冠状动脉造影和冠状动脉CT成像诊断冠心病的可重复性研究

目的:探究冠状动脉造影与冠状动脉CT成像重复性诊断冠心病的效果。方法:选取我院2017年6月—2018年6月疑似冠心病患者80例为研究对象,所有患者均在放射科同时通过冠状动脉造影(ICA)与冠状动脉CT成像(CTCA)检查后,分别由两名ICA医师与CTCA进行盲法原则分析,其中2名经验丰富的影像科医师按照盲法原则独立分析分析后,其中一名再次进行盲法重复分析,核对两名ICA医师与CTCA医师的诊断结果并将协商后的的看法作为诊断结果。结果:两名ICA医师的的诊断K值为0.78,两名CTCA医师的诊断K值为0.73。两名ICA医师的95%CI为0.79～0.89和0.69～0.81,同一医师诊断的CAD的K值为0.87、0.76,95%的CI为0.80～0.91和0.75～0.84。冠状动脉造影统一医师诊断管动脉狭窄程度一致的冠状动脉的比率83.89%,高于医师间的诊断81.2%,两者差异具有统计学意义(P <0.05),CTCA同一医师诊断CAD一致的冠动脉节段数比率94.11%高于92.15%。结论:不同医师以及同一医师前后两次诊断存在误差,采用可重复性ICA和CTCA诊断CAD能有效提高诊断正确率,有利于提高临床诊断效果以及患者治疗方案确定,且ICA法显著优于CACT法,临床冠心病诊断中应该采用ICA与CACT重复诊断,以避免诊断误差造成的不良影响。

急性心肌梗死行PTCA及冠动脉造影后即行支架植入术65例疗效观察

目的:探究急性心肌梗死行PTCA及冠动脉造影后即行支架植入术疗效。方法:选取本院2013年7月~2014年6月收治的65例急性心肌梗死患者,均行PTCA及冠动脉造影后即行支架植入术。统计术后即刻疗效、住院期间不良事件发生情况及随访期间并发症(心肌梗死、胸痛复发、出血、心源性死亡、再次血运重建等)发生情况。结果:65例患者支架植入血管分别为前降支、回旋支、右冠脉、对角支、钝缘支、后降支、左室后侧支;罪犯病变狭窄程度(87.46±6.75)%;病变处平均MLD(最小管腔直径)(0.25±0.03)mm;平均参考血管直径(2.65±0.08)mm;平均靶病变长度(33.15±1.72)mm;平均支架长度(21.89±5.12)mm,植入支架平均个数(2.03±0.58)个;支架植入后直径(2.65±0.04)mm;残余狭窄(1.68±0.07)%;住院期间未出现不良反应;65例患者术后均获得2年随访,4例复查造影,其中1例合并高血压者出现心绞痛,造影显示支架内再狭窄需重建冠脉血运。结论:急性心肌梗死行PTCA及冠动脉造影后即行支架植入术效果较为理想,且具有较高安全性,在临床治疗中具有重要意义。

经桡动脉或股动脉行冠状脉造影术后护理比较研究

目的对比观察经桡动脉冠状脉造影术与经股动脉冠状脉造影术患者术后护理特点,提高冠脉造影的安全性和有效性。方法选取80例采用冠状脉造影术诊断的患者进行观察,将采用经桡动脉冠状脉造影术诊断的40例患者分为观察组,将采用经股动脉冠状脉造影术诊断的40例患者分为对照组。两组患者均给予术后全面护理干预,观察两组住院时间、肢体制动时间、术后并发症及不适症状发生率。结果观察组住院时间(3.0±1.3)d、肢体制动时间(1.9±0.4)h,明显短于对照组(P<0.05);观察组术后迷走神经反射1例、排尿困难1例、肢体麻醉2例,除静脉血栓与穿刺点出血外,各项术后并发症及不适症状表现均明显少于对照组(P<0.05)。结论经桡动脉冠状脉造影术护理方法简单,患者的恢复时间短,并发症少,值得临床推广。

