Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting： which is better in patients with chronic obstructive pulmonary disease？

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

Mid-ventricular hypertrophic obstructive cardiomyopathy(MVHOCM) complicated with coronary artery disease:a case report

Mid-ventricular hypertrophic obstructive cardiomyopathy (MVHOCM) is a rare type ofcardiomyopathy that can be accompanied by apical aneurysm.We presented here a case report of MVHOCM with cornary artery disease.The sixty-four years old man was sent to hospital because ofventricular tachycardia.Large inversion T wave was showed on electrocardiography in the presence of abnormal coronary arteries and normal cardiac enzyme.Echocardiography showed an hourglass appearance of the left ventricle with an aneurysm in the apex and a pressure gradient between the outflow tract of left ventricle and the middle of the left ventricle was revealed by left-heart catheterization.

Nocturnal myocardial ischemic events and sleep-disordered breathing in patients with coronary artery disease

Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)

Accuracy of Cardiogoniometry in Diagnosis of Coronary Artery Disease in Patients with Angina Pectoris

Background: Cardiogoniometry (CGM) is a novel non-invasive technique for quantitative three-dimensional vectorial analysis of myocardial depolarization and repolarization. We aimed to determine the diagnostic value of cardiogoniometry for the identification of coronary artery disease (CAD) in patients with history of chest pain. Materials and Methods: Cardiogoniometry was performed in 190 patients with history of chest pain prior to diagnostic coronary angiography. Then cardiogoniometry parameters correlated with angiography findings to determine accuracy of cardiogoniometry for diagnose of CAD. Result: Cardiogoniometry showed a sensitivity of 72% and a specificity of 60%, which was less sensitive than perfusion scan but more sensitive than the ECG and comparable with exercise ECG. The specificity was less than these three methods. Conclusions: Cardiogoniometry is a new, noninvasive method which is helpful in identifying patients with coronary artery disease and can be performed at rest and free of risk such as radiation exposure, and also is suitable for patients who are not able to exercise.

Atrial fibrillation and coronary artery disease:An integrative review focusing on therapeutic implications of this relationship

The incidence of both atrial fibrillation(AF)and coronary artery disease(CAD)increases with advancing age.They share common risk factors and very often coexist.Evidence points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory level.In this review,we delineated this complex relationship,identified a common theme between the two,and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient management.Recent research indicates a high prevalence of CAD among AF patients undergoing coronary angiography.Further,the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal relationship.CAD adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical inhomogeneity.AF in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular system.In a nutshell,the two form a vicious cycle wherein one disease promotes the other.Most AF recommendations focuses on rate/rhythm control and prevention of thromboembolism.Very few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these patients.Inflammation and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two diseases.The relationship between AF and CAD is complex and much more than mere coincidence.The two diseases share common risk factor and pathophysiology.Hence,it is impractical to treat them in isolation.Accordingly,we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life among AF patients.

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.

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUND Coronary heart disease(CHD)is a type of coronary atherosclerotic heart disease.In recent years,the incidence of CHD has been increasing annually,with an increasing number of young patients.Severe CHD may cause severe myocardial ischemia or myocardial necrosis,which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIM To examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODS From February 2019 to January 2020,110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age:middle-aged group(n=55)and young group(n=55).The coronary arteries and clinical features of the patients were compared.RESULTS There were no significant differences in dyslipidemia,stroke history,high-density lipoprotein cholesterol,or triacylglycerol(P>0.05)between the two groups.In the young group,age,diabetes,hypertension,smoking history,body mass index,family history of CHD,drinking history,fibrinogen,low-density lipoprotein cholesterol,total cholesterol,and single-vessel disease were higher than those in the middle-aged group.Correspondingly,serum uric acid,hyperuricemia,myocardial infarction,Gensini score>50,collateral circulation,multivessel disease,double vessel disease,involvement of the right coronary artery,and involvement of the left main coronary artery were lower in the young group than in the middle-aged group.The middle-aged group mainly suffered from a high Gensini score,implicating multiple arteries,whereas the young group was mainly affected by single-vessel disease.The between-group difference was significant(P<0.05).CONCLUSION In CHD attacks,multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.

