Contrast induced neurotoxicity following coronary angiogram with Iohexol in an end stage renal disease patient

Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.

Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.

Progressive deterioration of left ventricular function in a patient with a normal coronary angiogram

Cardiac ischemia with a normal coronary angiogram can be caused by coronary microvascular dysfunction.A favorable prognosis,with excellent long-term clinical outcome,without major acute coronary events,has been consistently reported in these patients.We report a patient with a normal coronary angiogram and 3 episodes of myocardial infarctions,where the formation of a ventricular aneurysm and progressive deterioration of left ventricular function was documented,and hypoperfusion of the myocardium was confirmed by cardiovascular magnetic resonance imaging,This case suggests that myocardial ischemia caused by coronary microvascular dysfunction could have a poor prognosis.Whether this case represents a special clinical condition which is between the cardiac syndrome X and coronary artery disease remains to be investigated.

Role of coronary angiogram before transcatheter aortic valve implantation

BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation(TAVI).Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes,challenging the clinical value of routine coronary angiogram(CA).AIM To assess whether a selective approach to perform pre-TAVI CA is safe and feasible.METHODS This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI.A selective approach for performing CA tailored to patient clinical need was developed.Clinical outcomes were compared based on whether patients underwent CA.The primary endpoint was a composite of allcause mortality,myocardial infraction,repeat CA,and re-admission with heart failure.RESULTS Of 348 patients(average age 81±7 and 57%male)were included with a median follow up of 19(9-31)mo.One hundred and fifty-four(44%)patients,underwent CA before TAVI procedure.Patients who underwent CA were more likely to have previous myocardial infarction(MI)and previous percutaneous revascularisation.The primary endpoint was comparable between the two group(22.6%vs 22.2%;hazard ratio 1.05,95%CI:0.67-1.64,P=0.82).Patients who had CA were less likely to be readmitted with heart failure(P=0.022),but more likely to have repeat CA(P=0.002)and MI(P=0.007).In those who underwent CA,the presence of flow limiting lesions did not affect the incidence of primary endpoint,or its components,except for increased rate of repeat CA.CONCLUSION Selective CA is a feasible and safe approach.The clinical value of routine CA should be challenged in future randomised trials.

The coronary computed tomography angiogram: from the basics to advanced interpretation

Introduction According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……

Is There Still a Place for Post-Resuscitation Electrocardiogram for Therapeutic Management and Coronary Angiogram Indication after Out-of-Hospital Cardiac Arrest?

Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Primary percutaneous coronary intervention seems the strategy of choice in ST-segment elevation myocardial infarction but in other clinical presentations, benefit of coronary angiogram remains controversial. To improve management of out-of-hospital cardiac arrest and define the best timing to perform coronary angiogram, we suggest a study design based on ECG evaluation to define predictors of coronary artery disease after resuscitated cardiac arrest by distinguishing 3 groups according to ECG after resuscitation: ST segment elevation and LBBB;repolarisation disorder or no repolarisation disorder. Evaluation of ECG changes may still be useful as a triage method for establishing the indication for emergency coronary angiogram due to easy, non invasive and quick method and thus for limiting complications associated with this exam in acute phase.

Vessels Segmentation in Angiograms Using Convolutional Neural Network: A Deep Learning Based Approach

Coronary arterydisease(CAD)has become a significant causeof heart attack,especially amongthose 40yearsoldor younger.There is a need to develop new technologies andmethods to deal with this disease.Many researchers have proposed image processing-based solutions for CADdiagnosis,but achieving highly accurate results for angiogram segmentation is still a challenge.Several different types of angiograms are adopted for CAD diagnosis.This paper proposes an approach for image segmentation using ConvolutionNeuralNetworks(CNN)for diagnosing coronary artery disease to achieve state-of-the-art results.We have collected the 2D X-ray images from the hospital,and the proposed model has been applied to them.Image augmentation has been performed in this research as it’s the most significant task required to be initiated to increase the dataset’s size.Also,the images have been enhanced using noise removal techniques before being fed to the CNN model for segmentation to achieve high accuracy.As the output,different settings of the network architecture undoubtedly have achieved different accuracy,among which the highest accuracy of the model is 97.61%.Compared with the other models,these results have proven to be superior to this proposed method in achieving state-of-the-art results.

