Noninvasive Detection of Coronary Artery Stenosis Using 16-slice Spiral CT: a Comparison with Selective X-ray Coronary Angiography

The role of 16-slice spiral CT was selective X-ray coronary angiography （SCA） who were suspected of having coronary heart evaluated in the diagnosis of coronary stenosis, with serving as the reference standard. Sixty-five patients disease, without percutaneous transluminal coronary angioplasty or coronary bypass-grafting, were investigated using 16-slice CT. Eight patients with pre-scan heart rate of more than 80 beats/min were given β-blockers. After the retrospectively ECG-gated axial imaging reconstruction, volume redering （VR）, multi-planar reconstruction （MPR）, curved MPR and maximum intensity projection （MIP） were used to reconstruct. Every segment of coronary artery with a diameter ≥1.5 mm was assessed, and the presence on CT with a stenosis exceeding 50 % diameter reduction was compared with that on SCA. The reasons which lead to some segments unevaluable were analysed. Compared with SCA, 93 % coronary segments and 94 % main branches were evaluable. Residual cardiac motion artifacts, severe calcification and poor opacification made 58 %, 28 % and 14 % of the remaining 60 segments unevaluable respectively. Without routine administration of β-blockers, good coronary imaging quality can be acquired using 16-slice spiral CT. It is a reliable noninvasive method for detection of obstructive coronary artery disease.

NON-INVASIVE IMAGING OF CORONARY ARTERY WITH 16-SLICE SPIRAL COMPUTED TOMOGRAPHY

To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis. Methods Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany) in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice col-limation 16 mm×1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm×0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist) (370 mgI/mL) or Omnipaque (350 mgI/mL) and 30 mL 0.9% NaCl chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases, among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed. Results Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluationof image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the sec-ond class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia, and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensi-tivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% resp-ectively. Conclusion As a non-invasive and quick method, 16-slice coronary CTA is sensitive and specific to diagnose the stenosis of coronary arteries and can be used as a screening method in the diagnosis of CHD.

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.

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.

基于X-ray造影图像的主要冠状动脉血管直径测量的研究

冠脉血管直径的测量是冠心病诊断的基础。利用图像处理的方法实现冠脉直径的测量,并在此基础上给出了冠脉的正常直径,比传统意义上的百分比狭窄率更具有应用价值。采用103个病例进行统计研究。其中男病例51个,女病例52个。按照美国心脏病协会分段准则,把冠脉树分成了27段,利用已知导管直径计算真实冠脉段直径。结果给出了冠脉平均直径、中点直径、冠脉长度和弯曲率四个参数的均值和标准差。其结果与尸检结果比较接近。在处理冠脉直径狭窄时,这些参数可作为参考值,在冠状动脉病变分析中具有非常重要的应用价值。

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.

New approach to the automatic segmentation of coronary artery in X-ray angiograms

For the segmentation of X-ray angiograms （XRA）, the essential feature and the prior knowledge of angiographic image were analyzed, and a multi-feature based fuzzy recognition （MFFR） algorithm was proposed to infer the local vessel structure in this paper. Guided by the prior knowledge of artery vessel, a probability tracking operator （PTO） can rapidly track along the artery tree, and walk across the weak region or gaps because of disturbance or preprocessing to angiographic image. Another, the accurate measurement of the vascular axis-lines and diameters can be synchronously implemented in the tracking process. To correctly evaluate the proposed method, a simulated image of CAT and some clinical XRA images were used in the experimentations. The algorithms performed better than the conventional one： given one start-point, on average 92.7% of the visible segments or branches was automatically delineated; the correctness ratio of vessel structure inference reached to 90.0% on the average.

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.

Comparative Study on 16-slice CT Coronary Angiography vs Con-ventional Coronary Angiography―A Report of 38 Cases