Implications of left atrial volume index in patients with three-vessel coronary disease:A 6.6-year follow-up cohort study

Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.

Comprehensive assessment of a post-coronary bypass graft patient with cardiovascular magnetic resonance imaging and multi-detector computed tomography

Coronary bypass graft surgery (CABG) is a revascularization procedure which reduces myocardial ischemia and cardiovascular morbidity and mortality in selected patients;however, up to 40% of saphanous vein grafts may degenerate over 10 years. Although coronary angiography is the gold standard to detect graft patency and native vessel disease, sometimes it is difficult to locate the grafts resulting in increased exposure to radiation and contrast administration. This case highlights the utility of cardiac computerized tomography and magnetic resonance imaging to provide comprehensive noninvasive assessment in a patient post CABG.(J Geriatr Cardiol 2007;4:244-247.)

老年慢性阻塞性肺病合并冠状动脉疾病的微生态变化分析

目的分析老年慢性阻塞性肺病(COPD)合并冠状动脉疾病(CAD)患者肺部及肠道微生态的变化,并探讨其免疫调控机制。方法选择2022年1—6月四川省医学科学院·四川省人民医院(电子科技大学附属医院)老年医学科收治的COPD老年患者为研究对象,其中,COPD组患者20例和COPD合并CAD组患者20例,并选取同期健康老年人群15例作为对照组,检测肺部和肠道样本菌群及外周血炎症因子。结果各组样本间细菌多样性指数比较差异无统计学意义(P>0.05)。在门水平上,COPD合并CAD组与对照组相比,肺部和肠道菌群中厚壁菌门减少,变形菌门、放线菌门均增多(P<0.05);与COPD组相比,肠道菌群中厚壁菌门减少,放线菌门增多(P<0.05)。在属水平上,COPD合并CAD组的肺部菌群中假单胞菌属增多,链球菌属、韦荣氏菌属、普雷沃氏菌属、放线菌属减少(P<0.05);肠道菌群中埃希氏菌属增多,拟杆菌属、肠球菌属、乳杆菌属减少(P<0.05)。在细胞因子表达水平上,COPD合并CAD组的白细胞介素(IL)-2、IL-4、IL-6、肿瘤坏死因子(TNF)-α升高,IL-10降低(P<0.05)。结论COPD合并CAD患者的肺部及肠道微生物菌群数量和构成存在显著差异,表明肺部和肠道微生态失衡及全身炎症反应可能增加COPD患者罹患CAD风险。调节微生物群组成或其代谢物的途径,可能是老年慢性共病的潜在治疗策略。

阻塞性冠心病患者CCTA高危斑块特征和冠状动脉狭窄程度与冠状动脉血流储备分数异常的关联性分析

目的分析阻塞性冠心病(CAD)患者冠状动脉CT成像(CCTA)高危斑块特征和冠状动脉狭窄程度与冠状动脉血流储备分数异常的关联性。方法回顾性分析2017年1月至2018年6月于河北北方学院附属第一医院行CCTA检查并确诊为CAD的139例患者临床资料,纳入205支冠状动脉,依据冠状动脉基于CT血流储备分数(FFR_(CT))值,将冠状动脉分为FFR_(CT)异常组(FFR_(CT)≤0.80,117支)和FFR_(CT)正常组(FFR_(CT)>0.80,88支)。比较两组高危斑块特征、冠状动脉狭窄程度,采用logistic回归分析冠状动脉狭窄程度、高危斑块特征对FFR_(CT)异常的影响。结果FFR_(CT)异常组正性重构(PR)、低密度斑块(LAP)发生率显著高于FFR_(CT)正常组(P<0.05)。两组冠状动脉狭窄程度比较差异有统计学意义(P<0.05)。冠状动脉重度狭窄、LAP、PR是促进FFR_(CT)异常的独立危险因素(P<0.05)。结论CCTA冠状动脉重度狭窄及LAP、PR与FFR_(CT)异常发生密切相关,该特征有助于指导临床更好地识别血流动力学异常患者。

