血管内超声显像在冠心病中的应用

近年来，血管内超声显像发展迅速。本文介绍了所需的设备及其在正常冠脉显像，冠心病诊断和介入性治疗中的应用。     

血管内超声在冠心病的临床应用

20世纪90年代起,血管内超声成像(intravascu-lar ultrasound,IVUS)已成为冠心病诊断和介入的弥补影像学。IVUS可显示血管壁及粥样斑块的组织形态学特征,发现冠状动脉(冠脉)造影不能显示的血管病变,观察分叉处或血管重叠处的模糊病变。用于指导和评价冠脉介入治疗及效果,探讨介入治疗机制与预后的关系。     

血管内超声的新技术进展

血管内超声在冠心病诊断与治疗中发挥着非常重要的作用。近年来,出现许多血管内超声新技术,极大的丰富了其应用,现着重描述血管内超声的新技术进展。     

血管内超声在冠心病诊断与治疗中的应用进展

血管内超声(IVUS)是近年来发展起来的一项新影像学技术,在冠心病的诊断与治疗中有重要的临床应用价值.其用于评价冠状动脉病变较冠脉造影(CAG)准确,对冠心病的诊断和治疗决策有着很好的指导作用.本文就目前研究,综述IVUS在冠心病诊断与治疗中的应用进展.     

冠心病的中医辨证分型与同型半胱氨酸的相关性研究

目的观察不同证型冠心病病人的同型半胱氨酸(Hcy)水平,以期为冠心病辨证论治提供客观指标。方法选取在我院住院确诊为冠心病病人68例,根据血瘀症和痰浊症诊断标准分为血瘀组33例,痰浊组35例,并选择健康体检者34名作为正常对照组。结果冠心病组Hcy水平为(27.550±17.224)mmol/L,高于对照组(9.753±4.342)mmol/L(P<0.01);冠心病血瘀证组Hcy水平为(27.775±13.157)mmol/L,高于痰浊组(21.553±12.320)mmol/L(P<0.05)。结论Hcy水平升高程度可为冠心病的分型提供参考依据。     

血管内超声显像在冠心病诊断中的应用进展

冠状动脉造影只能显示血管腔的轮廓，而血管内超声不仅能反映管腔形态、又能显示粥样斑块的性质和血管重构，本文就其在冠心病诊断中的应用特点及其局限性作一综述。     

血管内超声比较急性冠状动脉综合征患者与稳定型心绞痛患者滋养血管的特点

目的探讨急性冠状动脉综合征(ACS)患者与稳定型心绞痛(SAP)患者病变血管中滋养血管的特点。方法选取2018年1-12月在湘潭市中心医院心内科住院行虚拟组织学-血管内超声(VHIVUS)分析的70例患者进行回顾性研究,其中30例为ACS患者,40例为SAP患者。比较两组患者的基线资料、斑块VH-IVUS特点及滋养血管特点。结果ACS组与SAP组滋养血管在最小管腔截面的出现率比较(96.7%比92.5%,P=0.852),差异无统计学意义;ACS组滋养血管在近端参考截面(90.0%比77.5%,P=0.018)、远端参考截面(90.0%比62.5%,P<0.001)的出现率均显著高于SAP组,差异均有统计学意义;ACS组患者最小管腔截面[(2.9±1.2)条比(1.7±1.1)条,P<0.001]、近端参考截面[(1.8±1.2)条比(1.2±1.0)条,P=0.003]及远端参考截面[(1.6±1.1)条比(1.0±0.9)条,P=0.002]滋养血管的平均数量均显著高于SAP组,差异均有统计学意义。结论ACS患者斑块滋养血管的数量较SAP患者多,提示斑块内滋养血管的数量与其易损性相关。通过IVUS分析滋养血管特点是评估斑块易损性的另一种可行方法。     

冠状动脉造影和血管内超声诊断冠心病的对比研究

对38例冠心病患者行冠状动脉造影(CAG)及血管内超声(IVUS)检查.结果经CAC检查未发现冠脉有明显狭窄病变8例,而IVUS检查均发现不同程度斑块形成;CAG、IVUS的平均直径狭窄率分别为71.21%±9.81%、74.77%±8.58%,P＜0.01;CAG、IVUS的平均面积狭窄率74.36%±10.75%、80.88%±7.77%,P＜0.01.提示CAC可能低估冠脉病变狭窄程度,IVUS可作为有益补充,协助早期诊断.     