The clinical application of 16-slice CT coronary angiography （CTCA） and the impact of plaques differently characterized on assessing coronary artery stenosis were evaluated. Thirty-eight patients with coronary artery disease diagnosed by conventional coronary angiography （CAG） underwent 16-slice CTCA （collimation： 16×0.75 mm; rotation time： 420 msec; kernel： 35f; effective current： 500 mAs; tube voltage： 120 kV）. The interval between CTCA and CAG was within one month. CTCA was evaluated by consensus of two independent experienced radiologists unknowing CAG findings. Original images, maximum intensity projections and multiplanar reconstructions were used to assess coronary artery stenosis. For a determined plaque an attenuation value ≥ 130 HU was considered as calcified, and 〈130 HU noncalcified. The plaques were then classified into significant calcification （extensive calcification）, medium calcification （small isolated calcification） and noncalcification. The diagnostic accuracy of 16-slice CTCA findings as well as to detect ≥50% stenoses caused by plaques was evaluated respectively regarding CAG as the standard of reference. In comparison with CAG findings, the sensitivity, specificity, positive and negative predictive value derived from CTCA for mild stenosis （〈50%） were 72.7%, 38.5%, 50%, 62.5%, respectively; for moderate stenosis （50%-75%） 82.4%, 72.7%, 70%, 84.2%, resepctively; and for severe coronary stenosis （〉75%） 85%, 90.5%, 81%, 92.7% respectively. With the increase of stenoses degree, the value of CTCA was greater. For the classification of the plaque calcification with ≥50% stenosis CTCA attained the sensitivity, specificity, positive and negative predictive value for severe calcificatoin 73.3% 22.2%, 61.1% and 33.3%, respectively; for moderate calcification 70%, 55.6%, 63.6% and 62,5%, respectively; for noncalcification 93.8%, 85.7%, 93.8% and 85.7% respectively. CTCA was restricted in assessing coronary artery stenosis in the presence of calcification, but CTCA value was much improved in assessing non-calcified stenosis. It was concluded that 16-slice CTCA could provide useful information about coronary artery stenosis, especially for severe stenosis （≥ 50%） and non-calcified plaque. Since CTCA is a noninvasive technique, it may be useful in screening coronary artery disease.

成人冠状动脉起源异常的分类及其发生率

目的探讨成人冠状动脉起源异常（AOCA）类型及其发生率。方法对2000年10月-2006年10月在我院行冠状动脉造影（1 520例）检出的26例存在AOCA患者资料,以及国内2006年10月以前发表的有关成人AOCA研究的8篇文献资料进行综合分析。结果9组资料冠状动脉造影总例数48 158例,检出AOCA 439例,检出率0.91%。右冠状动脉起源异常发生率0.55%（267例）,明显高于左冠状动脉0.36%（174例）,差异有统计学意义（P〈0.01）。右冠状动脉起源于左冠窦为最常见类型,占41.5%（182例）;其次为前降支和回旋支独立开口,占26.0%（114例）。结论我国成人AOCA多见于右冠状动脉,其中具有潜在临床危险的右冠状动脉起源于左冠窦为最常见类型,提示加强国人AOCA研究具有重要临床意义。

冠心病患者血浆血栓调节蛋白水平的测定

为了研究血浆血栓调节蛋白（ＴＭ）水平在冠心病中的意义，采用酶联免疫吸附试验测量５８例冠心病病人的ＴＭ水平。依照冠状动脉造影将病人分成３组：１组为单支病变组；２组为双支病变组；３组为３支及３支以上病变组。结果显示：１、２、３组的ＴＭ水平均比对照组显著增加。１组、２组、３组的ＴＭ水平依次增高，且３组与１组比较具有显著性差异。糖尿病病人的血浆ＴＭ水平显著高于非糖尿病者。结果表明，用血浆可溶性ＴＭ水平评价冠心病病人的内皮细胞损伤程度和范围具有很大价值。

川崎病并发严重冠状动脉病变患儿旁路移植术术前评估及术后随访

目的回顾性总结川崎病(KD)并发严重冠状动脉病变患儿的影像学诊断、冠状动脉旁路移植术结果及随访情况。方法复旦大学附属儿科医院2006年8月至2008年3月收治5例(男3例,女2例)KD并发严重冠状动脉病变患儿,年龄12个月至10岁4个月。所有患儿均在KD急性期予IVIG治疗,其中3例予2次。病程第15～21天均行超声心动图(ECHO)检查发现冠状动脉病变;之后常规随访ECG和ECHO,并口服阿司匹林和双嘧达莫或氯吡格雷。1例患儿行64排螺旋CT(MSCT)检查,2例行99Tcm-MIBI心肌灌注显像检查。在病程6～65个月行选择性冠状动脉造影检查,并行冠状动脉旁路移植术及冠状动脉成形术。结果 1/5例在病程中有心绞痛发作,3/5例有心功能不全,1/5例无症状。1/5例有心肌梗死发生并在恢复过程有ECG记录;2/5例ECG有ST-T改变;2/5例ECG未见异常。ECHO除均显示多发性冠状动脉瘤(CAA)外,3/5例还显示左心房和左心室增大,左室射血分数(LVEF)和短轴缩短率的降低,2/5例左室壁运动不协调,与99Tcm-MIBI检查结果一致。冠状动脉造影均可见多发性CAA且至少一处为中等或巨大CAA,并伴有血栓形成和远端闭塞。MSCT与冠状动脉造影检查结果一致。年龄最小的1例患儿(手术时22个月)在冠状动脉移植术中死亡,其余4例术后即刻效果满意。在8～24个月的随访中,1例LVEF较低,随访1年未达到正常;1例术后18个月复发KD,治疗顺利,复查ECHO和MSCT未见冠状动脉进一步损害。4例患儿目前仍在随访中。结论 KD并发冠状动脉病变应定期随访ECG、ECHO,必要时进行99Tcm-MIBI和MSCT检查;如考虑手术需行冠状动脉造影仔细评估冠状动脉病变部位和程度。有心肌缺血表现需及时行冠状动脉旁路移植术和冠状动脉成形术,手术的近期效果显著,远期疗效有待长期随访结果。

