Factors influencing the functional significance in intermediate coronary stenosis

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.

Safety and efficacy of frequency-domain optical coherence tomography in evaluating and treating intermediate coronary lesions

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.

Clinical Utility of N-13 Ammonia Cardiac PET Perfusion Imaging in the Assessment of Epicardial Coronary Lesions of Intermediate Range

Objective: To identify the high risk myocardial perfusion defects which prognosticate the future ischemic cardiac events, on Positron emission tomography (PET) myocardial perfusion imaging (MPI) of intermediate coronary stenosis (ICS) on coronary angiogram (CAG) with negative single photon emission computed tomography (SPECT) MPI in chronic stable angina (CSA) patients. Methods: For this study non-infarcted CSA patients of single vessel disease (SVD) on CAG with ICS and normal LV function were selected. In all patients with negative stress SPECT MPI, stress PET MPI was done. In both scans, extent score (ES), severity score (SS), total severity/extent score ratio (TS-ES R) and Left ventricular dilatation (LVD) were noted. Patients with Positive PET MPI were closely followed for 2yrs and PCI was performed depending on symptoms. Results: Out of 47 study group patients, during 2yr follow up period, 11 out of 15 patients with ischemia positive PET MPI underwent percutaneous coronary intervention (PCI). Indication for PCI was rest or persistence or recurrence of angina. Four of 15 patients remained asymptomatic. In medically managed vs. PCI done patients, mean of ES was 1.2 ± 0.5 vs. 2.3 ± 1, SS was 1.2 ± 0.5 vs. 5.3 ± 1.9, TS-ESR was 1 vs. 2.5 ± 0.5 which was statistically significant (p = 0.01). Conclusion: It was inferred that subgroup of PET MPI positive ICS patients with basal PET MPI showing SS > 5 and TS-ES R > 1.5 with LVD during stress required close follow up as they are likely require PCI subsequently. Condensed Abstract: As negative for inducible ischemia by single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is associated with low cardiac event rate, even though positive imaging by Positron emission tomography myocardial perfusion imaging (PET MPI), in patients with intermediate Coronary stenosis (ICS) may not require immediate percutaneous coronary intervention (PCI). We fol-lowed these patients for two 2yrs and identified that basal PET MPI showing total severity score > 5 and total severity/ extent score ratio > 1.5 with Left ventricular dilatation during stress required PCI subsequently.

Clinical efficacy and gene chip expression analysis of Shenzhu Guanxin recipe granules(参术冠心方颗粒) in patients with intermediate coronary lesions

OBJECTIVE: To evaluate the clinical efficacy and safety of Shenzhu Guanxin recipe granules(参术冠心颗粒, SGR) in treating patients with intermediate coronary lesions(ICL), and to investigate the potential mechanism though a transcriptome sequencing approach. METHODS: ICL patients with Qi deficiency and phlegm stasis were adopted and randomly assigned to a case group or a control by random number generator in a 1∶1 randomization ratio to evaluate the clinical efficacy. RESULTS: There was no significant difference between the two groups in coronary computed tomography angiography related indexes in the two groups before and after intervention. Through the gene chip expression analysis, it is finally concluded that there are 355 differential mRNAs(190 up-regulated genes and 165 down regulated genes) when compared the SGR group and placebo group. Through protein-protein interaction network analysis of differentially expressed genes, 10 hub genes were finally obtained: CACNA2D2, CACNA2D3, DNAJC6, FGF12, SGSM2, CACNA1G, LRP6, KIF25, OXTR, UPB1. CONCLUSIONS: SGR combined with Western Medicine can be safely used to treat ICL patients with Qi deficiency and phlegm stasis. The possible mechanism of action and relevant gene loci and pathway were proposed.

Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient:A pilot outcome study

AIM To investigate the patient-outcomes of newly developed pressure drop coefficient(CDP) in diagnosing epicardial stenosis(ES) in the presence of concomitant microvascular disease(MVD).METHODS Patients from our clinical trial were divided into two subgroups with:(1) cut-off of coronary flow reserve(CFR) < 2.0;and(2) diabetes.First,correlations were performed for both subgroups between CDP and hyperemic microvascular resistance(HMR),a diagnostic parameter for assessing the severity of MVD.Linear regression analysis was used for these correlations.Further,in each of the subgroups,comparisons were made between fractional flow reserve(FFR) < 0.75 and CDP > 27.9 groups for assessing major adverse cardiac events(MACE:Primary outcome).Comparisons were also made between the survival curves for FFR < 0.75 and CDP > 27.9 groups.Two tailed chi-squared and Fischer's exact tests were performed for comparison of the primary outcomes,and the log-rank test was used to compare the Kaplan-Meier survival curves.P < 0.05 for all tests was considered statistically significant.RESULTS Significant linear correlations were observed between CDP and HMR for both CFR < 2.0(r = 0.58,P < 0.001) and diabetic(r = 0.61,P < 0.001) patients.In the CFR < 2.0 subgroup,the %MACE(primary outcomes) for CDP > 27.9 group(7.7%,2/26) was lower than FFR < 0.75 group(3/14,21.4%);P = 0.21.Similarly,in the diabetic subgroup,the %MACE for CDP > 27.9 group(12.5%,2/16) was lower than FFR < 0.75 group(18.2%,2/11);P = 0.69.Survival analysis for CFR < 2.0 subgroup indicated better event-free survival for CDP > 27.9 group(n = 26) when compared with FFR < 0.75 group(n = 14);P = 0.10.Similarly,for the diabetic subgroup,CDP > 27.9 group(n = 16) showed higher survival times compared to FFR group(n = 11);P = 0.58.CONCLUSION CDP correlated significantly with HMR and resulted in better %MACE as well as survival rates in comparison to FFR.These positive trends demonstrate that CDP could be a potential diagnostic endpoint for delineating MVD with or without ES.

CCTA-AI联合FFR-CT诊断冠状动脉狭窄病变的应用价值研究

目的评估计算机断层扫描血管成像(CCTA)与人工智能(AI)联合心肌灌注分数(FFR-CT)对冠状动脉狭窄病变的诊断价值。方法选择于2022年1月至2023年2月到南阳市中心医院接受诊治的80例疑似冠状动脉狭窄病变患者作为观察对象。所有患者均接受CCTA以及冠状动脉造影(CAG)检查,其检查的间隔时间应在14天内,然后通过AI软件自动对CCTA的图像进行重建和计算,同时计算FFR-CT的数值。计算人工智能辅助的心脏计算机断层扫描(CCTA-AI)联合FFR-CT诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果80例患者经CAG检查确诊,72例患者为冠状动脉狭窄病变,占比为90%;8例患者为非冠状动脉狭窄病变,占比为10%。CCTA-AI联合FFR-CT检查的敏感度、特异度、阳性预测值、阴性预测值、准确度以及AUC值均高于CCTA-AI、FFR-CT单独检查,差异有统计学意义(P<0.05)。结论采用CCTA-AI联合FFR-CT检查诊断冠状动脉狭窄病变具有较高的诊断效能,其敏感度及特异度均得到显著提高。

Usefulness of lumen area parameters determined by intravascular ultrasound to predict functional significance of intermediate coronary artery stenosis

Background Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making for patients with intermediate coronary stenosis is still controversial. We designed this study to assess the optimal intravascular ultrasound （IVUS） criteria for predicting functional significance of intermediate coronary lesions. Methods We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter 〉2.50 mm. IVUS of intermediate coronary lesions were performed before intervention. Pressure-derived fractional flow reserve （FFR） was measured at maximal hyperemia induced by adenosine infusion. An FFR 〈0.80 was considered as abnormal functional significance. Results For the overall 165 lesions, the mean FFR value was 0.84±0.09. The diameter of the stenosis by visual estimation on angiogram was （59.63±11.29）%. Minimum lumen diameter （MLD）, minimum lumen area （MLA） and plaque burden （PB） were （2.00±0.36） mm, （3.88±1.34） mm2, （67.28±9.89）% respectively by IVUS measurements. An FFR 〈0.80 was seen in 43 lesions （30.5%）. There was a moderate correlation between IVUS parameters and FFR, including MLD （r=0.372, P 〈0.001 ）, MLA （r=0.442, P 〈0.001 ） and PB （t=-0.172, P 〈0.05）. MLA was a predictor for FFR as a continuous variable independent of possible confounding variables （P 〈0.05）, and MLA and PB, were predictors for FFR 〈0.80 as binary variables （P 〈0.05）. The best cutoff value of MLA to predict FFR 〈0.80 was 〈3.15 mm2, with a 73.6% diagnostic accuracy; sensitivity 71.4%, specificity 67.0%, AUC=0.709, and P 〈0.001. The cutoff value of the PB to predict FFR 〈0.80 was 65.45%; sensitivity 82.6%, specificity 41.2%, AUC=0.644, and P 〈0.01. If both MLA and PB were taken into account, the negative predictive value and the positive predictive value were 88.7% and 64.8% respectively. Conclusions Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values. IVUS-derived MLA 〉3.15 mm2 may be useful to exclude FFR 〈0.80, but poor specificity limits its applicability for physiological assessment of lesions 〈3.15 mm2. MLA was one of many factors affecting coronary flow hemodynamics. Both MLA and PB should be taken into account when determining functional ischemia.