Association between serum uric acid level and the severity of coronaryartery disease in patients with obstructive coronary artery disease

Background Many studies have shown that the serum uric acid(SUA) level is one of the cardiovascular risk factors. The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease(CAD) assessed by angiography and the Syntax score in patients with obstructive CAD.Methods Participants who visited our hospital for a coronary angiography, from December 2007 to September 2012, were eligible for this analysis. SUA and other blood parameters after at least 12-hour fast were determined. First, the patients were divided into tertiles according to their Syntax scores(low Syntax score group: Syntax score ≤10.0; moderate Syntax score group: 10.0 <Syntax score ≤18.0; high Syntax score group: Syntax score >18.0). Second, to clarify the association between SUA levels and major adverse cardiovascular events(MACEs), all patients were divided into two subgroups on the basis of SUA levels. The cutoff value of SUA was defined by diagnostic criteria of hyperuricemia. Patients were separated into normal SUA group(n=251, with SUA <416 μmol/L for men and SUA <357 μmol/L for women) and high SUA group(n=96, with SUA ≥416 μmol/L for men and SUA ≥357 μmol/L for women). All participants were followed for a mean of 22.0 months(1–75 months, interquartile range: 28 months) for major adverse cardiovascular events(MACEs), including all-cause death, recurrent nonfatal myocardial infarction(re-MI) and recurrent percutaneous coronary intervention(re-PCI). Results A total of 347 patients were registered for the study. The SUA levels in the high Syntax score group were significantly higher than that of the moderate Syntax score group and the low Syntax score group((392.3±81.6) μmol/L vs.(329.9±71.0) μmol/L, P <0.001;(392.3±81.6) μmol/L vs.(311.4±64.7) μmol/L, P <0.001). The SUA level was positively correlated not only with the Syntax score(r=0.421, P <0.001; 95% CI: 0.333–0.512), but also with the number of diseased vessels(r=0.298, P <0.001; 95% CI: 0.194–0.396). After multiple linear regression analysis, SUA levels were identified to be independently correlated with a high Syntax score(B=0.033, 95% CI 0.023–0.042, P <0.001). Compared with the normal SUA subgroup, the high SUA subgroup tended to have a higher Syntax score(19.9±8.7 vs. 13.6±7.5, P <0.001) and more multi-vessel disease(70.8% vs. 46.6%, P <0.001). Follow-up data showed a higher incidence of MACE in the high SUA subgroup(20.8% vs. 6.0%, P <0.001). Binary Logistic regression analysis indicated that the elevated SUA can predict the long-term prognosis of patients with obstructive CAD(OR=2.968, 95% CI 1.256–7.011, P=0.013). KaplanMeier analysis showed a significantly lower event-free survival rate in patients with high SUA levels than in the normal SUA subgroup(79.2% vs. 94.0%, Log rank=17.645, P <0.001). Conclusions SUA levels were independently associated with the severity of CAD in patients with obstructive CAD. An elevated SUA is associated with cardiovascular events and may be useful as a biomarker of the severity of CAD.