冠状动脉树结构的三维重建

由于双平面X射线造影系统只能提供两幅有限的投影数据 ,冠状动脉树的三维重建在匹配、优化几何变换矩阵等方面存在困难。研究了冠状动脉树结构的特征点自动识别方法 ,提出几何变换矩阵的优化方法和一种新型、简便的分段匹配方法。通过对两幅X射线造影图像进行细化、分割和匹配等处理 ,实现了冠状动脉树结构的三维重建。

经桡动脉冠状动脉介入诊疗232例临床分析

目的 探讨经桡动脉冠脉介入诊疗的可行性及安全性.方法 选择符合冠脉造影指征且Allen＇s试验阳性患者232例,首选以右桡动脉途径行冠脉造影,对符合介入指征者158例行介入治疗.结果 造影成功221例,成功率95.3%,失败11例,其中7例为穿刺不成功（桡动脉痉挛）,另外4例因动脉狭窄或迂曲（桡动脉迂曲1例、肱动脉狭窄1例、锁骨下动脉及头臂干迂曲2例）导致导管无法通过.对造影成功者中适合行介入的患者158例进行PTCA支架术,154例经桡动脉途径成功置入支架235枚,成功率97.5%,失败的4例均因痉挛指引导管无法到位.造影及介入治疗不成功者改股动脉途径均获成功.术后8例发生手臂肿胀,2例出现手腕部局部水泡,无桡动脉闭塞发生.结论 经桡动脉行冠脉介入诊疗安全可行,创伤小,并发症少,患者容易接受,值得推广.

空腹血糖水平与冠状动脉病变SYNTAX积分的关系

目的：分析存在冠状动脉病变的患者空腹血糖水平与冠状动脉病变复杂程度的关系。方法回顾性收集2009年1月至2011年1月于北京大学第三医院疑诊为冠心病并行冠状动脉造影（CAG）证实存在冠状动脉病变的929例患者的临床和CAG资料。根据SYNTAX积分对患者进行分组，应用双变量相关分析，多元逐步回归分析和Logistic回归分析空腹血糖水平与冠状动脉SYNTAX积分之间的相关性。结果①929例患者中，以SYNTAX积分分为：低危组（积分＜22分）47例，中危组（22分≤积分＜33分）189例，高危组（积分≥33分）693例。组间比较显示，患者年龄、空腹血糖水平、空腹血糖异常和既往糖尿病患者比例，差异具有统计学意义。②相关分析提示， SYNTAX积分与空腹血糖呈相关性（r=0.167，P=0.000）。亚组分析则显示，仅在无糖尿病史患者中，SYNTAX积分与空腹血糖之间存在相关性（r=0.149，P=0.000）；而在既往糖尿病史患者中，两者不具有相关性。③多元逐步回归分析显示，空腹血糖水平与SYNTAX积分独立相关（β=0.452， P=0.002）。亚组分析显示，仅在既往无糖尿病史亚组中，空腹血糖水平与SYNTAX积分独立相关（β=1.039，P=0.000）。④将SYNTAX中危组和高危组合并为中高危组，以SYNTAX积分作为因变量，以性别、年龄、高血压、糖尿病、高脂血症、吸烟、空腹血糖为自变量，进行Logistic回归分析，在整组和无糖尿病史亚组中均筛选出两个变量即：年龄（整组OR 1.033，95%CI 1.017～1.049， P=0.000；无糖尿病史组OR 1.039，95%CI 1.020～1.059，P=0.000）和空腹血糖水平（整组OR 1.114，95%CI 1.038～1.195，P=0.003；无糖尿病史组OR 1.299，95%CI 1.088～1.387，P=0.001）。结论存在冠状动脉病变的患者空腹血糖水平可能反映冠状动脉病变的复杂程度，具有预测中高SYNTAX积分的作用，尤其适用于无糖尿病史患者。

基于概率跟踪的冠状动脉造影图像的血管树提取

采用传统的基于跟踪的方法分割冠状动脉X射线造影图像的血管时,易受血管节点和曲率的影响.对此,本文提出了基于多特征测度的概率跟踪模型和中心线优化算子,该方法能够准确地分割出血管树的骨架并进行中心线优化.实验中,该方法不仅避免了传统方法的弊端,而且具有较低的计算耗时、较高的鲁棒性、全自动性:一次选定跟踪的起点,可以自动提取出80%以上冠状动脉树.

