探讨冠状动脉CT血管造影(CCTA)联合四维斑点跟踪超声心动图(4D－STE)对冠状动脉粥样硬化患者发生主要不良心脏事件(MACE)的预测价值。

选取胶州市人民医院北院收治的103例冠状动脉粥样硬化患者，所有患者均接受CCTA及4D－STE检查。随访1 a统计MACE发生率，并分析发生MACE者与未发生MACE者冠状动脉狭窄程度及心肌各节段应变[环周应变(GCS)、径向应变(GRS)、左室整体纵向应变(GLS)、面积应变(GAS)]幅度变化情况。

随访1 a，MACE发生率为20.39%(21/103)；发生MACE组冠状动脉狭窄程度以3、4级为主，未发生MACE组以1、2级为主，且发生MACE组冠状动脉狭窄程度3级(52.38%)、4级(38.10%)所占比例高于未发生MACE组(17.07%、2.44%)；1级(0.00%)、2级(9.52%)所占比例低于未发生MACE组(30.49%、50.00%)(P<0.05)；两组心肌各节段应变(GCS、GRS、GLS、GAS)幅度比较，差异无统计学意义(P<0.05)。

CCTA可准确评估冠状动脉狭窄程度，4D－STE可定量评估心肌各节段应变幅度，二者联合有助于提高对MACE的预测价值，为临床防治工作提供依据。

To evaluate the predictive value of coronary CT angiography (CCTA) combined with four-dimensional speckle tracking echocardiography (4D-STE) for major adverse cardiac events (MACE) in patients with coronary atherosclerosis.

A total of 103 patients with coronary atherosclerosis admitted to the North Area of Jiaozhou People's Hospital were examined by CCTA and 4D-STE. The incidence of MACE was counted at 1 year follow-up, and the degree of coronary stenosis and the amplitude of myocardial strains (GCS, GRS, GLS, GAS) in patients with and without MACE were analyzed.

The incidence of MACE was 20.39% (21/103) in the first year of follow-up. The degree of coronary artery stenosis in the MACE group was mainly grade 3 and 4, while that in the non-MACE group was mainly grade 1 and 2. The proportions of grade 3 (52.38%) and grade 4 (38.10%) in the MACE group were higher than those in the non-MACE group (17.07% and 2.44%). The proportion of grade 1 (0.00%) and grade 2 (9.52%) in the MACE group was lower than that in MACE group (30.49% and 50.00%) (P<0.05). There was no significant difference in the amplitude of myocardial strains (GCS, GRS, GLS, GAS) between the two groups (P<0.05).

CCTA can accurately assess the degree of coronary artery stenosis, and 4D-STE can quantitatively assess the strain amplitude of myocardial segments. CCTA combined with 4D-STE can improve the predictive value of MACE and provide evidences for clinical prevention and treatment.