基于定量血流分数评估不同低密度脂蛋白胆固醇水平对冠状动脉临界病变的影响

目的:基于定量血流分数(QFR)评估探讨不同低密度脂蛋白胆固醇(LDL-C)水平对冠状动脉临界病变的影响以及导致冠状动脉临界病变进展的相关危险因素。方法:连续收集2020年1月至2021年2月于阜外华中心血管病医院行冠状动脉造影检查提示存在临界病变,并至少于11个月后行冠状动脉造影复查的219例患者,行离线QFR分析。根据随访时LDL-C水平将患者分为LDL-C达标组(LDL-C<1.8 mmol/L,148例患者191支血管)与LDL-C不达标组(LDL-C≥1.8 mmol/L,71例患者98支血管),比较两组间冠状动脉血管QFR和解剖相关指标如最小管腔直径、最小管腔面积、最大直径狭窄百分比、最大面积狭窄百分比等的不同,进一步分析导致冠状动脉血管QFR改变的影响因素。结果:LDL-C达标组患者的血管QFR值与基线相比差异无统计学意义(P>0.05),LDL-C未达标组患者QFR值较基线下降(P<0.05)。LDL-C达标组患者最大直径狭窄百分比和最大面积狭窄百分比更低,最小管腔直径和最小管腔面积更高(P均<0.05)。多因素Logistic回归分析发现体重指数>28 kg/m2、随访时LDL-C≥1.8 mmol/L、既往曾发生过心肌梗死是导致血管QFR下降的独立危险因素(P均<0.05)。结论:LDL-C达标组较LDL-C未达标组患者冠状动脉血管QFR、最小管腔直径和最小管腔面积更高,最大直径狭窄百分比和最大面积狭窄百分比更低。

基于CAD-RADS的高危斑块特征联合CT-FFR对冠状动脉临界病变预后的预测价值

目的:研究基于冠状动脉疾病报告和数据系统(coronary artery disease-reporting and data system,CAD-RADS)的高危斑块特征联合CT血流储备分数(fractional flow reserve derived from CT,CT-FFR)对冠状动脉病临界病变患者预后的临床应用价值。方法:在CAD-RADS结构式报告基础上,前瞻性研究冠状动脉CT血管造影(coronary artery CT angiography,CCTA)影像资料和临床资料,共301例临界病变患者纳入研究,影像观察指标包括CAD-RADS≥3、钙化积分≥100、斑块易损性特征、高危斑块、长病变、CT-FFR≤0.8,观察指标的组合包括CAD-RADS≥3 V、CAD-RADS≥3 V且CT-FFR≤0.8。研究终点为预后不良,包括主要不良心血管事件(major adverse cardiovascular events,MACE)及计划外有创冠状动脉造影(invasive coronary angiography,ICA)、血运重建手术,研究样本分为预后良好组和预后不良组。通过统计不同组间数据的差异,评价CAD-RADS高危斑块联合CT-FFR对临界病变患者预后的临床价值。结果:年龄、钙化积分、CAD-RADS类别、斑块易损性特征、高危斑块、长病变、CT-FFR在预后良好组和预后不良组间的差异有统计学意义(P<0.05);CAD-RADS类别、高危斑块、CT-FFR是冠状动脉临界病变预后的独立预测因子(P<0.05);CT-FFR≤0.8在CAD-RADS≥3组、钙化积分≥100组、不同斑块易损性特征组、高危斑块组、长病变组中发生率差异均有统计学意义(均P<0.05);观察指标组合(CAD-RADS≥3 V且CT-FFR≤0.8)预测预后不良的特异性、准确性和阳性预测值分别为97.2%、85.7%、88.7%,AUC为0.795(95%CI:0.731~0.858)。结论:基于CAD-RADS的高危斑块特征联合CT-FFR能有效预测MACE及计划外ICA、血运重建手术,指导临床针对性干预与治疗。

Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data:A case report

BACKGROUND Invasive functional evaluation by fractional flow reserve(FFR)is considered as a gold standard for the evaluation of intermediate coronary stenosis.However,in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain.Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent.Patient undergone invasive functional testing of intermediate lesion with preserved FFR(0.88),low coronary flow reserve(1.2)and very high index of microvascular resistance(84).Due to discrepancy in invasive functional parameters,intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma.Because of the preserved FFR and no signs of vulnerable plaque,the interventional procedure was deferred and the patient continued with optimal medications.CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.

临界病变冠心病患者中性粒细胞淋巴细胞比值与冠状动脉血流储备分数的相关性及其临床价值

目的:探讨临界病变冠心病患者中性粒细胞淋巴细胞比值(NLR)与冠状动脉血流储备分数(FFR)的相关性及其临床价值。方法:回顾性分析2022年1月至2023年8月在温州医科大学附属第五医院心内科住院的105例稳定性冠心病患者的临床资料,冠状动脉造影术前采集外周静脉血,计算NLR,冠状动脉造影术中同时行FFR检查。根据FFR结果分为FFR<0.8组(47例)和FFR≥0.8组(58例),比较两组患者资料。采用Pearson相关分析、限制性立方样条图(RCS)分析、多因素Logistic回归分析及ROC曲线评估临界病变冠心病患者NLR与FFR的相关性及NLR预测冠状动脉生理性缺血的临床价值。结果:FFR<0.8组患者糖尿病史、白细胞总数、中性粒细胞计数、NLR、hsCRP明显高于FFR≥0.8组,而FFR<0.8组患者淋巴细胞计数显著低于FFR≥0.8组,差异有统计学意义(均P<0.05)。Pearson相关分析显示NLR与FFR值之间存在负相关(r=-0.447,P<0.001)。RCS分析显示NLR与是否存在冠状动脉生理性缺血之间存在总体相关(P=0.001),但不存在非线性相关(P=0.123)。校正其他混杂因素影响后,多因素Logistic回归分析显示NLR是临界病变冠心病患者冠状动脉生理性缺血的独立预测因子(OR=4.101,95%CI=2.002~8.403,P<0.001)。ROC曲线分析显示预测冠状动脉生理性缺血的最佳NLR截点为2.34,灵敏度为80.90%,特异度为79.30%,ROC曲线下面积为0.814(95%CI=0.734~0.894)。结论:临界病变冠心病患者NLR与FFR之间具有负相关关系。NLR可以很好地预测临界病变冠心病患者是否存在冠状动脉生理性缺血,对此类病变治疗方案的选择具有较高的参考价值。

Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint:Pressure drop coefficient in patients with coronary artery dysfunction