遗传模糊连接法在CAG图像分割中的应用

鉴于模糊连接法分割连通物体的优势及冠脉造影(CAG)图像中血管连通的特点,用模糊连接法来分割CAG图像。模糊连接法在实现上存在困难,提出将遗传算法与模糊连接相结合来解决这一问题。首先指定目标物体上一点作为种子点。然后根据给定的模糊亲和度公式,用遗传算法求出任意点到种子点的模糊连接度。最后设定阈值,将模糊连接度高于阈值的点按原值显示,其他点置为背景,即可得到分割结果。实验结果表明,该方法能快速准确将血管提取出来,为二维CAG图像的自动诊断及可视化提供了依据。

老年冠心病患者经桡冠状动脉介入术后桡动脉闭塞的危险因素分析

目的分析老年冠状动脉粥样硬化性心脏病(冠心病)患者经桡动脉途径(transradial access,TRA)冠状动脉介入术后桡动脉闭塞(RAO)的危险因素。方法连续入选2019年1月至2021年12月于联勤保障部队第九○二医院心内科接受经桡动脉入径的冠状动脉介入治疗(PCI)的255例老年患者,根据术后1月桡动脉超声结果分为RAO组和非RAO组。比较两组人口学和临床资料,分析老年冠心病患者PCI术后1月桡动脉闭塞的危险因素。结果RAO组患者17例(6.67%);非RAO组患者238例(93.33%),RAO组术中肝素使用剂量低于非RAO组。RAO组术后3 d桡动脉内膜厚度高于非RAO组,桡动脉直径和桡动脉血流速度峰值低于非RAO组。较高的术后3 d桡动脉直径和术后3 d桡动脉血流速度峰值是老年冠心病患者经桡冠状动脉介入术后1月RAO的独立保护因素。术后3 d桡动脉直径和术后3 d桡动脉血流速度峰值的AUC分别为0.711和0.976,对术后1月RAO具有较高的诊断价值。结论术后3 d的桡动脉超声检查指标可作为1月RAO的预测因子,建议行桡动脉穿刺者出院前完善RAO评估,出现血流速度明显下降等情况的患者也应积极开展相关干预。

冠脉CTA与CAG的临床应用对比研究

目的探讨64排128层螺旋CT冠状动脉CTA和冠状动脉造影CAG的临床应用对比研究。方法回顾性分析2018年1月至2019年10月间35例均行冠脉CTA与CAG的患者影像资料,将左右冠状动脉主干及其小分支的狭窄数量及狭窄程度进行对比分析。结果发现CAG检查在左右冠状动脉主干的狭窄数量检出率及狭窄程度准确率与CTA检查结果基本一致(P<0.001,Kappa=0.518);但CAG检查在左右冠状动脉小分支的狭窄数量检出率及狭窄程度准确率均明显比CTA检查高(P=0.974,Kappa=0.001)。结论冠脉CTA检查可以准确对左右冠状动脉主干的狭窄数量检出率及狭窄程度作出判断,但对于左右冠状动脉小分支的判断上仍有提高空间;CAG作为冠心病的"金标准",通过对比研究分析,可验证CTA判断的准确性,并提高冠脉小分支狭窄的检出率,为临床提供最真实的影像学资料。

Obstructive sleep apnea is associated with severity and long-term prognosis of acute coronary syndrome

Background Obstructive sleep apnea （OSA） is a common disease in patients with acute coronary syndrome （ACS） and associated with an increased risk of fatal and nonfatal cardiovascular events. However, most patients in previous study were treated with bare metal stents and the sample sizes were relatively low. The goal of this study was to evaluate the influence of OSA on the severity and prognosis of patients admitted for ACS. Methods In this prospective cohort study, we enrolled patients with ACS who were hospitalized for coronary angiogram/percutaneous coronary intervention and undergone polysomnography. We divided the patients into two groups： moderate to severe OSA group [apnea-hypopnea index （AHI） 〉 15 events/h] and control group （AHI ≤ 15 events/h）. They were followed up for up 32 months. Then, we compared the ACS severity and long-term major adverse cardiovascular events （MACE） in patients with different severity of OSA. Results Five hundred and twenty nine patients were included in the final analysis, with 76% of them being men and an average age of 59 ＋ 10 years. The overall mean AHI is 29 ± 19 events/h, 70.5% of them （373/529） being with moderate to severe OSA and 29.5% （156/529） assign into control group. Compared with controls, patients with moderate or severe OSA exhibited a higher prevalence of hypertension as well as higher body mass index, SYNTAX score, Epworth score and length of hospitalization. With a median follow-up duration of 30 months, accumulative rate of MACE was also higher in patients with moderate or severe OSA than that in the control group （8.6% vs. 3.2%, P = 0.028）. After adjusting for baseline confounders by cox regression model, moderate to severe OSA was an independent risk factor of long-term MACE （P = 0.047, HR = 1.618, 95% CI： 1.069-3.869）. Conclusions The results of this study demonstrate that moderate or severe OSA is correlated with disease severity and associated with worse long-term prognosis in ACS patients. The results raising the possibility that early diagnose and interventions of OSA could improve long-term outcomes in ACS patients.