血管内超声显像在冠心病诊治中的应用

血管内超声显像 (IVUS)在过去的 10余年中逐步发展起来。 IVU S利用高频超声显像 ,不仅能显示冠脉管腔 ,而且还能显示血管壁的结构 ,包括动脉粥样硬化斑块。超声导管直径约 1mm ,频率 30～ 4 0 MHz,以每秒 30帧的显像速度实时二维横断面显像。用现代技术手段 ,超声导管的轴向分辨率可达到5 0～ 80μm。1　适应证与禁忌证IVU S检查是随心导管检查术进行的。因此 ,它的适应证和禁忌证也与心导管术一致。当血管造影提供的信息不足以解释临床症状和指导治疗时 ,往往需要 IVUS来补充。这些新技术可以帮助明确诊断 ,指导治疗手段的选择及…     

血管内超声检查的临床应用和研究进展

血管内超声（Intravascular ultrasound,IVUS）通过导管技术将微型化的超声探头置入血管腔内进行显像,可提供血管的横截面图象,不仅可以了解管腔的形态,还能直接显示管壁的结构,了解管壁病变的性质,     

增龄性冠状动脉斑块钙化特征分析在男性冠心病防治中的应用价值

目的利用血管内超声(IUVS)评价增龄性冠状动脉钙化斑块的形态学特征并分析其在冠心病防治中的应用价值。方法选取行冠状动脉造影(CAG)及IVUS检查的青年组、中年组、老年组三组不同年龄段男性冠心病患者103例,在介入治疗前对钙化病变血管进行IVUS检查,获取血管外弹力膜面积、斑块狭窄面积、管腔钙化斑块狭窄率,测量病变钙化弧度、钙化长度比与钙化指数,并进行年龄因素相关分析。结果①随着年龄的增长,各组靶血管病变的血管外弹力膜面积和斑块面积均有逐步减少与升高的变化趋势,差异有统计学意义(P<0.05)。②钙化弧度、重度钙化率、钙化长度比随着年龄增长而呈现显著增加趋势,在老年组变化程度最明显(P<0.05)。③相关性分析发现钙化相关指标与增龄后的管腔斑块狭窄等指标有显著正相关(P<0.05)。结论随着年龄的增长,斑块钙化的程度逐渐加重,且呈现向心性演变趋势。在IVUS辅助下进行钙化特征相关指标的测定对指导男性冠心病患者复杂钙化病变的介入治疗有重要意义。     

Prevention of coronary heart disease in south Asia

The great increase in rates of cardiovascular disease in developing countries will probably have grave implications for south Asia, which houses nearly a quarter of the world's population. Several factors might contribute to this effect, such as increased susceptibility of south Asian people to cardiovascular disease, unrecognised targets for preventive interventions, and restricted access to high-cost tertiary cardiovascular care for economically disadvantaged communities. Furthermore, prevention and control of cardiovascular disease does not feature prominently in the health care agendas of south Asian countries. To address these issues, therefore, a multifaceted approach is needed, which should include epidemiological studies to fill in the gaps in knowledge. Additionally, political, social, cultural, and economic issues need to be considered in prevention and control of these diseases, to identify and address key limitations and opportunities specific to the region. A set of recommendations outlining the approach is crucial.     

Impact of intravascular ultrasound in understanding transplant coronary artery disease

Intravascular ultrasound imaging has been recognized as a sensitive tool to study early transplant vasculopathy lesions. An early examination performed soon after transplantation allows one to study donor atherosclerosis. Further, serial follow-up imaging with meticulous site matching provides important information regarding the progression of donor atherosclerosis and the development of transplant vasculopathy lesions. This review highlights the contribution of intravascular imaging in understanding the transplant coronary artery disease. This review also outlines various methodologies employed by different investigators, and stresses the strengths and weaknesses of these methodologies for correct interpretation as well as comparison of data from different studies.     

双源CT与冠脉血管内超声对照评价冠脉斑块

目的比较血管内超声(intravascular ultrasound,IVUS)与双源CT(dual-source computedtomography,DSCT)对冠状动脉粥样硬化斑块定性、定量分析的准确性。方法入选21例冠心病患者,以美国心脏协会冠状动脉13分段法,每个节段均判断斑块的有无及斑块性质,血管狭窄程度,测量定量指标。以IVUS为标准评估DSCT对冠状动脉粥样硬化病变诊断的价值。结果与IVUS相比,21例患者的28支血管,DSCT对所有部位狭窄程度50%、50%～75%、75%的病变的检测的敏感性分别为79.2%(38/48)、89.5%(34/38)、100%(16/16)。以节段中斑块为基础,DSCT对病变节段中所有斑块检测的敏感性、特异性、阳性预测值、阴性预测值分别为96.0%(48/50)、86.5%(45/52)、87.3%(48/55)、95.7%(45/47)。DSCT检测非钙化斑块、钙化斑块的敏感性分别为91.9%(34/37)、92.3%(12/13),特异性分别为92.3%(12/13)、97.1%(34/35)。结论 DSCT可以准确诊断冠状动脉近中段中重度狭窄病变,具有较高的敏感性和阴性预测值;DSCT定量测量与IVUS结果相关性好,且可依据CT值的不同判断斑块的性质;DSCT区分非钙化斑块及在斑块的准确测量方面的可靠性有一定限制。     

Randomized evaluation of atorvastatin in patients with coronary heart disease: a serial intravascular ultrasound study.