AIM:To combine pressure and flow parameter, pressure drop coefficient(CDP) will result in better clinical outcomes in comparison to the fractional flow reserve(FFR) group. METHODS:To test this hypothesis, a comparison was made between the FFR < 0.75 and CDP > 27.9 groups in this study, for the major adverse cardiac events [major adverse cardiac events(MACE): Primary outcome] and patients’ quality of life(secondary outcome). Further, a comparison was also made between the survival curves for the FFR < 0.75 and CDP > 27.9 groups. Two-tailed χ~2 test proportions were performed for the comparison of primary and secondary outcomes. Kaplan-Meier survival analysis was performed to compare the survival curves of FFR < 0.75 and CDP > 27.9 groups(MedcalcV10.2, Mariakerke, Belgium). Results were considered statistically significant for P < 0.05. RESULTS: The primary outcomes(%MACE) in the FFR < 0.75 group(20%, 4 out of 20) was not statistically different(P = 0.24) from the %MACE occurring in CDP > 27.9 group(8.57%, 2 out of 35). Noteworthy is the reduction in the %MACE in the CDP > 27.9 group, in comparison to the FFR < 0.75 group. Further, the secondary outcomes were not statistically significant between the FFR < 0.75 and CDP > 27.9 groups. Survival analysis results suggest that the survival time for the CDP > 27.9 group(n = 35) is significantly higher(P = 0.048) in comparison to the survival time for the FFR < 0.75 group(n = 20). The results remained similar for a FFR = 0.80 cut-off. CONCLUSION: Based on the above, CDP could prove to be a better diagnostic end-point for clinical revascularization decision-making in the cardiac catheterization laboratories.

Clinical applications of fractional flow reserve in bifurcation lesions

Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.

Optimal morphometric and functional assessment of intermediate coronary lesions

Coronary lesions of intermediate severity, defined as 50%-70% luminal diameter narrowing by visualestimation at angiography, are frequently encountered in patients with stable or unstable coronary artery disease. Clinical decision making for patients with intermediate coronary stenosis is still challenging, but may be facilitated by assessing the morphology and physiological significance of these lesions.1 It is clear that angiographic stenosis is a highly unreliable surrogate for myocardial ischemia, as a significant proportion of anatomically high-grade lesions do not cause ischemia. Conversely, even for anatomically mild coronary lesions, a non-negligible rate of myocardial ischemia is consistently noted. Because the physiological significance of a lesion is mainly determined by both the severity of a stenosis and the amount of myocardium supplied, coronary angiography alone does not accurately predict the functional significance of intermediate coronary lesions.2,3

Intermediate coronary lesions: prognostic evaluation of plasma osteoprotegerin in elderly patients

<正>Objective To investigate the plasma osteoprotegerin(OPG)measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients meeting the inclusion criteria of suspicious chest pain or confirmed coronary artery disease(CHD),and intermediate stenosis lesions(20%~70%)in 3 main coronary arteries

Relationship between fibrinogen and fractional flow reserve in coronary intermediate lesions

Objective To study the relationgship and the clinical significance between plasma fibrinogen and fractional flow reserve(FFR)in coronary intermediate lesions.Methods The patients were from The Department of Cardiovascular of Affiliated Hospital of Xuzhou Medical College.Their coronary artery lesions were assessed by

CT血管造影结合血清Klotho和FGF23水平对冠脉临界病变血管狭窄程度的诊断价值

目的分析CT血管造影联合血清Klotho和成纤维细胞生长因子23(FGF23)水平对冠脉临界病变血管狭窄程度的诊断价值。方法选取2021年1月至2022年10月在我院诊治的185例冠脉临界病变患者作为研究对象,以冠拔动脉造影所测狭窄率为金标准,将患者分为轻度狭窄组80例、中重度窄组105例。采用酶联免疫吸附(ELISA)法对患者血清Klotho、FGF23水平进行测定。受试者工作特征(ROC)曲线分析血清Klotho、FGF23水平对冠脉临界病变血管狭窄程度的诊断价值;采用四格表分析CT血管造影联合血清NOX4、Galectin-3水平对冠脉临界病变血管狭窄程度的诊断价值。结果CT血管造影结果显示,冠脉临界病变患者狭窄率<50%有85例,狭窄率≥50%有100例,轻度、中重度狭窄组的符合率分别为87.50%、85.71%;与轻度狭窄组相比,中重度狭窄组冠脉临界病变患者血清Klotho水平明显降低(P<0.05),FGF23水平显著升高(P<0.05);Klotho、FGF23诊断冠脉临界病变血管狭窄程度的曲线下面积(AUC)分别为0.93、0.917;CT血管造影联合血清Klotho、FGF 23水平诊断冠脉临界病变血管狭窄程度的敏感度为95.24%、特异度为85.00%、准确度为90.81%,其诊断效能均高于CT血管造影、血清Klotho、FGF23单独诊断。结论冠脉临界病变中重度狭窄患者血清Klotho水平降低,FGF23水平升高,对冠脉临界病变血管狭窄程度具有一定诊断价值,联合CT血管造影可明显提高冠脉临界病变血管狭窄程度的诊断价值。

