四维应变技术评价冠心病患者PCI术前后左室舒张功能的研究

目的 应用四维应变成像 (4D-SI) 技术评价冠心病患者PCI术前后左室舒张功能。方法 根据疑似冠心病患者行冠脉造影术及左心导管检查结果,选取44例患者分为病例组：冠心病并左室舒张功能不全患者(需行PCI术)26例；对照组：冠心病并左室舒张功能正常18例。分别采集对照组及病例组PCI术前、术后3个月的常规超声心动图检测指标,测量左室舒张末期容积 (LVEDV) 、左室收缩末期容积 (LVESV) 、左室射血分数 (LVEF) ；运用 4D-SI 技术测得收缩末期纵向应变(GLS)、径向应变(GRS)、面积应变(GAS)、圆周应变(GCS)、纵向应变显像舒张指数(LSI-DI)、面积SI-DI (ASI-DI)、 径向SI-DI(RSI-DI)、圆周SI-DI(CSI-DI)。 结果 1.病例组GLS、GCS、GAS、GRS、LSI-DI、CSI-DI、ASI-DI、RSI-DI均小于对照组(P＜0.05)；病例组术后3月各参数均大于病例组术前(P＜0.05)；2. ROC 曲线分析结果显示LSI-DI的曲线下面积(AUC)0.921,截值为50.107%,灵敏度和特异性分别为89.2%、81.3%；ASI-DI的AUC 0.887,截值为49.233%,灵敏度和特异性分别为86.4%、79.1%。 结论 PCI术可有效改善冠心病患者左心室舒张功能,4D-SI的相关指标在一定程度上可评价冠心病患者左室舒张功能受损及PCI术后左室舒张功能的改善情况。     

Evaluation of left atrial function in patients with coronary artery disease by two-dimensional strain and strain rate imaging

Background: Left ventricular (LV) dysfunction in patients with coronary artery disease is shown by strain and strain rate imaging. However, left atrium (LA) function in patients with coronary artery disease (CAD) has not been assessed by this method. Methods and Results: In 34 CAD patients, including 17 patients with enlarged LA (LA diameter ≤ 4.0 cm) and 17 with normal‐size LA (LA diameter ≤ 4.0 cm), two‐dimensional strain echocardiographic imaging (2DSE) was performed. Twenty healthy subjects as a control group were included. Both conventional parameters and strain parameters, such as LA peak systolic strain (LAs S/SR), preatrial contraction strain (LAa S), peak systolic (LAs SR), early diastolic strain rate (LAe SR) and late diastolic strain rate (LAa SR), were measured. Conventional parameters were abnormal in CAD patients with enlarged LA (ELA), but there were no significant differences between CAD with normal‐size left atrium (NLA) and control groups. LAs S/SR and LAe SR were lower in patients than in normal controls, and were even lower in CAD‐ELA group (P < 0.05). LAa S/SR were lower in CAD patients with ELA (P < 0.05), but without a significant difference between CAD‐NLA and control groups. A significant correlation was observed between LAs S/SR and LA emptying fraction (r = 0.85, P < 0.05; r = 0.72, P < 0.05, respectively). LAa S/SR related well to LA ejection fraction (r = 0.68, P < 0.05; r = 0.61, P < 0.05, respectively). LAs SR was most accurate in identifying both CAD patients with NLA from controls and CAD patients from controls (area under the curve: 0.91; 0.95, respectively). Conclusions: LA diastolic dysfunction occurs prior to LA systolic dysfunction in CAD patients, and LAs SR is the most accurate index in identifying patients with CAD. (Echocardiography 2011;28:1095‐1103)     

Non-Doppler Two Dimensional Strain Imaging for Evaluation of Coronary Artery Disease

