Journal of Infection and Public Health 13 (2020) 2045–2048

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Journal of Infection and Public Health

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Original Article

Effects of different CT angiography technology-based nursing

methods on patients with coronary artery heart diseases
Jie Sun a , Xia Guo b , Xiaofang Geng b , Xiaofang Ren c,∗
a
Department of Nursing, Dongying People’s Hospital, Dongying City 257091, China
b
Department of Obstetrics, Dongying People’s Hospital, Dongying City 257091, China
c
Department of Emergency Intensive Care Unit, Dongying People’s Hospital, Dongying City 257091, China

a r t i c l e i n f o a b s t r a c t

Article history: To study the nursing effects of different CT angiography (CTA) technology-based nursing methods on
Received 7 May 2019 patients with coronary artery heart diseases (CHD), CHD patients treated in Dongying People’s Hospi-
Received in revised form 16 June 2019 tal were selected as the research objects and were divided into the control group and the observation
Accepted 21 June 2019
group. Different coronary CTA nursing methods, i.e. the routine nursing and the psychological nursing,
were performed to the control group and the observation group respectively. During the experiment,
Keywords:
patients performed self-evaluations, which included the Self-rating Anxiety Scale (SAS) and the Self-
CTA
rating Depression Scale (SDS). Biological indicators of patients, including heart rate (HR), diastolic blood
Nursing effect
CHD patients
pressure (DBP), and systolic blood pressure (SBP), were measured before and after patients accepted
Psychology different nursing methods. In addition, the quality of coronary CTA images was evaluated. The results
showed that HR, DBP, SBP, SAS scores, and SDS scores of patients in the observation group were obvi-
ously lower than those in the control group, and the differences were statistically significant, besides, the
image quality of the observation group was significantly greater than that of the control group, which
was helpful for diagnosis and had statistical significances. Therefore, it is proved that the psychological
nursing of CHD patients can effectively reduce the negative emotions of patients, such as anxiety and
depression, which is conducive to CTA and can assist clinical diagnosis. The results provide a basis and
ideas for more accurate research in the future.
© 2019 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health
Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

Introduction due to abnormal lipid metabolism [6]. The massive accumulation

CT angiography (CTA), otherwise known as non-traumatic
angiography, combines a CT scan with an intravenous injection of
a special contrast agent to produce clearer pictures of blood ves-
sels and tissues in vivo [1]. CTA is a way of interventional detection
with the advantages of non-invasiveness and easy operation [2]. At
present, the commonly used contrast agent is iopromide [3]. Since
X-rays are impervious to the agent, CTA is used to diagnose the
presence or absence of lesions by intravenous injection of contrast
agent [4], which is valuable for the diagnosis of vascular variability
and vascular-related diseases, and the display of pathological and
vascular relationships [5].
Coronary artery heart disease (CHD) relates to the accumula-
tion of white plaques (lipids substance) on the smooth artery walls
∗ Corresponding author at: Department of Emergency Intensive Care Unit, Dongy-
ing People’s Hospital, No.317 South Road, Dongying City, Shandong province, China.
E-mail address: renxiaofangxfak00@163.com (X. Ren).
of these white plaques would lead to stenosis and occlusion of arte-
rial lumen and thrombosis, which reduces the cardiac blood supply
and causes angina pectoris, myocardial infarction, and other seri-
ous threats to humans [7,8]. Currently, CTA is utilized to diagnose
CHD clinically [9]. However, patients are prone to psychologi-
cal conditions of anxiety, nervousness, and depression during the
examination, whose heart rates (HR) are speeded up, thereby the
effects of CTS are affected [10]. Therefore, for the accurate diag-
nosis, the medical personnel should actively and enthusiastically
communicate with the patient to alleviate their negative emotions,
thereby reducing their heart rates and assisting them to complete
the examination [11].
In summary, the diagnosis of CHD depends on CTA, and the
psychological states of the patients directly affect the effects of
CTA. Therefore, the effects of different CTA nursing methods for
CHD patients were compared. CHD patients were selected as the
research objects. CTA was performed, and different nursing meth-
ods were used as an intervention to observe and analyze the