冠状动脉CT血管造影在评估冠心病病变部位及程度的价值分析

目的:分析冠状动脉CT血管造影(CTA)在评估冠心病病变部位及狭窄程度。方法:回顾性研究2018年1月—2022年12月苏州市相城人民医院诊断的冠心病患者150例。患者均接受冠状动脉CTA及冠脉造影检查,分析冠状动脉CTA对病变部位的诊断价值,分析冠状动脉CTA对病变程度的诊断价值。结果:冠状动脉CTA对于左前降支诊断准确62例,漏诊5例,误诊7例,一致性检验(Kappa=0.821,P<0.05),一致性较好;冠状动脉CTA对于回旋支诊断准确78例,漏诊4例,误诊9例,一致性检验(Kappa=0.814,P<0.05),一致性较好;冠状动脉CTA对于右冠诊断准确120例,漏诊8例,误诊5例,一致性检验(Kappa=0.867,P<0.05),一致性很好。冠状动脉CTA对于中度狭窄诊断准确168例,漏诊13例,误诊8例,一致性检验(Kappa=0.786,P<0.05),一致性较好;冠状动脉CTA对于重度狭窄诊断准确89例,漏诊9例,误诊8例,一致性检验(Kappa=0.837,P<0.05),一致性较好。结论:冠状动脉CTA对于冠心病有重要的诊断意义,可以评估病变部位及狭窄程度,为临床医师判断病情提供一定参考。

血管内超声或血流储备分数指导冠状动脉临界病变介入治疗的临床效果

目的：评价在冠脉临界病变患者中，经血管内超声（IVUS）指导介入治疗的患者与经测定血流储备分数（FFR）指导介入治疗的患者的远期临床效果。方法选取冠脉造影证实冠脉狭窄程度40%~70%的患者共226例（293处病变），分为血管内超声指导组98处病变、血流储备分数指导组101处病变、药物治疗组94处病变。在血管内超声指导组中，如狭窄处最小管腔面积（MLA）＜4 mm2行冠脉支架置入术；在血流储备分数组中，如FFR＜0.8予以行介入治疗。术后随访1年，比较3组患者的主要心血管不良事件发生率（死亡、心梗、靶血管重建）。结果（1）3组患者冠脉造影显示的狭窄程度及病变长度无明显差别；（2）血管内超声指导组行冠脉介入治疗术的患者比例高于血流储备分数指导组（P＜0.001）；（3）3组患者的主要心血管不良事件的发生率无明显差别（P=0.182）。结论血流储备分数检测及血管内超声检查均可以用于指导冠脉临界病变的介入治疗策略，血管内超声检查仅依靠单一的测定狭窄处最小管腔面积作为介入治疗的标准可能会增加介入干预患者比例。

血管内超声在冠状动脉临界病变诊断和介入治疗中的应用

目的:探讨血管内超声(IVUS)在冠状动脉(冠脉)造影显示的临界病变诊断和介入治疗中的应用价值。方法:对经选择性冠脉造影提示临界病变的96例患者的110处病变进行IVUS检查,根据IVUS测定的最小管腔面积≤4.0 mm2作为冠脉介入治疗的标准,分为干预组和未干预组,分析病变的狭窄程度及粥样硬化斑块性质。结果:110处临界病变的平均最小管腔面积为(4.83±2.24)mm2,46处最小管腔面积≤4.0 mm2的病变成功置入冠脉支架;IVUS显示干预组的最小管腔面积小于未干预组(3.47±0.44)mm2比(5.69±1.57)mm2,(P<0.05);同时干预组的斑块负荷大于未干预组,但差异无统计学意义(68.50±5.98)%比(62.89±7.69)%,(P>0.05)。两组的定性结果差异无统计学意义(P>0.05)。结论:对冠脉造影显示的临界病变行IVUS检查可进一步明确临界病变的狭窄程度和病变的性质,指导下一步治疗。