潘生丁^(99)Tc-MIBI心肌灌注断层显像阳性患者的冠脉造影对比

目的：通过对８２例潘生丁９９Ｔｃ－ＭＩＢＩ心肌灌注单光子发射计算机断层显像（ＳＰＥＣＴ）阳性患者的冠状动脉造影（ＣＡＧ）比较，了解ＳＰＥＣＴ对具体病变血管检出的特异性和阳性预测值。方法：对１９９５年６月～１９９８年５月疑诊冠心病患者行ＳＰＥＣＴ后，作ＣＡＧ８２例进行对比分析，按照ＳＰＥＣＴ分区与ＣＡＧ所显示血管的关系进行同组自身对照。结果：ＣＡＧ显示冠脉病变：左前降支５０支，回旋支３２支，右冠脉４８支。ＳＰＥＣＴ缺血分区所代表的冠脉病变：左前降支：５９支，回旋支：４１支，右冠脉：５３支。分析显示左前降支（ＬＡＤ）、回旋支（ＬＣＸ）、右冠脉（ＲＣＡ）被检出的敏感性均为１００％，特异性分别为：７８％、８５％、８７％，阳性预测值分别为：８５％、７８％、９１％。结论：潘生丁９９Ｔｃ－ＭＩＢＩ心肌灌注单光子发射计算机断层显像对冠状动脉粥样硬化性心脏病（冠心病）具体病变血管的定位诊断也能提供可靠的信息。可作为进行介入治疗和判断介入治疗后心肌血运情况的重要依据之一。

超声心动图对冠状动脉瘘的诊断价值

目的探讨超声心动图在冠状动脉瘘中的诊断价值。方法13例经手术和/或冠状动脉造影证实的冠状动脉瘘患者,回顾分析术前二维及彩色多普勒超声检查。结果超声检查显示冠状动脉异常扩张,并能追踪观察其走行、部位、内径、大小。多普勒在瘘口附近可测及异常的血流。结论彩色多普勒超声心动图诊断冠状动脉瘘及其合并畸形直接、安全、快捷,具有重要的临床价值。

介入治疗心肌桥和心肌桥并发严重冠状动脉粥样硬化病变的疗效观察

目的:探讨冠脉内药物支架置入治疗心肌桥及心肌桥并发严重冠状动脉粥样硬化病变的疗效。方法:对14例急性心肌梗死的心肌桥患者(冠状动脉造影示心肌桥均位于前降支,心脏收缩时血管狭窄75%～95%,病变长度为10～22mm。8例并发心肌桥近端冠状动脉粥样硬化伴狭窄和完全闭塞,5例为心肌桥以外冠状动脉粥样硬化伴狭窄和完全闭塞,1例为单纯心肌桥。)行吉威雷帕霉素药物支架于冠状动脉粥样硬化伴狭窄和完全闭塞及部分患者心肌桥处。结果:术中即刻造影示冠状动脉粥样硬化狭窄和闭塞处及置入支架的心肌桥压缩影像消失,血流恢复,TIMI3级,管腔无残余狭窄。随访3～18个月有3例再发心绞痛,经药物治疗后症状缓解。结论:对有心肌桥和心肌桥并发严重冠状动脉脉粥样硬化病变的患者,可以选择药物支架置入治疗,但远期疗效仍需更多的病例研究证实。

0D-1D coupling model and 3D fluid-structure interaction model based on coronary CT angiography for displaying hemodynamic characteristics of coronary artery stenosis

Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Based on CCTA data of the stenosed left anterior descending branch(LAD)in a patient with coronary heart disease,an 0D-1D coupling model and 3D FSI model were built,respectively.Then hemodynamic characteristic indexes,including the pressure,flow velocity and wall shear stress(WSS)were obtained in every 0.01 s during 1 s at 5 sampling points(i.e.sampling point 1—5)using these 2 models,respectively,and the consistencies of the results between models were evaluated with Spearman correlation coefficient r s.Results The time consuming for construction of 0D-1D coupling model and 3D FSI model was 0.033 min and 704 min,respectively.Both models showed basically distribution of the pressure,flow velocity and WSS of the stenosed LAD.For more details,the pressure at the stenosed segment of LAD and the proximal segment of stenosis were both higher,which gradually decreased at the distal segment of stenosis,and the flow velocity at the proximal segment of stenosis was in a relatively slow and uniform condition,with significantly increased flow velocity and WSS at the stenosed segment.Compared with 3D FSI model,0D-1D vascular coupling model was relatively unrefined and lack of distal flow lines when displaying blood flow velocity.For sampling point 2 at the stenosed segment of LAD,no significant consistency for pressure between 2 models was found(P=0.118),but strong consistency for the flow velocity and WSS(r s=0.730,0.807,both P<0.05).The consistencies of pressure,flow velocity and WSS between 2 models at the proximal and distal segment of stenosis,i.e.1,3—5 sampling points were week to moderate(r s=0.237—0.669,all P<0.05).Conclusion 0D-1D coupling model exhibited outstanding computational efficiency and might provide relatively reasonable results,while 3D FSI model showed higher accuracy for details and streamline when simulating LAD stenosis.

21例心血管X综合征临床分析

目的 分析心血管 X综合征的临床特征。方法 回顾性分析 2 1例经冠状动脉造影确诊的心血管 X综合征患者的临床症状、无创检查结果、治疗效果及合并症等。结果 除冠状动脉造影正常外 ,心血管 X综合征的临床表现、心电图、运动试验、胸痛缓解方式、治疗措施、易患因素等均与冠心病极为相同。结论 心血管 X综合征可能是冠心病的早期阶段或不同发展阶段 ,其发病机制可能是同一病理变化在冠状动脉主要分枝和微血管的不同部位的表现 ;从指导临床诊治角度考虑 ,将心血管

心肌桥患者心电图及平板运动试验结果分析

目的：研究分析心肌桥患者心电图及平板运动试验结果。方法：回顾分析我院2011年7月～2014年9月期间通过冠动脉造影术检测出心肌桥患者73例临床资料，并通过心电图与平板运动试验进行检测对比分析。结果：73例心肌桥患者中出现T波段变化与缺血性ST段表现者19例，占总数的26．0％，余下54例心电图显示为正常；按照临床表现分为表浅型（52例，71．2％）与深在型（21例，28．8％）；心肌桥长度：28例心肌桥长度在15mm以下，45例心肌桥长度到达16～34mm。结论：心肌桥患者的心肌桥长度和深度能够明显影响心肌缺血症状发生。

Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease

Objectives To investigate the relationship between serum fxee fatty acids （FFAs） levels and the severity of coronary artery lesions in elderly patients with coronary heart disease （CAD）. Methods A total of 172 elderly patients who underwent coronary angiography were divided into CAD group （n = 128） and non-CAD group （n = 44） according to the results of coronary angiography. Serum FFAs and lipid levels were measured and the Gensini score were calculated. Results No matter the differences between age, gender and the usage of stat- ins or not, there was no statistical significance in FFAs levels （P 〉 0.05）. In terms of the Gensini score, it was higher in patients aged 70-79 years than in patients 60-69 years old [15.00 （5.00, 34.00） vs. 10.00 （2.00, 24.00）, P 〈 0.05], higher in men than women [14.00 （4.00, 34.00） vs. 7.00 （2.50, 19.75）, P 〈 0.05], and higher in patients on statins [13.50 （4.25, 33.50）vs. 6.50 （2.00, 18.00）, P 〈 0.05]. The serum FFAs lev- els [449.50 （299.00, 624.75） mEq/L vs. 388.00 （258.50, 495.25） mEq/L, P 〈 0.05J and Gensini score [17.50 （8.00, 41.75） vs. 1.00 （0, 5.00）, P 〈 0.05] were higher in the CAD group than in the non-CAD group. In the CAD group, there was no statistical significance in FFAs levels among patients with different numbers of diseased coronary vessels （P 〉 0.05）. Furthermore, the FFAs levels were positively correlated with the Gensini score （r = 0.394, P = 0.005）. Regression analysis showed that the FFAs levels were related to the Gensini score independently after adjusting for the other risk factors. Conclusions The serum FFAs levels were associated with the Gensini score in elderly patients with CAD. It might indicate FFAs as a biomarker predicting the severity of coronary artery lesions.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Homocysteine is associated with the progression of non-culprit coronary lesions in elderly acute coronary syndrome patients after percutaneous coronary intervention