https://doi.org/10.1016/j.jiph.2019.06.023
1876-0341/© 2019 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
2046 J. Sun et al. / Journal of Infection and Public Health 13 (2020) 2045–2048
different nursing effects, which provide a certain reference for clin-
ical nursing.
Materials and method
Patients
100 CHD patients treated in Dongying People’s Hospital (from
August 2013 to July 2018), who were 45–80 years old with an
average age of 55.13, were selected. All patients were previously
diagnosed with CHD. They were divided into 2 groups, i.e. the con-
trol group (50 patients) and the observation group (50 patients),
through random number table method. The control group consisted
of 26 males and 24 females, aged 45–78 years, with an average
age of 54.87 years; the observation group consisted of 24 males
and 26 females, aged 46–80 years, with an average age of 55.39
years. No statistical differences were found between the 2 groups
in age, gender, career, and time of onset (P > 0.05); thus, they were
comparable.
Inclusion criteria: (1) patients who had high-risks of CHD; and
(2) patients who were conscious and willing to comply, and could
express themselves normally without any mental diseases.
Exclusion criteria: (1) patients who suffered from severe dis-
eases of lung, liver, kidney, or other organs; (2) patients who
suffered from severe cardiac insufficiency and severe HR disorders;
and (3) patients who were allergic to contrast agent iodine.
All the patients who were involved in the research had signed
informed consent forms and the research was subject to approval
by the Ethics Committee of Dongying People’s Hospital.
Coronary CTA
A 64-layer multi-slice CT system of the US GE Lightspeed VCT
model was used for coronary CTA. Before the CTA examination, the
patient should fast for more than 4 h and sat calmly in the CT waiting
room for 30 min to ensure a stable HR. Then, the HR of each patient
was measured; if it exceeded 70 times/min, the patient was asked
to take the metoprolol tartrate (Guangzhou Baiyunshan Pharma-
ceutical, China) depending on the advice of physician-in-charge.
When the CTA examination started, patients took the supine posi-
tions and were electrocardially gated. Then, they were asked to
control their respiratory rates, hold their breath for more than
20 s, and relax their bodies. Parameters for the CTA examination
were 120 kV of tube voltage, 400 mA of tube current, 0.625 mm
of layer thickness, 0.625 mm of layer spacing, and 512 × 512 of
the matrix. The examined sites were from the tracheal carina to
the palpebral. First, the plain scans were performed to observe
the calcification of the coronary arteries and assess the calcifica-
tion scores of the plaques; then, the Region of Interest (ROI) at the
aortic roots were chosen. Next, patients were injected with 20 mL
of high-concentration iodine-containing non-ionic contrast agent
iopromide (370 mgI/mL, Zhejiang Haichang Pharmaceutical, China)
through the veins in the middle right elbows by high-pressure
syringes at an average flow rate of 5 mL/s; the ROI time-density
curves were measured to obtain the cycle time. Patients were then
injected with 60 mL of iopromide contrast agent (370 mgI/mL) and
30 mL of saline through the veins in the right elbows by high-
pressure syringes at an average flow rate of 5 mL/s to perform the
CT enhancement scans of coronary arteries.
Image processing and analysis
The CTA images of CHD patients were imported into the
ADW4.42 workstation for image processing and analysis by 2
senior radiologists; in addition, the methods of multi-planar recon-
struction (MPR), maximum intensity projection (MIP), and volume
rendering (VR) reconstruction were utilized to reconstruct the 3D
CTA images. In the case of disagreements, the director of the radi-
ology department was consulted for consultation and discussion.
Different nursing methods for the examination of CHD patients
Patients in the control group accepted routine treatments.
Before coronary CTA started, their HR, diastolic blood pressure
(DBP), and systolic blood pressure (SBP) were monitored, and their
medical histories, drug allergies, and diets were recorded; in addi-
tion, their physical signs were assessed in detail. Then, patients
were assisted to get changed in the examination suits and have all
their metal accessories removed. After the examinations were suc-
cessfully completed, patients were given a large amount of water
to facilitate the drainage of the contrast agent.
Patients in the observation group accepted psychological cares.
Before coronary CTA started, in addition to the routine treatments
as the control group, their psychological states were observed by
asking their concerns and worries; then, medical personnel should
communicate with the patients for them to relax; specifically, med-
ical personnel introduced the usage of major equipment in the CT
room and explained the process and precautions of CTA examina-
tion to patients in detail, including the discomforts that may occur
during the examination, such as fever, nausea, chest tightness, and
urination; also, patients should be informed that the equipment
could be noisy, therefore they should be prepared psychologically.
Then, patients were asked to control their respiratory rates, hold
their breath for more than 20 s, and relax their bodies. In the exam-
ination room, joyful music should be played at lower decibel to
distract the attention and reduce the negative emotions of patients.
Evaluations and standards of the nursing effects of different
nursing methods on patients
The HR, DBP, and SBP of patients in both groups were recorded
and compared with the CTA results. The SAS scores indicated the
anxiety scales rated by patients themselves. The SDS scores indi-
cated the depression scales rated by patients themselves. A total
of 20 questions were included. Patients in both groups evaluated
their anxiety and depression scales before and after the examina-
tions. The higher the scores were, the more anxious and depressed
the patients were.
Image quality assessments and standards
According to the diagnostic criteria of CHD, the quality assess-
ments of CTA images were divided into 4 grades, i.e. grade I, grade
II, grade III, and grade IV. The assessment criteria were as follows:
Grade I: excellent image quality, clear coronary artery, vascular fill-
ing, and no artifacts; Grade II: satisfied image quality, mildly blurred
coronary artery, small artifacts in the vessel walls; Grade III: mod-
erate image quality, at least half of the coronary artery directions
were blurred, medium artifacts in the vessel walls; Grade IV: poor
image quality, vessel walls were seriously blurred, severe artifacts,
impossible of diagnosis.
Statistical analysis
Data processing and analysis were performed by using the
SPSS21.0 statistics software. Quantitative data consistent with nor-
mal distribution were described as the mean number ± standard
deviation. Comparison between the 2 groups was implemented by
two independent samples t-test or the rank sum test. Comparison
between different group rates was performed by chi-square test.
 J. Sun et al. / Journal of Infection and Public Health 13 (2020) 2045–2048 2047