Association of chronic obstructive pulmonary disease with coronary artery disease

Background The relationship between chronic obstructive pulmonary disease （COPD） and coronary artery disease （CAD） remains largely unknown. This study aimed to explore the association of COPD with CAD, especially with multi- vessel disease （VD）. Methods The data of 354 patients who underwent multi-detector computed tomography （MDCT） for suspected CAD were analyzed. Luminal narrowing was defined as at least one lesion 50% or greater stenosis. The analysis of serum biochemistry profile and spirometrywere performed on all eligible patients, and the diagnosis of COPD was defined as the criteria of Global Initiative for Chronic Obstructive Lung Disease. Results Patients with CAD had a significantly higher complication of COPD than those without CAD （11.8% vs. 3.7%, P 〈0.001）. Comparing with patients without COPD, those with COPD were more likely to have multi-VD, proportion of smoking and high C-reactive protein （CRP） （P 〈0.001）. Multivariate Logistic regression analysis revealed that the multi-VD was significantly correlated with COPD （P=-0.012） and CRP （P=0.015）. Conclusions There was a high complication of COPD in patients with CAD, and COPD may be a critical risk factor for CAD, especially for multi-VD. CAD and COPD were closely associated and the interplay of systemic inflammation might in part explain the relationship between them.

心脏体外震波治疗对冠心病患者心肌灌注及心电图的影响

目的探讨心脏体外震波治疗(CSWT)对冠心病患者负荷心肌灌注扫描及心电图结果的影响。方法纳入2016年12月至2022年8月因冠心病在北京医院住院诊治并行CSWT的患者。CSWT为3个月方案,共9次治疗。收集冠心病患者行CSWT前后的临床基本资料、心肌灌注扫描数据和心电图数据。比较CSWT前后心肌灌注扫描结果和心电图参数的变化。结果共有55例冠心病患者,其中男43例,平均年龄为(67.45±8.96)岁。CSWT前后12导联心电图ST段最大位移均无明显变化,心肌灌注扫描显示左心室整体负荷灌注总分(P=0.031)和整体可逆灌注总分(P=0.024)显著改善,静息左心室整体缺血面积显著缩小(P=0.034),差异均有统计学意义。靶节段负荷灌注评分(P=0.002)、靶节段可逆灌注评分(P=0.002)、靶节段负荷缺血面积(P=0.001)明显改善,差异均有统计学意义。结论CSWT对冠心病难治性心绞痛患者心电图ST段最大位移无影响,有助于改善心肌血流灌注,缩小缺血范围。

Intermittent Left Bundle Branch Block and Myocardial Ischemia in Patient Without Coronary Artery Stenosis:A Case Report

Left bundle branch block （ LBBB ）, traditionally viewed as an electrophysiologic abnormality, is increasingly recognized for its effects on hemodynamics and patient＇s prognosis^[1]. Exercise nuclear studies frequently show reversible perfusion defects in the absence of obstructive coronary artery disease^[2] and some patients with intermittent LBBB develop angina coincident with the onset of LBBB^[3]. We report a case of intermittent LBBB with abnormal stress technetium 99m TC single-photon emission computed tomography （SPECT） study and normal coronary artery angiography.

基于幂法则校正动态CT灌注心肌血流量评价心肌缺血

目的利用幂法则原理对心肌动态CT灌注(CTP)所测得心肌血流量(MBF)进行个体化校正,并评价其诊断心肌缺血的价值。方法回顾性纳入行CTP+冠状动脉CT血管成像(CCTA)扫描的疑似或确诊的冠心病病人86例,其中男47例,女39例,平均年龄(62.17±8.99)岁。使用Frontier平台分析病人MBF并计算冠状动脉三大分支支配区域的MBF。使用3D Slicer软件,通过阈值分割来计算冠状动脉管腔容量(V)并计算校正参数(K,K=MBF/V^(3/4))。利用AI影像辅助诊断平台计算靶血管病变部位的CT血流储备分数(FFR_(CT))值,并以FFR_(CT)>0.8和FFR_(CT)≤0.8在病人水平上分为非心肌缺血组和心肌缺血组,在血管水平上将冠状动脉3大主要分支[左冠状动脉前降支(LAD)、左冠状动脉回旋支(LCX)和右冠状动脉(RCA)]分别分为非缺血性狭窄组(FFR_(CT)>0.8)和缺血性狭窄组(FFR_(CT)≤0.8)。使用独立样本t检验比较病人水平和血管水平上不同分组之间MBF和K的差异,并绘制受试者操作特征(ROC)曲线评估其诊断效能。结果心肌缺血组MBF_(病人)和K_(病人)均低于非心肌缺血组(均P<0.05);缺血性狭窄组MBF_(LAD)、K_(LAD)、K_(LCX)和K_(RCA)均低于非缺血性狭窄组(均P<0.05)。K和MBF的诊断截断值分别为1.38和116 m L/(100 m L·min^(-1))时,K_(病人)的AUC(0.831)和阳性预测值(62.3%)最高,K_(LCX)准确度最高(77.3%),K_(RCA)敏感度(100%)和阴性预测值(100%)最高MBF病人的AUC(0.795)最高,MBFLCX特异度(89.1%)最高。结论基于幂法则原理可以使用病人冠状动脉灌注床的血管容量对MBF进行校正,并显著减少个体差异,提高CTP对心肌缺血的诊断效能。

