冠状动脉斑块病变血流动力学及无创评估方法的研究现状

冠状动脉CT血管造影(CCTA)已被广泛用于检测或排除显著的冠心病,且CCTA已成为评价冠状动脉解剖结构最主要的无创检查方法;但常规CCTA图像仅提供冠状动脉解剖学的评估,其改善临床预后效果不明显。为了克服常规CCTA的缺点,冠状动脉功能学的CT无创评估技术逐渐成熟,以CCTA图像为基础的冠状动脉血流动力学研究已成为热点。现主要对局部流体力学与冠状动脉粥样硬化的形成及进展的关系进行综述,并对CT心肌灌注及CT无创计算冠状动脉血流储备分数(FFR)进行阐述,为CT功能学无创评估方法对心肌缺血及冠状动脉粥样硬化性心脏病预后检测提供参考依据。     

无创评价冠心病患者冠状动脉病变范围与钙化积分的关系

无创冠状动脉CT血管成像(CCTA)广泛用于临床评价冠状动脉粥样硬化性心脏病(冠心病),在显示冠状动脉管壁情况上是强项,它是检测冠状动脉钙化(CAC)的最敏感工具之一。CAC是冠状动脉粥样硬化发展过程中某阶段的产物〔1〕,研究认为CAC对评价中度危险冠心病有重要意义。本研究采用辐射剂量更低,且具备更宽探测器、更强数据处理能力的320排     

老年人冠状动脉钙化定量测定的临床意义

冠心病是在冠状动脉粥样硬化基础上发展而来的。冠状动脉钙化是冠状动脉粥样硬化的标志。检出冠状动脉钙化就意味着冠状动脉粥样硬化的存在。早期、精确地检测出冠脉钙化是医学影像学责无旁贷的职责。1　冠脉钙化和冠心病的关系及影响因素　　冠心病是由于冠状动脉粥样硬化导致     

冠状动脉钙化特征在心血管风险评估中的价值

冠状动脉钙化（CAC）作为亚临床粥样硬化的标记物，可以反映冠状动脉粥样硬化的总体负荷，是对患者进行心血管风险分层和诊疗的重要工具。临床上评估和量化CAC最常用的是Agatston积分，此外，钙化的分布、密度、体积、形态等特征在风险评估及诊疗方面均具有指导意义。本文将从CAC多个特征的临床意义进行总结，为深刻理解CAC在心血管风险评估中的作用提供思路。     

电子束X线计算机断层摄影扫描机检测冠状动脉钙化的临床进展

冠状动脉钙化是冠状动脉粥样硬化发展至一定阶段的产物，是冠状动脉粥样硬化存在的标志；电于束X线计算机断层摄影扫描机是目前定量检测冠状动脉钙化的最佳无创影像方法，已成为其它无创检测冠状动脉钙化方法的参考标准，所测定的冠状动脉钙化积分与冠状动脉粥样硬化和冠状动脉狭窄之间有着密切关系。临床上应用电于束X线计算机断层摄影扫描机检测冠状动脉钙化作为冠状动脉粥样硬化性心脏病的初步筛选方法。现试就电于束CT检测冠状动脉钙化的临床基础及意义、冠状动脉钙化发生的可能机制作一综述。     

基于冠状动脉CT特征的机器学习技术评价冠状动脉粥样硬化斑块风险

冠状动脉CT血管造影(CCTA)作为冠心病的一线诊断工具,不但可以评估冠状动脉管腔狭窄的程度,也可以进一步分析斑块组成、形态和易损性,而基于CCTA图像的冠周脂肪CT定量检测则可以反映冠状动脉炎症情况,用于综合评估心血管事件远期风险。在此基础上,随着人工智能和影像组学技术的发展,冠心病患者个体化危险分层和治疗决策的制定越来越多地应用到了机器学习技术,该技术可以深度挖掘组织影像标志物,整合临床、生物学和CCTA影像学信息,构建精准无创预测模型,为进一步精确评估心血管风险提供强有力的支持。本文详细综述了CCTA检查在检测定量斑块易损性及冠状动脉炎症中的作用,并简要总结了基于影像组学的机器学习算法模型评估冠状动脉粥样硬化斑块风险的最新研究进展。     