Table 1
Effects of different nursing methods on heart rate, SBP and DBP in the two groups (x̄ ± s).

Groups DBP (mmHg) SBP (mmHg) Heart rate (times/min)

Control group before nursing 110.75 ± 4.58 140.82 ± 4.92 85.36 ± 2.14
Control group after nursing 95.53 ± 2.77a 120.74 ± 2.89a 78.45 ± 1.39a
Observation group before nursing 110.04 ± 4.43 140.25 ± 4.73 85.27 ± 2.07
Observation group after nursing 85.93 ± 2.39a 106.51 ± 2.55a 70.68 ± 1.00a
a
Indicated that the comparison with the control group was statistically significant.

Fig. 1. Anxiety score and depression score before and after nursing in both groups (A: the control group; B: the observation group).

Fig. 2. Image quality evaluation results (A: the control group; B: the observation group).

Results and discussion Table 2

Effects of different nursing methods on anxiety score and depression score in two
groups of patients (x̄ ± s).
Effects of different nursing methods on HR, SBP, and DBP of
patients Groups SAS SDS

Control group before nursing 53.79 ± 4.03 55.48 ± 4.51

The results were shown in Table 1. It was observed that the Control group after nursing 33.51 ± 3.38a 34.65 ± 3.52a
HR, SBP, and DBP of patients in the control group and the observa- Observation group before nursing 54.43 ± 4.34 55.67 ± 4.78
Observation group after nursing 27.17 ± 2.04a 28.25 ± 2.17a
tion group were almost the same before the examination. However,
a
after being treated with different nursing methods, the HR, SBP, Indicated that the comparison with the control group was statistically signifi-
cant.
and DBP of patients in the observation group were considerably
lower than those in the control group, and the differences were
statistically significant (*P < 0.05). those in the control group, and the differences were statistically
significant (*P < 0.05).
Effects of different nursing methods on anxiety scores and
depression scores of patients Effect of different nursing methods on CTA image quality