腺苷负荷心肌灌注显像评估川崎病心肌缺血的价值

目的 探讨腺苷负荷心肌灌注显像(MPI)评估儿童川崎病心肌缺血的安全性及临床价值。资料与方法 前瞻性收集2019年8月—2021年2月复旦大学附属儿科医院有川崎病病史且经超声心动图和冠状动脉造影明确有冠状动脉瘤者78例,行腺苷负荷MPI,分析腺苷负荷试验的安全性,并检测冠状动脉明显狭窄(≥75%)的敏感度和特异度,比较不同冠状动脉狭窄程度组腺苷负荷MPI阳性率的差异。结果 78例患儿均完成腺苷负荷试验,无严重副作用发生。其中44例负荷试验阴性者未行静息显像,减少了56.4%(44/78)的辐射暴露。腺苷负荷MPI检测冠状动脉明显狭窄的敏感度为66.7%,特异度为60.6%(40/66)。冠状动脉无狭窄组40.3%(21/52)、轻中度狭窄组35.7%、明显狭窄组66.7%的患儿负荷试验阳性,阳性率差异无统计学意义(χ^(2)=3.169,P=0.205)。结论 腺苷负荷试验在儿童中安全可行,负荷优先成像策略可减少辐射暴露,腺苷负荷MPI对评估、监测川崎病患儿心肌缺血具有重要价值。

血管内超声检测对缺血伴非阻塞性冠状动脉疾病患者用药及预后的影响

目的分析血管内超声(IVUS)对缺血伴非阻塞性冠状动脉疾病(INOCA)患者用药及预后的影响。方法选择2019年8月至2021年7月上海市普陀区利群医院心内科收治的INOCA患者160例,根据有无行IVUS检查将患者分为观察组和对照组各80例,观察组按IVUS检查结果再分为重度狭窄亚组(斑块负荷≥30%)和轻度狭窄亚组(斑块负荷<30%)。两组患者均行冠状动脉造影(CAG)检查,随访1年。记录两组患者影像学检查、用药情况和1年内发生主要不良心血管事件(MACE)的情况,计算两组患者用药总分。采用线性回归模型分析有无行IVUS检查对两组患者用药总分的影响。比较两组患者1年内发生MACE的情况,采用Cox回归模型,分析两组患者1年内发生MACE的影响因素。结果观察组IVUS发现CAG无法发现的不稳定斑块38例(47.5%),发现CAG未发现的肌桥5例(6.3%)。两组患者CAG检查的冠状动脉狭窄程度、CAG发现的肌桥占比、明确诊断的肌桥占比比较,差异均无统计学意义(均P>0.05)。观察组血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂、β受体阻滞剂的使用率高于对照组,差异均有统计学意义(均P<0.05)。重度狭窄亚组他汀类药物的使用率高于轻度狭窄亚组,钙通道阻滞剂的使用率低于轻度狭窄亚组,差异均有统计学意义(均P<0.05)。两亚组其他药物的使用率比较,差异均无统计学意义(均P>0.05)。回归分析显示行IVUS检查是两组患者用药总分的影响因素(P<0.05)。随访1年内,观察组发生MACE 3例(3.8%),对照组发生MACE 10例(12.5%),差异有统计学意义(P=0.043)。Cox回归模型显示行IVUS检查和CAG评级是两组患者1年内发生MACE的影响因素(P<0.05)。结论行IVUS检查能够指导INOCA患者用药,改善预后,值得推广。