Background The influence of homocysteine （Hcy） on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit coronary lesions （NCCLs） is controversial. This study aims to evaluate whether the plasma level of Hcy is related to the progression of NCCLs after percutaneous coronary stent implantation in elderly patients with acute coronary syndrome （ACS）. Methods A total of 223 elderly patients （〉 65 years old） with ACS undergoing stent im- plantation and follow-up coronary angiography were enrolled. Laboratory determination comprised of blood sample evaluation for Hcy was carried out before baseline coronary intervention. The patients were classified into two groups according to the blood Hcy tertiles （〉 15 mmol/L or 〈 15 mmol/L）. Patients were followed up for 12.2 months. NCCL progression was assessed by three-dimensional quantitative coronary angiography. Results A significantly higher ratio of NCCL progression was observed in the group with baseline Hcy concentrations above 15 mmol/L compared to the group with concentrations below 15 mmol/L （41/127, 32.3% vs. 14/96, 14.6%, P = 0.002）. Multivariate Cox regression analysis showed that Hcy and diabetes mellitus were independent risk factors for NCCL progression. The crude haz- ard ratio （HR） of NCCL progression for Hcy level was 1.056 （95% CI： 1.01-1.104, P = 0.015）. The adjusted HR of NCCL progression for Hcy level was 1.024 （95% CI： 1.007-1.042, P = 0.007）. The adjusted HR of NCCL progression for diabetes mellitus was 1.992 （95% CI： 1.15-3.44, P = 0.013）. Conclusions Hcy is an independent risk factor for NCCL progression after 12 months of follow-up in elderly patients with ACS who has undergone percutaneous coronary stenting.

Altered serum level of cartilage oligomeric matrix protein and its association with coronary calcification in patients with coronary heart disease

Background Cartilage oligomeric matrix protein （COMP） is mainly found in the skeletal system and vascular smooth muscle cells. Recent researches showed that it had a protective function on blood vessels and could also inhibit vascular calcification. We investigated the serum COMPs in coronary heart disease （CHD） patients, and the relationship between serum COMP and the calcification of coronary artery. Methods A total of 233 consecutive chest pain patients who first underwent coronary angiography followed by multi-slice computed to- mography （MSCT） within six months were recruited and divided into two groups according to the coronary angiography luminal diameter narrowing percentages： CHD group （diameter narrowing 〉 50%, n = 194） and control group （diameter narrowing 〈 50%, n = 39）. The Gen- sini score, Syntax score and coronary artery calcium score （CACs） were calculated. The serum COMP level was determined using ELISA. Results The levels of COMP were significantly higher in the CHD group than in the control group 155.7 （124.5-194.5） ng/mL vs. 128.4 （113.0-159.9） ng/mL, P = 0.019. There were no correlation between COMP, Gensini score, Syntax score, severity of coronary stenosis and the number of coronary artery with stenosis 〉 50%. The serum COMP was correlated with age （r = 0.294, P 〈 0.001）, fasting glucose （r = 0.163, P = 0.015）, HbAlc （r = 0.194, P = 0.015） and CACs （r = 0.137, P = 0.037）. Stepwise linear regression analysis showed that COMP level and age were independent predictors of CACs in the CHD patients （fl = 0.402, t = 2.612, P = 0.015; fl = 0.472, t = 3.077, P = 0.005）. Performance of COMP for predicting CHD was shown as area under curve （AUC）： 0.632, 95% CI： 0.549-0.715 and upper tertile CACs was AUC： 0.602, 95% CI： 0.5264）.678 in receiver operating characteristic （ROC） curve analysis. Conclusion Calcification of coronary artery was an independent predictor of serum COMPs.

Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction （AMI） is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging （2D-STI） in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention （PCI） in 30 patients with AMI, who had a left anterior descending coronary artery （LAD） culprit lesion. In addition, 20 patients who had minimal stenotic lesions （〈 30% stenosis） on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability （hazard ratio： 31.22, P 〈 0.01）. Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.

Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography

Objective To investigate the performance of dual-source computed tomography （DSCT） using high-pitch spiral fliPS） mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography （ICA）, while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate （HR） on image quality （P 〉 0.05）, while HR variability had a slight impact on that （P 〈 0.05）. Sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） of DSCT in detection of in-stent restenosis （ISR） based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant differ- ence on sensitivity, specificity, PPV and NPV between diameter 〉 3.0 mm group （93.3%, 97.9%, 87.5%, and 98.9%） and diameter 〈 3.0 mm group （80%, 93.3%, 80.0%, and 93.3%） （P 〈 0.05）, and that between stent number 〉 3 group （82.3%, 77.8%, 66.7%, and 60%） with 〈 3 group （97.3%, 80%, 96.5%, and 75%）. The effective dose of DSCT （1.4 ± 0.5 mSv） is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv （P 〈 0.01）]. Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR 〈 65 beats/rain.

Transcatheter closure of coronary artery fistula using Guglielmi detachable coil

Background Coronary artery fistula （CAF） is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil （GDC）.The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods ＆ Results From 2002 to 2007,there were 10 patients with CAFs （age range：28 to 56 year-old,7 males） who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary （n =5）,left circumflex （n =3）,left anterior descending artery （n =10） and left main trunk （n =1）.Median number of coil deployment for each fistula was 3 （range：1 to 6）.The pulmonary artery was the most common site of the distal communication of CAFs （n =14）,followed by right atrium （n =3）,left atrium （n =1） and left ventricle （n =1）.Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 （63.2％） CAFs,significant reduction of the flow in 5 （26.3％）,while 2 （10.5％） could not be closed due to small size.Nine （90％） patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 （70.5％） CAFs were occluded completely and 5 （29.5％） CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.

Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison wit

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.

Positive correlation between plasma PCSK9 and tissue factors levels in patients with angiographically diagnosed coronary artery disease and diabetes mellitus

Background Pro-protein convertase subtilisin/kexin type 9 （PCSK9） is a secreted protein that influences plasma levels of low-density lipoprotein cholesterol （LDL-C）. Both oxidized LDL and tissue factor （TF） contributed to the development of prothrombofic state. The pre- sent study aims to explore the relationship between plasma level of PCSK9 and that of TF in patient with coronary artery disease （CAD）. Methods From July 2013 to March 2014, we enrolled 197 consecutive patients who underwent coronary angiography because of suspected CAD at Beijing Anzhen Hospital in this study. All patients had no history of using lipid-lowering medication. Of these 197 patients （1B 1 male and 66 female, mean age 56.9 ± 11.8 years）, 81 had angiographically diagnosed CAD. Clinical data were collected. Plasma PCSK9 and TF were measured using enzyme-linked immunosorbent assay （ELISA）. Levels of plasma PCSK9 and TF were compared and their correlation analyzed among different patient groups. Results Both plasma levels of PCSK9 （279.8 ± 60.4μg/L vs. 216.5 ± 45.3μg/L, P 〈 0.01） and TF （156.4 ± 26.6 μg/mL vs. 112.1 ± 38.3 μg/L, P 〈 0.01） were significantly higher in patients with CAD, as compared with those with- out CAD. Correlation analysis showed plasma level of PCSK9 was significantly correlated with that of TF in both patients with and without CAD. However, multivariate regression analysis after adjustment for age, gender, smoking, alcohol, hypertension and hyperlipidemia showed that only in CAD patients with type 2 diabetes mellitus, there was significant positive correlation between plasma levels of PCSK9 and TF （β = 0.353, P 〈 0.01）. Coneluslons The plasma level of PCSK9 is independently and positively associated with that of TF in CAD patients with diabetes mellitus, but not in those without diabetes mellitus. Further study is needed to investigate the underlying mechanism.