左卡尼汀预防急性冠脉综合征(ACS)患者冠状动脉造影(CAG)和/或经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的意义

目的探讨左卡尼汀对于预防急性冠脉综合征(acute coronary syndromes,ACS)患者冠状动脉造影(coronary artery angiography,CAG)和/或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后发生对比剂肾病(contrast-induced nephropathy,CIN)的意义。方法连续入选2016年1—12月复旦大学附属中山医院心内科诊断为ACS并接受CAG及PCI,并于围手术期接受左卡尼汀治疗的患者共416例,选取同期年龄、性别、基础肾功能匹配且未接受左卡尼汀治疗的ACS患者416例,探讨两组患者的CIN发生率。结果左卡尼汀组CIN发生率(46/416,11.1%)与对照组(62/416,14.9%)差异无统计学意义。亚组分析中,肾功能正常患者的CIN发生率在左卡尼汀组(26/249例,10.4%)与对照组(28/252,11.1%)之间差异无统计学意义;肾功能轻中度异常(30 mL · min^-1 · 1.73 m^-2 ≤eGFR<90 mL · min^-1 · 1.73 m^-2 )患者的CIN发生率在左卡尼汀组(20/167,13.2%)显著低于对照组(36/164,18.3%)( P =0.016)。整体研究人群中,低LVEF值、eGFR、HCT和对比剂用量是CIN的独立危险因素,肾功能轻中度异常人群中,低LVEF值、eGFR、HCT、HbA 1C、对比剂用量和左卡尼汀使用情况是CIN的独立危险因素。结论左卡尼汀未能显著降低肾功能正常的ACS患者的CIN发生率,但对于轻中度肾功能不全的ACS患者,在术前充分水化的基础上围手术期联合使用左卡尼汀可以显著降低CIN的发生率。

Correlation between Hypertension and SYNTAX Score in Patients with Chest Pain Admitted to Cardiology Department for Coronary Angiography

Background: Hypertension is associated with an increased risk of cardiovascular events, cardiovascular and all-cause mortality. However, the diagnostic ability of hypertension for the presence and severity of CAD (coronary artery disease) has not been elucidated. This study investigates the relationship between hypertension and CAD complexity using the SYNTAX score to determine hypertension’s roles in coronary heart disease progression. Method: This is a prospective study that includes consecutive 410 adult patients at mean age (61 ± 11 years) who are admitted to Cardiology Department and undergo invasive coronary angiography (CAG) where a significant coronary lesion (SCL) is defined as stenosis ≥50% in vessel diameter ≥ 1.5 mm. The SYNTAX scores were calculated using the SYNTAX score algorithm. Results: The mean rank of SYNTAX score was significantly higher among hypertension than non-hypertension (mean rank: 279, 184, p = 0.006) groups. SYNTAX score was positively correlated with age (r: 0.263, p < 0.001) and LDL (correlation coefficient 0.102, p = 0.038) but inversely with HDL (r: 0.107, p = 0.031), in multivariate linear regression age (regression coefficient 0.3, p < 0.001), male (-4.4, p = 0.002), HDL (-6.4, p = 0.002) were significant independent risk factors for SYNTAX score, in ordinal regression model aging (odd ratio: 1.08, p < 0.001), being a male (2.84, p = 0.026), HDL (0.05, p < 0.001), BMI (0.86, p = 0.020) were significantly independent predictor of increase or decrease probability of falling in high syntax score group. Conclusion Hypertension affects the distribution of SYNTAX score among patients with and without hypertension, and the prevalence of significant coronary lesions was more frequent in hypertensive patients. Hypertension was not a predictor of significant or complex coronary artery lesion, but advanced age, being a male, HDL, LDL and BMI are considered as independent risk factors for high SYNTAX score, Subsequently and the complexity of CAD. Therefore, when patients with CAD have these factors, we expect that the Patient’s CAD complexity will be high.