The results were shown in Table 2 and Fig. 1. It was observed
that the anxiety scores and the depression scores of patients in the
control group and the observation group were virtually the same
before the examination. However, after being treated with differ-
ent nursing methods, the anxiety scores and depression scores of
patients in the observation group were considerably lower than
The results were shown in Table 3 and Fig. 2. In the control group,
images in Grades I and II accounted for 86%, while in the observation
group, images in Grades I and II accounted for 96%, indicating that
the image quality of the observation group was significantly higher
than that of the control group, and the differences were statistically
significant (P < 0.05).
2048 J. Sun et al. / Journal of Infection and Public Health 13 (2020) 2045–2048
Table 3
Effect of different nursing methods on image quality in control group and observation group.
Groups Grade I (cases)
Control group 30
Observation group 42
Conclusion
The effects of different CTA nursing methods on CHD patients
were compared. CHD patients treated in Dongying People’s Hos-
pital were selected as the research subjects and were randomly
divided into the control group and the observation group. Coro-
nary CTA was performed on patients in both groups, who accepted
different nursing methods, i.e. the routine nursing and the psy-
chological nursing [12]. Before and after the patients accepting
different nursing methods, they were asked to evaluate the SAS and
SDS scores by themselves; in addition, physical indicators includ-
ing HR, DBP, and SBP were measured to evaluate the image quality
of coronary CTA. The results showed that the HR, SBP, DBP, anxiety
scores, and depression scores of patients in the observation group
were considerably lower than those in the control group, and the
differences were statistically significant. Meanwhile, the quality of
CTA images of the observation group was also considerably higher
than that of the control group, which was helpful for diagnosis and
had statistical significances. Compared with the routine nursing
method, the psychological nursing method could effectively reduce
the negative emotions of patients, such as anxiety and depression,
and was more conducive to CTA and could improve the reliability
of clinical diagnosis [13].
Therefore, through the comparison of different nursing effects
of routine and psychological nursing methods on CHD patients, it
is proved that the psychological nursing method can effectively
reduce negative emotions of patients, such as anxiety and depres-
sion, decrease the HR, SBP, and DBP of patients, and is more
conducive to CTA, which thereby improves the reliability of clinical
diagnosis. However, the experiment also has certain deficiencies.
For example, the sample data collection is compact and the result
is biased to a certain extent. Therefore, the data capacity could be
further increased in subsequent research to obtain more valuable
results.
Funding
No funding sources.
Competing interests
None declared.
Ethical approval
Not required.
Grade II (cases) Grade III (cases) Grade IV (cases)
13 5 2
6 2 0
References
[1] Chen MY, Rochitte CE, Arbab-Zadeh A, Dewey M, George RT, Miller JM, et al.
Prognostic value of combined CT angiography and myocardial perfusion imag-
ing versus invasive coronary angiography and nuclear stress perfusion imaging
in the prediction of major adverse cardiovascular events: the CORE320 multi-
center study. Radiology 2017:161565.
[2] Mangold S, Wichmann JL, Schoepf UJ, Caruso D, Tesche C, Steinberg DH, et al.
Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-
source CT and automated tube voltage selection: clinical application in a non-
obese and obese patient population. Eur Radiol 2017;27(6):2298.
[3] Lee KY, Hwang BH, Kim TH, Kim CJ, Kim JJ, Choo EH, et al. CT angiography
images of coronary artery stenosis provide a better prediction of risk than
traditional risk factors in asymptomatic individuals with type 2 diabetes: a
long-term study of clinical outcomes. Diabetes Care 2017;40(9), dc161844.
[4] Lu MT, Douglas PS, Udelson JE, Adami E, Ghoshhajra BB, Picard MH, et al. Safety
of coronary CT angiography and functional testing for stable chest pain in
the PROMISE trial: a randomized comparison of test complications, incidental
findings, and radiation dose. J Cardiovasc Comput Tomogr 2017;11(5):373–82.
[5] Vaněk P, Bradáč O, de Lacy P, Konopková R, Lacman J, Beneš V. Vertebral artery
and osseous anomalies characteristic at the craniocervical junction diagnosed
by CT and 3D CT angiography in normal Czech population: analysis of 511
consecutive patients. Neurosurg Rev 2017;40(3):1–8.
[6] Fung TT, Isanaka S, Hu FB, Willett WC. International food group–based diet
quality and risk of coronary heart disease in men and women. Am J Clin Nutr
2018;107(1):120–9.
[7] Uchida Y. Recent advances in fluorescent angioscopy for molecular imag-
ing of human atherosclerotic coronary plaque. J Atheroscler Thromb
2017;24(6):539–51.
[8] Gao BF, Shen ZC, Bian WS, Wu SX, Kang ZX, Gao Y. Correlation of hypertension
and F2RL3 gene methylation with prognosis of coronary heart disease. J Biol
Regul Homeost Agents 2018;32(6):1539–44.
[9] Yu O, Kaikita K, Ishii M, Mitsuse T, Ito M, Arima Y, et al. Total thrombus-
formation analysis system predicts periprocedural bleeding events in patients
with coronary artery disease undergoing percutaneous coronary intervention.
J Am Heart Assoc Cardiovasc Cerebrovasc Dis 2017;6(4):e005808.
[10] Aronov DM, Bubnova MG, Ioseliani DG, Krasnitsky VB, Shovkun TV, Novikova
NK, et al. The complex program of rehabilitation of patients with ischemic heart
disease after coronary artery bypass surgery in ambulatory cardiorehabilita-
tional department: clinical effects of third stage of rehabilitation. Kardiologiia
2017;57(3):10–9.
[11] Lewis EF, Wang R, Punjabi N, Gottlieb DJ, Quan SF, Bhatt DL, et al. Impact of con-
tinuous positive airway pressure and oxygen on health status in patients with
coronary heart disease, cardiovascular risk factors, and obstructive sleep apnea:
a Heart Biomarker Evaluation in Apnea Treatment (HEARTBEAT) analysis. Am
Heart J 2017;189:59–67.
[12] Liang J, Wang H, Xu L, Dong L, Fan Z, Wang R, et al. Impact of SSF on diag-
nostic performance of coronary computed tomography angiography within 1
heart beat in patients with high heart rate using a 256-row detector computed
tomography. J Comput Assist Tomogr 2018;42(1):54–61.
[13] Nguyên UC, Cluitmans MJM, Luermans JGLM, Strik M, de Vos CB, Kietselaer
BLJH, et al. Visualisation of coronary venous anatomy by computed tomog-
raphy angiography prior to cardiac resynchronisation therapy implantation.
Netherlands Heart J 2018;26(9):433–44.