CORONARY ANGIOGRAPHY WITH DUAL SOURCE COMPUTED TOMOGRAPHY:INITIAL EXPERIENCE

Objective To explore the scan technique and image quality of coronary angiography with dual source computed tomography(CT) without oral metoprolol preparation.Methods Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients.Calcium scoring with plain scan images as well as multi-planar reconstruction(MPR),maximum intensity projection(MIP),and volume rendering technique(VRT) reconstruction with enhanced scan images were performed in all cases.The scan technique and post-reconstruction experience was summarized.The image quality was classified as 1 to 4 points,and coronary segments classified according to the American Heart Association standards were evaluated.Results The average calcium score of the 600 cases was 213.6±298.7(0-3 216.5).The average heart rate of the enhanced scan was 82.1±16.2(47-139) bpm.The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method,two or more phases supplemented method,and electrocardiogram editing method.Altogether 8 457 coronary segments were evaluated,among which 97.2% were evaluated as point 1,1.7% point 2,0.5% point 3,and 0.6% point 4.The coronary segments in 261 cases were completely normal,while 360 segments were diagnosed with <50% stenosis and 625 segments with ≥50% stenosis.Conclusions Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation.Heart rate is not a major source of the artifact,coronary segments can be well shown with single or multiple-phase reconstruction method.

Factors Associated with Coronary Artery Disease in Young Population(Age≤40):Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease （CAD） in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients （204 men, 13 women） were assigned to CAD group, and 75 （68 men, 7 women） to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers （209/292, 71.6%）, and more than half had body mass index （BMI）〉24 kg/m2 （230/292, 78.8%） and usually took high-fat diet （162/292, 55.5%）. The proportion of heavy smokers （smoking history ≥10 years and t〉20 cigarettes per clay） were significantly higher in the CAD group than in the non-CAD group [20.7% （45/217） vs. 9.3% （7/75）, P=0.015）]. Heavy smoking [odds ratio （OR）, 1.89; 95% confidence interval （CI）, 1.74-2.05], hypertension （OR, 1.56; 95% CI, 1.48-1.65）, alcohol （OR, 1.37; 95% CI, 1.30-1.46）, type 2 diabetes mellitus （OR, 1.37; 95% CI, 1.25-1.50）, high-fat diet （OR, 1.35; 95% CI, 1.28-1.43）, and BMI〉24 kg/m2 （OR, 1.09; 95% CI, 1.03-1.17） were factors related to CAD in the young patients （all P〈0.05）. Total cholesterol （4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L）, low-density lipoprotein cholesterol （2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L）, lipoprotein a （134.97±109.70 mg/L vs. 101.58±58.39 mg/L）, uric acid （359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L）, erythrocyte sedimentation rate （9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour）, high-sensitivity C-reactive protein （3.42±4.39 mg/L vs. 2.80±_3.77 mg/L） and Big endothelin-1 （1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL） in plasma were significantly increased in the CAD group compared with the non-CAD group （all P〈0.05）. Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.