经双侧桡动脉途径对照造影行冠状动脉慢性闭塞病变介入治疗的研究

目的评价冠状动脉慢性闭塞病变(CTO)介入治疗中经双侧桡动脉途径进行左右冠状动脉造影定位的可行性及安全性。方法选择2006年6月—2007年6月本院行择期冠状动脉造影的CTO患者中存在对侧侧支循环的4例患者,经一侧桡动脉送入导引导管,经另一侧桡动脉送入造影导管,通过对侧造影使侧支循环及闭塞远端显影,帮助判断导丝是否在真腔,证实导丝在真腔后进行球囊扩张及支架置入术。结果4例均经对侧造影行经皮冠状动脉球囊扩张及支架置入,术中均未发生冠状动脉夹层及穿孔等并发症,术后症状明显缓解。结论经双侧桡动脉途径对照造影,通过侧支循环使CTO远端显影帮助判断导丝位置是一种安全有效的介入治疗方法。

老年患者冠状动脉造影术的并发症及其处理

目的 :总结我院老年患者冠状动脉造影术并发症的发生率及处理方法。方法 :用 Judkins法行冠状动脉造影和左室造影 ,记录术中、术后出现的并发症。结果 :2 4 5例老年患者手术成功率为 99.6 % ,心律失常发生率为 13.1% ,其中室速和室颤发生率分别为 1.7%和 0 .4 % ,严重缓慢性心律失常发生率为 2 .0 % ,心绞痛发生率为 6 .4 % ,血管并发症发生率为 2 .4 % ,造影剂过敏 3.2 % ,导管打结 0 .4 % ,发热 0 .8% ,排尿困难 2 .0 %。以上并发症经及时处理均得到缓解。结论 :老年患者进行冠状动脉造影检查有一定的并发症发生率 。

血清脂联素与冠心病患者冠脉病变程度相关性研究

目的观察冠状动脉粥样硬化性心脏病(简称冠心病)患者血清脂联素水平与冠脉病变程度的相关性,探索冠心病患者血清脂联素对病情的诊断价值及相应治疗的意义。方法随机选择66例经冠状动脉造影(CAG)确诊为冠心病的患者作为冠心病组,根据CAG结果中显示的冠脉病变支数进行病变程度分组,又将冠心病组分为单支病变组20例,双支病变组28例,多支病变组18例。另选择18例CAG未见冠脉狭窄的非冠心病患者作为非冠心病组。检测以上所有患者血清脂联素含量,比较冠心病患者与非冠心病患者、冠脉病变程度不同组患者血清脂联素含量变化。结果冠心病组血清脂联素含量低于非冠心病组,差异有统计学意义(P<0.01);冠心病患者血清脂联素与冠脉病变支数相关性分析显示,各组间两两比较,差异有统计学意义(P<0.05),即随着冠脉病变支数的增加,血清脂联素逐渐降低。结论血清脂联素在一定程度上可以预测是否存在冠心病以及冠脉病变的程度。

颈动脉超声联合血清同型半胱氨酸在冠状动脉粥样硬化性心脏病诊断中的应用价值

目的:探讨颈动脉超声联合血清同型半胱氨酸(Hcy)在冠状动脉粥样硬化性心脏病(CAD)诊断中的应用价值。方法:选取161例经冠脉造影证实为CAD的患者为研究对象,作为观察组,另选取同期161例健康体检者为对照组,比较两组患者颈动脉超声结果、血清同型半胱氨酸(Hcy)水平的差异,分析与冠状动脉狭窄相关的危险因素。结果:观察组与对照组比较,颈动脉内-中膜厚度(IMT)分别为(1.25±0.19)mm∶(0.84±0.20)mm,Crouse斑块积分分别为(8.87±2.89)分、(3.86±1.44)分,血清Hcy水平分别为(17.59±2.82)μmol/L、(6.29±2.99)μmol/L),差异均具有统计学意义(P<0.05);观察组中冠状动脉中度狭窄、重狭窄、闭塞三个亚组比较,颈动脉内-中膜厚度(IMT)、Crouse斑块积分呈明显的递增趋势(P<0.05);而血清Hcy水平与CAD患者冠脉狭窄程度无相关性(P>0.05)。结论:颈动脉超声联合Hcy检测可以作为CAD的临床诊断筛查手段,同时颈动脉超声还能预判CAD冠脉的狭窄程度。