Over the recent years, strain echocardiography has emerged as a quantitative technique for the evaluation of global and segmental cardiac function. Strain is a measure of deformation, expressed as a percent change in a segment's length compared to its predeformation length. Strain rate (SR) is the local rate of deformation or strain per unit time. Recently non-Doppler two dimensional strain imaging has been developed. This technique is based on tracking ultrasonic speckles from the two dimensional echocardiographic images. These speckles are followed over a number of successive frames, and myocardial velocity is calculated by measuring frame-to-frame changes. This technique is independent of the Doppler angle of incidence and allows measurement of several vectors of strain within myocardial tissue. Non-Doppler strain is a powerful tool, enabling detection of subtle abnormalities in myocardial function. Current evidence shows that non-Doppler strain imaging may allow identification of the early changes that occur with ischemic insult to the myocardium. It may also provide a tool for identification of scarred, non-viable myocardium, with similar accuracy to that of cardiac MRI. Non-Doppler strain imaging is likely to become a standard tool in the evaluation of patients with ischemic heart disease.     

Fatty liver disease is associated with underlying cardiovascular disease in HIV-infected persons(*)

Background

Cardiovascular disease is an increasing concern among HIV‐infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV‐infected persons.

Methods

We performed a cross‐sectional study in HIV‐infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined as a liver‐to‐spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression models.

Results

We included in the study 223 HIV‐infected adults with a median age of 43 years [interquartile range (IQR) 36–50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy‐five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1–100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01).

Conclusions

Coronary atherosclerosis as detected using CAC is prevalent among young HIV‐infected persons. The detection of fatty liver disease among HIV‐infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction.     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

肺心病合并冠心病心电图分析

目的探讨肺心病合并冠心病心电图的特点。方法回顾我院住院病例选择肺心病和肺心病合并冠心病各120例均行同步十二导联心电图检查,必要时进行24 h动态心电图检查对比心电图的变化。结果肺心病合并冠心病组(合并组)比肺心病组心电图改变明显,两者有显著差异结论心电图及动态心电图的某些特殊改变能提示肺心病合并冠心病。     

Giant left main coronary artery aneurysm in association with severe atherosclerotic coronary disease

Aneurysms of the coronary arteries occur in 1.5–4.9% of coronary angiograms. Only a few cases of a giant aneurysm of the left main coronary artery in conjunction with severe atherosclerotic coronary disease have been reported. This report details the exceptional case of a 72-year-old patient with a giant “true saccular” aneurysm branched on the left main coronary artery. The development of an aneurysmal dilatation in conjunction with progression of coronary arteriosclerosis, observed from two different angiographic studies at an interval of 25 years, is very illustrative for evolutive atherosclerotic heart disease. This finding may support the hypothesis that atherosclerosis may be the common etiology for coronary aneurysmal dilatation. Cathet. Cardiovasc. Diagn. 42:54–57, 1997. © 1997 Wiley-Liss, Inc.     

The effect of type 2 diabetes mellitus on multiple obstructive coronary artery disease

Background

Although type 2 diabetes mellitus (T2DM) individuals easily develop three-vessel disease (3VD) coronary artery disease (CAD), there is very little information available about their left ventricle (LV) functions. The purpose of this study is to evaluate the LV function using two-dimensional speckle tracking echocardiography (2-D STE) in T2DM patients with 3VD.

Methods

One hundred and three consecutive patients with confirmed 3VD CAD were enrolled and divided into two groups, while 53 patients with DM and 50 patients without. The control group was composed of 30 age- and sex-matched healthy individuals. All patients underwent 2-D STE and standard echocardiograms. The durations of DM and the level of HbA1c were also recorded.

Result

Between the 3VD-DM and 3VD-non-DM groups, normal echocardiography did not reveal any appreciable differences. However, patients with 3VD-DM had significantly lower global longitudinal strain (GLS) than those with 3VD-non-DM (15.87 ± 2.51 vs.17.56 ± 2.72, p < .05) by 2-D STE strain measurement. Besides, patients whose duration of DM excess 5 years showed significant lower GLS than those with less than 5 years duration (14.25 ± 2.31 vs. 16.65 ± 1.96, p = .007). However, there was no difference in GLS between the 3VD-DM patients with HbA1c ≥ 7% and HbA1c < 7%.

