目的 比较冠脉成像(CTA)与心电 图在诊断隐匿性冠心病患者中的应用。 方法 回顾性分析我院收治的120例拟诊断 为隐匿性冠心病患者的临床资料，所有 患者均先后接受CTA检查、动态心电图检 查以及CAG检查。以CAG结果为金标准， 评价CTA以及动态心电图筛查冠心病的灵 敏度、特异度、阳(阴)性预测值和Kappa 值(一致性)。结果 以CAG为金标准，CTA 诊断冠脉狭窄的灵敏度为0.981，特异度 为0.867，准确度为0.967，阳性预测值 为0.981，阴性预测值为0.867，Kappa值 为0.848，CTA与CAG具有较好的一致性； 动态心电图检查诊断冠脉狭窄的灵敏 度为0.971，特异度为0.533，准确度为 0.917，阳性预测值为0.936，阴性预测值 为0.727，Kappa值为0.570，动态心电图 与CAG的一致性一般；CTA诊断轻、中、 重度管腔狭窄的灵敏度分别为0.995、 0.979、0.944；动态心电图检查示心肌 缺血部位与CAG中狭窄血管具有一定相关 性。结论 CTA与动态心电图诊断隐匿性冠 心病均具有一定临床价值，CTA诊断灵敏 度更高，与金标准一致性更好，动态心电 图可为无症状心肌缺血进行初步筛查。

Objective To compare the application of coronary angiography (CTA) and electrocardiogram in the diagnosis of patients with latent coronary heart disease. Methods The clinical data of 120 patients with latent coronary heart disease admitted to our hospital were retrospectively analyzed. All patients were given CTA, dynamic electrocardiography and CAG. The CAG results were used as the gold standard to evaluate the sensitivity, specificity, positive (negative) predictive value and Kappa value (consistency) of CTA and dynamic electrocardiogram in the screening of coronary heart disease. Results With CAG as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and the Kappa value of CTA in the diagnosis of coronary stenosis were 0.981, 0.867, 0.967, 0.981, 0.867 and 0.848, and CTA and CAG had good consistency. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and the Kappa value of dynamic electrocardiography in the diagnosis of coronary stenosis were 0.971, 0.533, 0.917, 0.936, 0.727 and 0.570, and the dynamic electrocardiogram and CAG had general consistency. The sensitivities of CTA in the diagnosis of mild, moderate and severe stenosis were 0.995, 0.979 and 0.944 respectively. Dynamic electrocardiography showed that myocardial ischemia site was associated with stenotic vessels in CAG. Conclusion CTA and dynamic electrocardiogram have certain clinical value in the diagnosis of latent coronary heart disease. CTA has higher diagnostic sensitivity and better consistency with gold standard, and dynamic electrocardiogram can be used for initial screening of asymptomatic myocardial ischemia.