Highly sensitive troponin I assay in the diagnosis of coronary artery disease in patients with suspected stable angina

BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community physicians to be assessed by specialists within the hospital system in rapid access chest pain clinics(RACPC).The role of a highly sensitive troponin I(uscTnI)assay in the diagnosis of suspected CAD in a RACPC in a“real-life”setting in a non-academic hospital has not been explored.AIM To examine the diagnostic value of uscTnI(detection limit 0.12 ng/L,upper reference range 8.15 ng/L,and detected uscTnI in 96.8%of the reference population),in the evaluation of stable CAD in a non-selected patient group,with several co-morbidities,who presented to the RACPC.METHODS One hundred and seventy two RACPC patients were assigned to either functional or anatomical testing according to the hospital protocol.RESULTS The investigations offered to patients were exercise tolerance test 7.6%,24 h ECG 1.2%,Echocardiogram 14.5%,stress echocardiogram 8.1%,coronary computed tomography angiography(CCTA)12.8%,coronary angiogram 13.4%,17.4%were diagnosed with non-cardiac chest pain,3.5%treated as stable angina,8.2%reviewed by cardiologists,electronic medical records were not available in 10.4%.Receiver operating characteristic curves for CAD used uscTnI values measured in patients who underwent functional testing,angiogram or CCTA.Values>0.52 ng/L showed 100%sensitivity and at>11.6 ng/L showed 100%specificity.In the range>0.52-11.6 ng/L,uscTnI may not have the same diagnostic potential.In patients assigned to coronary angiogram higher concentrations of uscTnI was associated with severe CAD.Low levels of uscTnI and low pre-test probability of CAD(QRISK3)may decrease patient numbers assigned to CCTA.CONCLUSION The uscTnI diagnostic cut-off values in a RACPC will depend on patient population and their presenting co-morbidity.In the presence of clinical comorbidities and previous CAD the uscTnI needs to be used in conjunction with clinical assessment.

Value of the 6 minute walk test in predicting multi vessel coronary arterial disease

The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischaemic syndromes is as yet not validated. 95 patients undergoing coronary angiography for assessment of chronic stable angina performed the 6MWT according to a modified protocol. The gamma correlation test indicated a moderately significant relationship between ECG changes plus symptoms at the end of the 6MWT and multi vessel coronary arterial disease. The T wave changes showed no significant correlation. Hence the 6MWT is a useful tool in the risk stratification of stable ischaemic syndromes which can be safely performed in a general ward prior to hospital discharge. It would be a useful preliminary test before planning a programme of cardiac rehabilitation.

Comparative Nursing Study of Patients Undergoing Coronary Intervention Therapy in Different Ways

Purpose: To compare the surgical indicators, perioperative complications and postoperative psychological status of patients with coronary interventional therapy (CIT) by radical artery and femoral artery puncture approaches. Methods: 120 patients with CIT were divided into femoral artery group (FAG) and radial artery group (RAG) according to the operation ways. The interventional operation was performed by the same surgeon team and methods. Data of surgical indicators and perioperative complications were recorded and collected. The psychological questionare survey was made within 48 hours the after surgery by the hospital anxiety and depression scale (HAD), and the results were scored by the psychiatrist. Results: The age, sex, ethnicity, education level, disease type, and combined diseases of the two groups had homogeneity without statistical difference. There was no obvious difference in X-ray exposure time, contrast agent usage and operation time in two ways (P > 0.05). The success rate of one-time catheterization was higher in FAG than in RAG (P Conclusion: CIT via radial artery can reduce the incidence of postoperative complications, postoperative physical discomfort and psychological problems such as anxiety and depression of patients.

Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer Coronary Artery Disease Patients

Background: Fractional flow reserve (FFR)-guided interventions, though proved to be safe, continue to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. 7.7%;and PCI 32.4% vs. 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. The rate of 2-year major adverse cardiovascular events (MACE) was 0.9%. Conclusion: This study supports the use of FFR in determining treatment strategy in ACS or CCS patients with low MACE. Resting FFR value of <0.87 may be an alternative to intracoronary nitroglycerine/adenosine/Nikorandil-induced FFR in predicting positive FFR particularly in hemodynamically unstable patients, and who are intolerant to hyperemic drugs.