BACKGROUND: It is unclear whether a marked reduction of low-density lipoprotein-cholesterol (LDL-C) in patients with coronary heart disease (CHD) and mild hypercholesterolemia leads to less progression of atherosclerosis. METHODS AND RESULTS: Patients with CHD and hypercholesterolemia (100相似文献   

Procedural implications of intravascular ultrasound morphologic features of chronic total coronary occlusions

Although the success rates of percutaneous coronary intervention of chronic total occlusions (CTOs) have improved, morphologic features are not well known. We analyzed experience at 4 centers where intravascular ultrasound (IVUS) was performed in 67 native artery CTO lesions (mean CTO duration 6.3 months) just after the lesion was crossed with a guidewire (n = 7) or after dilatation with a 1.5-mm (n = 46) or 2.0-mm (n = 14) balloon. IVUS detected calcium somewhere in the CTO in 96%; however, only 68% had mild calcium. IVUS identified a proximal end of the CTO in all lesions, but a distal end of the CTO in only 50%. An intramural hematoma was observed in 34% of CTOs, suggesting that the guidewire frequently entered the medial space during successful recanalization. CTOs were longer, vessel area was smaller, and total calcium index was greater in lesions with hematomas (p = 0.003, 0.05, and 0.03, respectively). Inadequate reflow after the procedure was observed in 9% and was associated with longer lesions and intralesional calcium. CTO length as measured with angiography was shorter than the length as measured with IVUS (p = 0.02). Calcium was detected on the angiogram in 61% (p = 0.054 vs IVUS). Most typical angiographic findings associated with a low rate of procedural success were not associated with different IVUS morphologies. In conclusion, CTO lesions had multiple small calcium deposits, intramural hematomas were common and were indicative of guidewire penetration into the medial space during the CTO procedure, especially in long calcified lesions in smaller vessels, and inadequate reflow after the procedure was correlated with more complex CTO morphology.     

Reproducibility of serial intravascular ultrasound measurements in patients with angiographically silent coronary artery disease after heart transplantation

BACKGROUND: Intracoronary ultrasound (ICUS) imaging is the most sensitive method for the early detection and serial evaluation of vasculopathy of transplants. Both lack of agreement between observers and lack of agreement between serial, independent pullback procedures (repeatability), which can result in a variable intraluminal catheter position may limit the reproducibility of ICUS measurements. OBJECTIVE: To evaluate the reproducibility of serial measurements of standard linear and area cross-sectional coronary dimensions in patients with non-obstructive transplant vasculopathy. METHODS: We performed ICUS imaging of patients without angiographic evidence of obstructive epicardial coronary artery disease after heart transplantation. A 30 MHz phased-array transducer was used. Two independent pullbacks of the left anterior descending coronary artery were performed and recorded on CD-ROM for off-line quantitative analysis of the most severely diseased site. Agreement of observers and repeatability of serial measurements were calculated by the use of linear regression analysis and Bland-Altman plots. RESULTS: Regarding agreement of observers, correlation coefficients for intra-observer agreement ranged from r = 0.98 to r = 0.99; those for interobserver agreement ranged from r = 0.87 to r = 0.98. Serial measurements of the identical coronary artery cross-section within independent catheter pullback procedures were possible for 104 of 112 target lesions (92.90/%). Correlation coefficients ranged from r = 0.91 to r = 0.97 (for lumen diameter r = 0.91, for lumen area r = 0.93, for vessel diameter r = 0.91, for vessel area r = 0.97, for thickness of plaque r = 0.96 and for area of plaque 0.94). The mean difference of measurements was around zero for all parameters with SD from 0.13 to 0.4 mm for linear parameters and from 1.53 to 1.82 mm2 for area parameters. CONCLUSION: Serial intravascular ultrasound measurements are highly reproducible without any evidence of systematic error and a SD of differences of measurements beyond the maximal spatial resolution of currently available intravascular ultrasound catheters.     

Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound

OBJECTIVES: This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS). BACKGROUND: Acute coronary syndromes result from spontaneous plaque rupture and thrombosis. METHODS: We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed. RESULTS: Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%. CONCLUSIONS: Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.