冠状动脉钙化临床研究与诊断

冠状动脉钙化是判断冠状动脉粥样硬化的可靠指标,所以对冠状动脉钙化的研究是对亚临床动脉粥样硬化的干预与研究的重要内容,本文对冠状动脉钙化与血管狭窄、斑块稳定性与心血管事件关系及其诊断和治疗进展等方面进行综述。     

多排螺旋CT对冠状动脉钙化的检测

冠状动脉钙化是冠状动脉粥样硬化病变标志之一,反映了粥样硬化斑块,特别是钙化斑块的存在和分布。在过去10余年里,大量电子束CT研究围绕冠状动脉钙化的临床价值、检测方法和可重复性以及冠状动脉钙化演变等热点课题而展开。随着多排螺旋CT的不断发展和普及,它在冠状动脉钙化检测方面的价值也在进行研究,该文就多排螺旋CT在这些方面研究现状作一综述。     

冠状动脉钙化临床研究与诊断

冠状动脉钙化是判断冠状动脉粥样硬化的可靠指标,所以对冠状动脉钙化的研究是对亚临床动脉粥样硬化的干预与研究的重要内容,本文对冠状动脉钙化与血管狭窄、斑块稳定性与心血管事件关系及其诊断和治疗进展等方面进行综述.     

冠状动脉CT血管造影综合评估易损斑块的进展

急性冠状动脉综合征（ACS）是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。与稳定斑块相比,容易破裂的斑块具有明显的影像学特征：大斑块体积,低衰减斑块,餐巾指环标志,正性重构和点状钙化,这为在导致临床事件之前运用非侵入性成像识别易损斑块提供了独特的机会。随着影像技术的发展,冠状动脉CT 血管造影（CCTA）无创性评价冠状动脉易损斑块的作用已成为国内外研究热点。笔者就CCTA在评估冠状动脉斑块易损性方面的临床应用现状与进展等方面作一综述。     

冠状动脉CT血管成像对冠心病预后预测价值及治疗策略的指导意义

冠状动脉CT血管成像是筛查和诊断冠状动脉粥样硬化性心脏病的无创检查手段,但指南对于冠状动脉CT血管成像结果用于临床决策方面并无明确推荐,治疗方案的选择仍多根据临床经验决定.现从冠状动脉狭窄程度、冠状动脉钙化积分和斑块类型等的预后价值及治疗策略进行综述.     

冠状动脉计算机体层成像血管造影在冠状动脉疾病的临床应用

冠状动脉计算机体层成像血管造影是诊断冠状动脉疾病的一个优秀无创评价测试工具。虽然冠状动脉造影是冠状动脉粥样硬化性心脏病的金标准,但有充分的证据来支持冠状动脉计算机体层成像血管造影的性价比,而且它的临床应用范围广。本次综述的目的是对冠状动脉计算机体层成像血管造影在冠状动脉疾病临床应用中的诊断准确性和预测价值的概述;对冠状动脉计算机体层成像血管造影的新兴领域,包括双源计算机体层成像、多排螺旋计算机体层成像进行讨论,以及冠状动脉计算机体层成像血管造影的局限性和突出展示其未来的发展方向。     

Identifying and redefining stenosis by CT angiography

Coronary computed tomographic angiography (CCTA) has emerged as a novel noninvasive method for the evaluation of not only coronary artery stenosis but also arterial wall and plaque features. Recent developments in CCTA technology enable the simultaneous assessment of coronary stenosis, atherosclerotic plaque characteristics, physiologic significance of lesion-specific ischemia, and cardiac function. Through these studies, the prognostic significance of individual coronary lesions and ventricular function can be determined and used to direct therapy. Future studies are needed to establish the totality of coronary artery plaque measures that improve clinical utility.     