Conclusions

Compared to patients with 3VD alone, those with 3VD-DM have a lower cardiac function. In 3VD-DM patients, the duration of DM is a significant factor that contributes to cardiac function deterioration, whereas, the glucose control state has limited influence.     

冠状动脉硬化性心脏病和老年性痴呆

弄清冠状动脉硬化性心脏病是否与老年性痴呆有关联,有助于老年性痴呆的防治。我们从共同的危险因素载脂蛋白E4基因型以及二者的临床、病理的相关性方面,综述了冠状动脉硬化性心脏病与老年性痴呆的关系。其机制有待进一步研究。     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

冠心病患者血清可溶性E-选择素检测的意义

目的　探讨血清可溶性E 选择素在监测冠心病病情及与冠状动脉病变程度的关系。方法　 81例冠心病患者 ,按临床诊断分为 4组 :急性心肌梗死 (AMI) 17例、不稳定性心绞痛 (UAP) 2 4例、稳定性心绞痛 (SAP) 2 0例和对照组患者 2 0例。检测各组患者血清可溶性E 选择素的水平 ,并比较各组间的差异。对冠心病患者的冠状动脉损害行Gensini评分 ,并与其血清可溶性E 选择素水平进行直线相关分析。结果　 (1)AMI组、UAP组及SAP组的血清可溶性E 选择素水平比对照组高 ;(2 )AMI组、UAP组可溶性E 选择素水平和SAP组相比 ,其值增加明显 ;AMI组和UAP组结果相似 ;(3)急性冠脉综合征 (AMI组 +UAP组 )血清可溶性E 选择素水平与冠状动脉Gensini评分呈正相关。结论　血清可溶性 E选择素可能是冠状动脉粥样硬化的标志 ,参与了冠心病的发病过程 ,在急性冠脉综合征中 ,其值与冠状动脉病变程度密切相关。     

冠状动脉病变早期临床诊断的多因素分析

目的 :评估各种方法对冠心病早期诊断的价值 ,探索早期冠心病的独立预报因子。方法 :收集 46例经冠状动脉造影确定的冠心病患者症状、静息心电图和常规临床检查等相关信息进行统计学分析。结果 :冠状动脉造影 2 1例正常 （正常组 ） ,2 5例出现冠状动脉狭窄 （冠心病组 ） ,平均狭窄程度为 （46± 15 ） %。比较两组的一般情况、临床症状、甘油三酯、胆固醇、低密度脂蛋白、负荷心电图、放射线及心脏超声等项目 ,各项指标无显著差异 ,L ogistic回归显示这些因素对冠心病的早期诊断无预测意义。结论 :冠心病患者的早期病变以临床常规各项方法难以准确检测和预报 ,冠状动脉造影是确诊冠心病者早期病变的最佳方法。     

冠状动脉造影检查在冠心病诊断中作用的再探讨

目的探讨冠状动脉造影（CAG）检查在诊断冠心病中作用,就其对多年来被认为是金标准作用进行再探讨。方法对138例怀疑有冠心病的患者,均经普通ECG,动态ECG,活动平板和CAG。结果只有71例患者的冠状动脉造影检查符合目前冠心病标准,其余67例患者冠状动脉未达标（轻度-中度狭窄,或完全正常或仅见散在斑块形成）。结论冠心病的诊断是一个较为复杂的问题,CAG检查是诊断冠心病的一个重要依据,有相当比例的冠心病患者（CAG）无明显异常。     

冠心病患者血浆内皮素水平

采用放免技术,测定了28例次冠心病患者冠状窦血及外周静脉血内皮素水平,结果显示,冠状静脉窦血ET为132.82±23.14pg/ml,外周静脉血ET为104.25±21.08pg/ml,冠状窦血ET高于外周静脉血,P<0.001,但两者相关性良好,r=0.808,P<0.001.研究发现,不同类型冠心病外周血ET高低次序为急性心梗、不稳定型心绞痛、稳定型心绞痛、正常人.冠心病患者冠脉循环ET水平高于外周静脉血,但两者相关性良好,ET随冠心病患者病情程度加重及冠脉病变范围增大而升高.