基于冠状动脉CT血管造影的斑块特征指数对稳定性冠心病患者病变特异性心肌缺血的诊断价值

目的探讨基于冠状动脉CT血管造影(coronary CT angiography,CCTA)构建的斑块特征指数对稳定性冠心病(coronary artery disease,CAD)患者病变特异性心肌缺血的预测价值。方法前瞻性地纳入2020年10月至2022年3月于复旦大学附属中山医院收治的稳定性CAD患者90例,包括狭窄程度在30%~90%的目标血管135支。所有患者2周内均接受了CCTA、侵入性冠脉造影和有创血流储备分数(fractional flow reserve,FFR)测量。根据有无血流动力学显著性狭窄,分为心肌缺血人群(FFR≤0.80,n=30)和非缺血人群(FFR>0.8,n=60),将135支目标血管分为病变特异性心肌缺血组(FFR≤0.8,n=36)和非病变特异性心肌缺血组(FFR>0.8,n=99)。采用单因素和多因素logistic回归分析诊断病变特异性心肌缺血的影响因素,并建立基于CCTA的斑块特征指数的回归模型。采用ROC曲线分析基于CCTA的斑块特征指数对稳定性CAD患者病变特异性心肌缺血的预测效能。结果心肌缺血人群与非缺血人群在年龄、体质量指数、性别、心血管危险因素、药物治疗史方面差异均无统计学意义。与非缺血组相比,心肌缺血组的斑块长度、斑块面积、面积狭窄百分比、动脉粥样硬化斑块总体积、血管体积、脂质斑块体积水平较高,点状钙化、正性重塑、餐巾环征的比例较高,而最小管腔面积较小(均P<0.05)。单因素和多因素logistic回归分析结果显示,最小管腔面积(OR=0.303,95%CI 0.178~0.517,P<0.001)和总动脉粥样硬化体积(OR=1.006,95%CI 1.002~1.010,P=0.003)为稳定性CAD患者病变特异性心肌缺血的独立预测因子。基于CCTA的斑块特征指数预测概率的回归方程为P=1/[1+e-(-1.19441×MLA+0.006058×TAV+0.600912)],其诊断病变特异性心肌缺血的AUC为0.879(95%CI 0.811~0.928),总体诊断准确度、灵敏度、特异度、PPV、NPV分别为80.0%、83.3%、78.8%、58.8%、92.9%。结论在稳定性CAD患者中,基于CCTA的斑块特征指数对病变特异性心肌缺血有较高的预测价值,具有良好的临床应用前景。

冠状动脉CT血管成像配合动态心电图检查对冠心病心肌缺血的诊断价值

目的分析冠状动脉CT血管成像配合动态心电图检查在冠心病心肌缺血中的诊断价值。方法纳入2023年1月至2023年5月我院收治的856例疑似冠心病心肌缺血患者,行冠状动脉CT血管成像及动态心电图检查,以核素心肌灌注显像为金标准,比较冠状动脉CT血管成像配合动态心电图检查在冠心病心肌缺血中的诊断价值。结果核素心肌灌注显像结果显示,856例患者中阳性526例,阴性330例。冠状动脉CT血管成像配合动态心电图的准确度、灵敏度、阳性预测值及阴性预测值均高于冠状动脉CT血管成像、动态心电图单独检查(P<0.05)。结论冠状动脉CT血管成像配合动态心电图检查在冠心病心肌缺血中的诊断效能较高,可为临床治疗提供更准确的依据。