Recent Improvement in Coronary Computed Tomography Angiography Diagnostic Accuracy

Although invasive coronary angiography has been the gold standard for evaluating coronary artery disease (CAD), it should not be routinely performed as an initial test to assess CAD in subjects with suspected CAD by the recent guidelines, due to cost, invasiveness, and measurable risk. Coronary computed tomography angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of CAD becomes of great promise with high diagnostic accuracy. Although artifact issues have created some challenges for CCTA, recent advances—including the introduction of more detectors, leading to broader coverage, and faster and higher‐definition scanners—allow improved precision and fewer uninterpretable studies. This review article summarizes the current key literature regarding the diagnostic accuracy of CCTA in native coronary arteries, stents, coronary artery bypass grafts, lesions with high calcification, and the functional assessment of CAD.     

冠状动脉钙化的研究进展

冠状动脉钙化是冠状动脉粥样硬化患者不良预后的危险因素。多种因素与冠状动脉钙化的发生和发展相关,包括性别、年龄、持续的炎症状态、高血压、高脂血症和糖尿病等,近年来人们越来越关注非传统高危因素,以期为冠状动脉钙化的一级预防开辟新的思路。不断发展的影像学技术也为冠状动脉钙化的早期发现和发生机制的研究提供了很好的帮助。文章将重点回顾冠状动脉钙化的高危因素、发生机制、检查手段、临床意义及其治疗的研究进展,旨在提高人们对冠状动脉钙化的进一步认识和重视水平。     

Coronary calcification by electron beam tomography: comparison with coronary risk factors and angiography

The development and progression of coronary artery disease is the result of exposure to a variety of different risk factors. In larger populations, strong associations exist between risk factors and the development of both angiographic and clinical coronary artery disease. But, this relationship is extremely variable in individual subjects. Coronary calcification is a specific marker of coronary artery disease. Its formation and progression is determined by largely identical risk factors compared with angiographic coronary artery disease. Coronary calcification quantitated by electron beam tomography (EBT) thus enables the non-invasive assessment of whether the risk factor exposure has actually led to the development of coronary atherosclerosis in an individual subject. Whereas other non-invasive tests focus on the physiological consequences of coronary obstruction, EBT represents anatomic disease itself. Because the propensity of plaques to cause coronary obstruction partly depends on the degree of arterial remodelling, large plaques may not necessarily appear as high-grade stenoses angiographically. Indeed, angiography and EBT evaluate two facets of atherosclerotic plaque disease, i.e. luminal obstruction and calcified plaque itself. Coronary calcification is strongly associated with the presence, extent, and severity of angiographic coronary artery disease. A number of studies have shown that it is clearly superior in this respect compared with conventional risk factors. However, because of the indirect relationships between plaque formation and luminal obstruction, EBT does not permit the site-specific prediction of coronary stenoses. Recent investigations have focused on the ability of EBT to represent the extent of anatomic coronary artery disease, which is an important predictor of future cardiac events. The availability of a simple, non-invasive test for the direct visualization of coronary artery disease holds great promise regarding improved definitions of the relationships between risk factors and coronary atherosclerosis as well as regarding the diagnosis of non-obstructive coronary disease, which can nevertheless result in acute events.     

冠状动脉钙化研究进展

冠状动脉钙化越来越受到重视,发现钙化即意味着亚临床动脉粥样硬化的存在,而动脉硬化不一定都有钙化。通常钙化越严重,冠脉管腔狭窄程度也就越高。但有时二者却缺乏很好的相关性。现就冠脉钙化的发生机制,冠脉钙化及积分与冠心病及其严重程度的关系,冠脉钙化检测方法及积分,血管重构在严重的冠脉钙化却没有明显的管腔狭窄中的作用等方面做一综述。     

他汀类药物与冠状动脉钙化关系的研究进展

冠状动脉钙化在冠状动脉粥样硬化、糖尿病血管病变和慢性肾脏病等多种疾病中普遍存在,他汀类药物是冠状动脉粥样硬化性心脏病等血脂代谢紊乱患者的常用药物。既往研究显示,他汀类药物可能具有抑制冠状动脉钙化的作用,而新近研究则提出相反意见。鉴于目前他汀类药物与冠状动脉钙化关系存在一定争议,故本文就冠状动脉钙化发生机制,他汀类药物与冠状动脉钙化关系及两者关系矛盾性结论成因作一分析。