心脏彩色多普勒超声在慢性心力衰竭患者临床诊断中的特异度和灵敏度研究

目的:探讨心脏彩色多普勒超声在慢性心力衰竭(CHF)患者临床诊断中的应用,以及诊断的特异度和灵敏度。方法:选取医院收治的80例CHF患者,其中心功能分级中Ⅰ级24例,Ⅱ级36例,Ⅲ级20例。所有患者行心脏彩色多普勒超声检查,且均经冠状动脉造影(CAG)检查确诊,分析80例CHF患者心脏彩色多普勒超声检查结果,诊断效能、漏诊、误诊、E峰/Ea峰值、左室舒末内径(LVDd)、左房前后径(LAD)以及左室射血分数(LVEF)情况。结果:80例CHF患者心功能检测中,CAG检查阳性75例(占93.8%),阴性5例(占6.2%);心脏彩色多普勒超声检查阳性78例(占97.5%),阴性2例(占2.5%);心脏彩色多普勒超声检查阳性率与CAG检查相比,差异均无统计学意义。心脏彩色多普勒超声检查特异度、灵敏度及准确率与CAG检查相比,差异均无统计学意义。80例患者心脏彩色多普勒超声误诊2例(占2.6%),漏诊7例(占6.7%);心脏彩色多普勒超声诊断中E峰/Ea峰值、LVDd、LAD及LVEF情况与心功能分级存在相关性,心功能分级越高,E峰/Ea峰值、LVDd及LAD越高,LVEF越低,Ⅲ级心功能异常患者的E峰/Ea峰值、LVDd及LAD高于Ⅱ级和Ⅰ级患者(F=12.126,F=13.557,F=12.604;P<0.05),Ⅲ级心功能异常患者的LVEF低于Ⅱ级和Ⅰ级患者(F=14.120,P<0.05)。结论:在CHF患者临床诊断中,心脏彩色多普勒超声诊断效能较高,值得应用。

冠状动脉周围脂肪组织及冠状动脉斑块预测CAHD非阻塞性病变进展的临床研究

目的探讨基于冠状动脉CT血管造影(coronary computed tomography angiogram,CCTA)的基线斑块特征和冠状动脉周围脂肪参数对冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAHD)非阻塞性冠状动脉病变进展的影响及预测价值。方法回顾性分析2012-01/2022-06月在作者医院住院期间行CCTA检查的CAHD患者的资料。早期CCTA结果显示为非阻塞性冠状动脉病变,在1~5年的观察期内发生急性心肌梗死、接受血运重建或第二次CCTA检查显示进展为重度及以上的患者为进展组(n=36);同期两次CCTA结果均显示非阻塞性冠状动脉的为对照组(n=57)。对比两组患者的临床资料及CCTA相关参数。分析CCTA相关参数对非阻塞性冠状动脉进展的预测价值。结果两组患者性别构成比较差异具有统计学意义(P<0.05)。两组患者的冠状动脉周围脂肪组织衰减指数(fat attenuation index,FAI)、高危斑块、点状钙化、低密度斑块及狭窄程度组间比较差异具有统计学意义(P均<0.05)。多因素Logistic回归显示,冠状动脉周围FAI、点状钙化及低密度斑块是非阻塞性冠状动脉病变进展的独立危险因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,应用模型冠状动脉周围FAI+点状钙化+低密度斑块联合预测CAHD非阻塞性冠状动脉进展的曲线下面积(area under the curve,AUC)最高(AUC=0.813,P<0.05)。结论基于CCTA的冠状动脉周围FAI、点状钙化及低密度斑块为CAHD非阻塞性冠状动脉进展的影响因素,联合多种参数预测冠状动脉病变进展的价值较高。

中药川芎嗪拮抗内皮素－1致冠脉收缩效应的初步观察

用冠脉造影方法观察中药川芎嗪（ＴＭＰ）对内皮素－１（ＥＴ－１）致狗冠脉收缩的拮抗效应。ＥＴ－１５０～１００ｐｍｏｌ冠脉内给药引起冠脉内径减小１７％～２０％（Ｐ＜０．０２），伴有心电图缺血改变。实验组静滴ＴＭＰ８０ｍｇ／ｋｇ后，冠脉内径增加２０％（Ｐ＜０．０３），而且再给相同剂量ＥＴ－１未引起冠脉内径减小，也无心肌缺血发生。可见，ＥＴ１可引起冠脉收缩及心肌缺血，ＴＭＰ能扩张冠脉并拮抗ＥＴ－１的冠脉收缩效应，防止心肌缺血发生。