Background Angiographic evaluation of left main coronary artery(LMCA) bifurcation lesions is often limited. two dimensional(2D) quantitative coronary angiography(QCA) with segmental analysis provides accuracy for quan...Background Angiographic evaluation of left main coronary artery(LMCA) bifurcation lesions is often limited. two dimensional(2D) quantitative coronary angiography(QCA) with segmental analysis provides accuracy for quantification of the degree of stenosis in the main vessel and side branch ostium but can be affected by foreshortening and variable magnification. The accuracy of three dimensional(3D) QCA has recently developed to overcome 2D QCA limitations, however, accuracy and precision of 3D bifurcation QCA measurements in LMCA bifurcation lesions has not been established.Methods We investigated whether such 3D and 2D bifurcation QCA measurements differ in their accuracy in assessing significant LMCA bifurcation lesions defined by intravascular ultrasound(IVUS) as a minimum luminal area(MLA) <6 mm2 of LMCA and MLA <4 mm2 of proximal left anterior descending(LAD) and/or proximal left circumflex(LCX)Results LMCA bifurcation lesions were assessed in 44 patients undergoing elective percutaneous coronary intervention. From 2D QCA measurements, MLA correlated moderately with threshold intravascular ultrasound MLA for LMCA(r=0.81, P <0.000 1), LAD(r=0.54, P=0.000 1) and LCX(r=0.58, P <0.000 1). Severity of lesion as MLA by derived 3D QCA, correlated moderately with threshold intravascular ultrasound MLA for LMCA(r=0.84, P <0.000 1), LAD(r=0.53, P=0.000 2); LCX(r=0.66, P <0.000 1). Overall, the C statistics tended to be slightly higher for 3D QCA and 2D QCA measurements in LMCA segment compared with proximal LAD and LCX segments, and there were no significant predictive power of percent diameter stenosis and percent area stenosis on 3D QCA for LCX IVUS MLA <4 mm2(percent diameter stenosis: area under curve 0.55, cutoff 23%, sensitivity 88%, specificity 37%, P=0.618 6; percent arer stenosis: area under curve 0.56, cutoff 41%, sensitivity 83%, specificity 38%, P=0.518 4, respectively).Conclusions The accuracy of 3D bifurcation QCA in detecting significant LMCA bifurcation lesions is limited, especially the proximal LCX ostium. When IVUS is not available or contraindicated, 3D QCA may assist in the evaluation of intermediate LMCA lesions with MLA.展开更多
AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients wi...AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.展开更多
AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary art...AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline values.RESULTS: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/min.CONCLUSION: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.展开更多
Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosi...Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.展开更多
Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 in...Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR 〈 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis （QCA）. The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR 〈 0.8 was found in 70 （34%） of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters （MLD, r = 0.372, P = 0.000） and the reference vessel diameters （RVD, r = 0.217, P〈 0.002） were negatively correlated with percent area stenosis （AS, r = -0.251, P = 0.000） and percent diameter stenosis （DS, r = -0.210, P = 0.000）. Age, MLD and the lesion location in different coronary arteries were the inde- pendent determinants of FFR 〈 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.展开更多
文摘Background Angiographic evaluation of left main coronary artery(LMCA) bifurcation lesions is often limited. two dimensional(2D) quantitative coronary angiography(QCA) with segmental analysis provides accuracy for quantification of the degree of stenosis in the main vessel and side branch ostium but can be affected by foreshortening and variable magnification. The accuracy of three dimensional(3D) QCA has recently developed to overcome 2D QCA limitations, however, accuracy and precision of 3D bifurcation QCA measurements in LMCA bifurcation lesions has not been established.Methods We investigated whether such 3D and 2D bifurcation QCA measurements differ in their accuracy in assessing significant LMCA bifurcation lesions defined by intravascular ultrasound(IVUS) as a minimum luminal area(MLA) <6 mm2 of LMCA and MLA <4 mm2 of proximal left anterior descending(LAD) and/or proximal left circumflex(LCX)Results LMCA bifurcation lesions were assessed in 44 patients undergoing elective percutaneous coronary intervention. From 2D QCA measurements, MLA correlated moderately with threshold intravascular ultrasound MLA for LMCA(r=0.81, P <0.000 1), LAD(r=0.54, P=0.000 1) and LCX(r=0.58, P <0.000 1). Severity of lesion as MLA by derived 3D QCA, correlated moderately with threshold intravascular ultrasound MLA for LMCA(r=0.84, P <0.000 1), LAD(r=0.53, P=0.000 2); LCX(r=0.66, P <0.000 1). Overall, the C statistics tended to be slightly higher for 3D QCA and 2D QCA measurements in LMCA segment compared with proximal LAD and LCX segments, and there were no significant predictive power of percent diameter stenosis and percent area stenosis on 3D QCA for LCX IVUS MLA <4 mm2(percent diameter stenosis: area under curve 0.55, cutoff 23%, sensitivity 88%, specificity 37%, P=0.618 6; percent arer stenosis: area under curve 0.56, cutoff 41%, sensitivity 83%, specificity 38%, P=0.518 4, respectively).Conclusions The accuracy of 3D bifurcation QCA in detecting significant LMCA bifurcation lesions is limited, especially the proximal LCX ostium. When IVUS is not available or contraindicated, 3D QCA may assist in the evaluation of intermediate LMCA lesions with MLA.
基金Supported by the National Natural Science Foundation of China,No.81570363the National Key Research and Development Program of China,No.2016YFA0201304the Priority Academic Program Development of Jiangsu Higher Education Institutions,No.KYZZ15_0263
文摘AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.
文摘AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline values.RESULTS: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/min.CONCLUSION: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.
文摘Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
文摘Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR 〈 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis （QCA）. The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR 〈 0.8 was found in 70 （34%） of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters （MLD, r = 0.372, P = 0.000） and the reference vessel diameters （RVD, r = 0.217, P〈 0.002） were negatively correlated with percent area stenosis （AS, r = -0.251, P = 0.000） and percent diameter stenosis （DS, r = -0.210, P = 0.000）. Age, MLD and the lesion location in different coronary arteries were the inde- pendent determinants of FFR 〈 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.
