Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with ...Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.展开更多
Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging afte...Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging after coronary microembolization. This study was designed to investigate the imaging of the left ventricle using delayed contrast enhanced magnetic resonance imaging as well as the left ventricular ejection fraction after coronary microembolization in animal models.Methods Eight miniswine, of either sex （body weight 21-25 kg）, were used to make the coronary microembolization model. After coronary angiography, a 2.8F infusion catheter was placed in the left anterior descending artery with the tip located between the second and third diagonal branches. Microspheres with the diameter of 42μm and mean dosage of 1.2×10^5 were selectively infused into the left anterior descending artery. First pass and stressed first pass perfusion scan were performed after cine images were acquired. Then a second bolus of 0.15 mmol/kg gadolinium DTPA was given at a rate of 2 ml/s. Ten minutes later, delayed contrast enhanced magnetic resonance images of the left ventricular wall were evaluated. Serum changes of tumor necrosis factor a （TNF-α） were evaluated by enzyme-linked immunosorbent assay （ELISA）.Results Hypoenhancement was not observed at first pass perfusion at the anterior wall of the left ventricle. Hyperenhancements of the anterior-septal and anterior wall of the left ventricle was in evidence on delayed enhancement images 6 hours after microembolization and disappeared one week later. The characteristic change of coronary microembolization on delayed contrast enhanced magnetic imaging was non-enhanced regions within the hyperenhancement zone. Left ventricular ejection fraction measured by magnetic resonance imaging decreased significantly from 0.451±0.063 at baseline to 0.362±0.070 at the sixth hour （P 〈0.01）, and recovered to 0.431±0.053 one week later （P 〈0.01 vs 6th hour）. Compared with baseline values, the left ventricular end systolic volume enlarged significantly at 6th hour and at one week after microembolization （P 〈0.05 and P 〈0.01 respectively）. Serum TNF-α increased significantly at 6th hour （22.62±6.96） pg/ml compared with baseline （16.83±3.45） pg/ml （P 〈0.05） and it further increased to （27.44±3.97） pg/ml at one week after coronary microembolization and was significantly higher than that at baseline （P 〈0.01）.Conclusions On delayed contrast enhanced magnetic resonance imaging, hyperenhancement of the anterior-septal and anterior wall of the left ventricle show at 6th hour but not at one week after coronary microembolization. This might represent the characteristic imaging after coronary microembolization. The left ventricular ejection fraction decreased at 6th hour and recovered one week later after coronary microembolization. Although impairment of left ventricular function could be recovered at 1 week after coronary microembolization, the left ventricular remodeling process still continued in concert with continuously elevation of serum TNF-α.展开更多
目的冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变严重影响患者的心肌血供和临床预后,开通闭塞血管可以减少某些特定患者的不良心脏事件,改善左室收缩功能。然而对于CTO介入术后的患者缺乏能够预测远期左室收缩功能改善与否...目的冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变严重影响患者的心肌血供和临床预后,开通闭塞血管可以减少某些特定患者的不良心脏事件,改善左室收缩功能。然而对于CTO介入术后的患者缺乏能够预测远期左室收缩功能改善与否的特异性标志物。方法入组复旦大学附属中山医院冠状动脉CTO病变的患者,应用1.5T心脏磁共振扫描明确术前及术后6个月的左室射血分数(left ventricular ejection fraction,LVEF)改善情况,同时ELISA法检测术前和术后24小时的外周血血管抑素水平,结合多因素Logistic回归分析血管抑素水平改变对远期LVEF改善的预测价值。结果2014年1月至6月期间共26例CTO病变患者完成6个月的磁共振随访,平均年龄56岁,术后6个月的LVEF显著高于术前值[(61.1±8.0)%比(56.9±6.7)%,P=0.046]。其中,LVEF改善超过10%的8人,LVEF改善未达10%的18人。LVEF改善组的术后血管抑素水平较术前显著升高[(307.9±116.4)ng/ml比(161.2±82.3)ng/ml,P<0.01],而在LVEF未改善组则无差异。多因素Logistic回归,同时控制年龄、eGFR、NT-pro-BNP后,手术前后血管抑素差值仍旧是LVEF改善的独立预测因素(OR=1.015,95%CI=1.000~1.031,P=0.045)。结论冠状动脉CTO病变血管介入术后心功能改善组患者血管抑素水平显著升高;手术前后的血管抑素差值与远期左室收缩功能改善独立相关。展开更多
文摘Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30671998）.
文摘Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging after coronary microembolization. This study was designed to investigate the imaging of the left ventricle using delayed contrast enhanced magnetic resonance imaging as well as the left ventricular ejection fraction after coronary microembolization in animal models.Methods Eight miniswine, of either sex （body weight 21-25 kg）, were used to make the coronary microembolization model. After coronary angiography, a 2.8F infusion catheter was placed in the left anterior descending artery with the tip located between the second and third diagonal branches. Microspheres with the diameter of 42μm and mean dosage of 1.2×10^5 were selectively infused into the left anterior descending artery. First pass and stressed first pass perfusion scan were performed after cine images were acquired. Then a second bolus of 0.15 mmol/kg gadolinium DTPA was given at a rate of 2 ml/s. Ten minutes later, delayed contrast enhanced magnetic resonance images of the left ventricular wall were evaluated. Serum changes of tumor necrosis factor a （TNF-α） were evaluated by enzyme-linked immunosorbent assay （ELISA）.Results Hypoenhancement was not observed at first pass perfusion at the anterior wall of the left ventricle. Hyperenhancements of the anterior-septal and anterior wall of the left ventricle was in evidence on delayed enhancement images 6 hours after microembolization and disappeared one week later. The characteristic change of coronary microembolization on delayed contrast enhanced magnetic imaging was non-enhanced regions within the hyperenhancement zone. Left ventricular ejection fraction measured by magnetic resonance imaging decreased significantly from 0.451±0.063 at baseline to 0.362±0.070 at the sixth hour （P 〈0.01）, and recovered to 0.431±0.053 one week later （P 〈0.01 vs 6th hour）. Compared with baseline values, the left ventricular end systolic volume enlarged significantly at 6th hour and at one week after microembolization （P 〈0.05 and P 〈0.01 respectively）. Serum TNF-α increased significantly at 6th hour （22.62±6.96） pg/ml compared with baseline （16.83±3.45） pg/ml （P 〈0.05） and it further increased to （27.44±3.97） pg/ml at one week after coronary microembolization and was significantly higher than that at baseline （P 〈0.01）.Conclusions On delayed contrast enhanced magnetic resonance imaging, hyperenhancement of the anterior-septal and anterior wall of the left ventricle show at 6th hour but not at one week after coronary microembolization. This might represent the characteristic imaging after coronary microembolization. The left ventricular ejection fraction decreased at 6th hour and recovered one week later after coronary microembolization. Although impairment of left ventricular function could be recovered at 1 week after coronary microembolization, the left ventricular remodeling process still continued in concert with continuously elevation of serum TNF-α.
