Objective To identify clinical characteristics associated with the minimum lumen area (MLA) of proximal or middle intermediate lesions in the left anterior descending (LAD) artery, and to develop a model to predic...Objective To identify clinical characteristics associated with the minimum lumen area (MLA) of proximal or middle intermediate lesions in the left anterior descending (LAD) artery, and to develop a model to predict MLA. Methods We retrospectively analyzed demographic data, medical history, and intravascular ultrasound findings for 90 patients with intermediate lesions in the LAD artery. Linear regression was used to identify factors affecting MLA, and multiple regression was used to develop a model for predicting MLA. Results Age, number of lesions, and diabetes mellitus correlated significantly with MLA of proximal or middle intermediate lesions. A regression model for predicting MLA (mm2) was derived from the data: 7.00 - 0.05 × (age) - 0.50 × (number of lesions). A cut-off value of 3.1 mm2 was proposed for deciding when to perform percutaneous coronary intervention. Conclusion This model for predicting MLA of proximal or middle intermediate lesions in the LAD artery showed high accuracy, sensitivity, and specificity, indicating good diagnostic potential.展开更多
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 Cardiovasc...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
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 th...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.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
In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typicall...In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.展开更多
<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 i...<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展开更多
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 f...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.展开更多
文摘Objective To identify clinical characteristics associated with the minimum lumen area (MLA) of proximal or middle intermediate lesions in the left anterior descending (LAD) artery, and to develop a model to predict MLA. Methods We retrospectively analyzed demographic data, medical history, and intravascular ultrasound findings for 90 patients with intermediate lesions in the LAD artery. Linear regression was used to identify factors affecting MLA, and multiple regression was used to develop a model for predicting MLA. Results Age, number of lesions, and diabetes mellitus correlated significantly with MLA of proximal or middle intermediate lesions. A regression model for predicting MLA (mm2) was derived from the data: 7.00 - 0.05 × (age) - 0.50 × (number of lesions). A cut-off value of 3.1 mm2 was proposed for deciding when to perform percutaneous coronary intervention. Conclusion This model for predicting MLA of proximal or middle intermediate lesions in the LAD artery showed high accuracy, sensitivity, and specificity, indicating good diagnostic potential.
文摘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
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.
基金the project of Traditional Chinese Medicine Bureau of Guangdong Province:Research on the Mechanism of Shen Shu Guan Xin Fang in Reducing Hypoxia Induced Myocardial Cell Injury by Regulating miR-24 (No. 20221108)Science and Technology Projects in Guangzhou:Exploring the Intervention of Shenzhu Guanxin Formula on Myocardial Ischemia Based on MiR-24 Mediated Bim/Caspase Apoptosis Signal Pathway Mechanism Research (No. 202201010521)+1 种基金the Science and Technology Innovation Projects of Shenzhen:to Study the Mechanism of Hesperidin in Improving Heart Failure Based on Myocardial Inflammation Mediated by MtDNAs GAS-STING Signaling Pathway (No. JCYJ20220530144212026)Futian Healthcare Research Project:To Study the Anti-atherosclerosis Effects and Mechanism of Shenzhu Guanxin Decoction on Inhibiting Platelet-mediated Inflammation Based on the Theory of "Phlegm-stasis Interjunction"(No. FTWS2022012)。
文摘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.
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.
文摘In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.
文摘<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
基金This work was supported by grants from the Capital Characteristic Clinical Application Research from Beijing Science and Technology Committee (No. Z111107058811003), the National Natural Science Foundation of China (No. 81070260, No. 81200167), the Beijing Natural Science Foundation (No. 7102099) and the Young Core Fund from Peking University Third Hospital.
文摘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.