAD的一致性。结果 500 排CT诊断在节段水平诊断CAD的灵敏度、 特异度、阳性预测值、阴性预测值分别 为90.63%、99.01%、85.29%、99.40%， 血管水平诊断CAD的灵敏度、特异度、阳 性预测值、阴性预测值分别为80.0%、 92.19%、76.19%、93.65%，患者水平 诊断CAD的灵敏度、特异度、阳性预测 值、阴性预测值分别为80.0%、92.59%、 85.71%、89.29%，且与冠脉造影比较后， CT冠脉成像在节段、血管及患者水平的 准确率为98.51%、89.29%、88.10%，且 Kappa值分别为0.871、0.710、0.737。结 论 CT冠脉成像检查冠心病准确较高，可 运用于风湿性左房室瓣病变术前冠心病筛 查。

Objective To explore the value of CT coronary angiography in the preoperative coronary heart disease (CAD) screening in the rheumatic left atrioventricular valve lesions. Methods 42 cases of patients with rheumatic left atrioventricular valve lesions were selected for the study, and they were treated with 500-row CT coronary angiography and then selective coronary angiogram before valve surgery. The sensibility, specificity, positive or negative predictive value (PPV or NPV), and accuracy of coronary angiography for the diagnosis of CAD were evaluated in segmental, vascular and patient levels by contrast with coronary angiogram results. And the Kappa values were used to evaluate the consistency of coronary angiography and coronary angiogram in the diagnosis of CAD. Results The sensibility, specificity, PPV and NPV levels of CT in the diagnosis of CAD on segmental level were 90.63%, 99.01%, 85.29% and 99.40% respectively, and the four indexes in the the diagnosis on vascular level were 80%, 92.19%, 76.19% and 93.65%, and the four indexes in the diagnosis on patients level were 80%, 92.59%, 85.71% and 89.29% respectively. After comparsion with coronary angiogram, the accuracy rates of the 500-row CT coronary angiography in the segmental, vascular and patients levels were 98.51%, 89.29% and 88.10%, and the Kappa values were 0.871, 0.710 and 0.737 respectively. Conclusion CT coronary angiography can have a high accuracy rate in checking coronary heart disease, and can be used in the preoperative coronary heart disease screening in the rheumatic left atrioventricular valve lesions.