A cross-sectional study on coronary artery disease diagnosis in patients with peripheral artery disease

PurposeCompared with healthy individuals, patients with peripheral artery disease (PAD) generally have a very high risk of subclinical Coronary artery disease (CAD) and cardiovascular events. To determine the correlation between CAD in PAD patients, thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD.MethodsThis clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016. In this research, PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination. In addition, this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test.ResultsWith the statistical results, the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography. Further, 30.93% of asymptomatic CAD prevalence was observed in PAD patients. The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD, particularly in patients with diabetes and dyslipidemia.ConclusionThere exists a strong correlation between PAD and CAD. Hence, precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.     

中性粒细胞/淋巴细胞比值与冠状动脉造影后造影剂肾病的相关性分析

【目的】探讨中性粒细胞/淋巴细胞比值(NLR)与冠状动脉造影(CAG)后造影剂肾病(CIN)的相关性。【方法】以本院心内科收治的行CAG检查的患者125例为研究对象。根据是否发生CIN,将125例患者分为CIN组和非CIN组。比较两组的基线资料,采用多因素logistic逐步回归分析筛选CIN的独立危险因素,采用受试者工作曲线(ROC)分析NLR比值预测CIN的价值。【结果】125例患者发生CIN共23例,发生率为18.4%。与非CIN组比较,CIN组患者年龄大,糖尿病比例高,尿素氮、血肌酐、尿β2微球蛋白、C反应蛋白以及NLR比值均明显升高(P<0.05),肾小球滤过率(GFR)明显降低(P<0.05),造影剂用量明显增加(P<0.05)。多因素logistic逐步回归分析显示:高龄、糖尿病、基础肾功能不全、血肌酐、C反应蛋白、NLR比值、造影剂用量是发生C1N的独立危险因素(P<0.05)。当cutoff取6.5,NLR预测CIN的曲线下面积为0.865,灵敏度为85.9%,特异度为83.4%。【结论】NLR比值≥6.5时是发生CIN的独立危险因素,对于预测CIN有较高的价值。     

Updated Trends,Disparities, and Clinical Impact of Neuroimaging Utilization in Ischemic Stroke in the Medicare Population: 2012 to 2019

ObjectiveThe purpose of this study was to update trends, investigate sociodemographic disparities, and evaluate the impact on mortality of stroke neuroimaging across the United States from 2012 to 2019.MethodsRetrospective cohort study using CMS Medicare 5% Research Identifiable Files, representing consecutive ischemic stroke emergency department or hospitalized patients aged ≥65 years. A total of 85,547 stroke episodes with demographic and clinical information were analyzed using Cochran-Mantel-Haenszel tests and logistic regression. Outcome measures were neuroimaging (CT angiography [CTA], CT perfusion [CTP], MRI, MR angiography [MRA]) utilization, acute treatment (endovascular thrombectomy [EVT] and intravenous thrombolysis [IVT]), and mortality while in the hospital and at 30 days and 1 year post discharge.ResultsSignificantly increasing utilization trends for CTA (250%), CTP (428%) and MRI (18%), and a decreasing trend for MRA (?33%) were observed from 2012 to 2019 (P < .0001). Controlling for covariates in the logistic regression models, CTA and CTP were significantly associated with higher EVT and IVT utilization. Although CTA, MRI, and MRA were associated with lower mortality, CTP was associated with higher mortality post discharge. Less neuroimaging was performed in rural patients; older patients (≥80 years) had lower utilization of CTA, MRI, and MRA; female patients had lower rates of CTA; and Black patients had lower utilization of CTA and CTP.ConclusionsCTA and CTP utilization increased in the Medicare ischemic stroke population from 2012 to 2019 and both were associated with greater EVT and IVT use. However, disparities exist in neuroimaging utilization across all demographic groups, and further understanding of the root causes of these disparities will be crucial to achieving equity in stroke care.     

Contrast circulation in adult fontan patients using MR Time Resolved Angiography: Application for CT pulmonary angiography

BackgroundWhen patients with Fontan circulation require a computed tomographic pulmonary angiogram (CTPA), there are significant challenges in achieving adequate contrast opacification due to the altered anatomical connections. This study used Time Resolved Angiography with Interleaved Stochastic Trajectories (TWIST) Magnetic Resonance Angiography (MRA) to examine contrast circulation in a cohort of patients with Fontan circulation who were having routine MRI follow up to inform the contrast timing of any subsequent CT.MethodsThis is a single centre, cross-sectional, observational, retrospective study. The time to peak (TTP) signal intensity from the MRA was recorded using regions of interest on the aorta, pulmonary arteries, cavae and Fontan conduit. Patients were grouped by ejection fraction, global longitudinal strain, indexed stroke volume and cardiac index to examine if these cardiac performance parameters affected the mean TTP. Statistical analysis was performed to find the mean TTP for each of the vessels, which was consequently compared between the different cardiac performance parameters.Results35 patients were included in the study. Mean TTP contrast enhancement was 31s in the thoracic aorta, 46s in the right pulmonary artery, 41s in the left pulmonary artery and 55s in the Fontan conduit. Cardiac performance shows no statistically significant relationship to the peak contrast enhancement whether measured by ejection fraction, global longitudinal strain, stroke volume index or cardiac index.ConclusionThe mean optimal timing for a single-phase examination of the Fontan circulation, following an upper limb injection, was 55 s following start of contrast injection irrespective of cardiac performance. In TWIST MRA, the IV bolus is 4–5 s duration. A longer bolus is required for CTA, around 20s, suggesting an additional delay will be required. We propose that an optimal single phase CTPA to be protocolled at 70 s following the start of contrast injection, assuming adequate iodinated contrast dose.     

CT血管成像三维重建技术在布加综合征中的应用价值

目的 评估CT血管成像三维重建在布加综合征中的应用价值。方法 选取2011年2月至2013年12月就诊的布加综合征患者93例为研究对象,采用CT血管成像技术评估其门静脉、下腔静脉及肝静脉病变情况。结果 所有患者中,病变累及下腔静脉者(Ⅰ型和Ⅲ型)69例(74.19%),下腔静脉隔膜形成者34例(49.28%);肝静脉受损者(Ⅱ型和Ⅲ型)59例(63.44%),肝静脉隔膜形成者15例(25.42%);另有2例患者下腔静脉和肝静脉均有隔膜形成。56例(60.22%)患者存在侧支循环,食管胃底静脉曲张阳性39例(41.94%),脾脏肿大73例(78.49%),腹水36例(38.71%),肝脏尾状叶增大8例(8.6%),肾静脉血栓形成6例(6.45%)(双侧受累2例,单侧受累4例),原发性肝细胞癌5例(男性4例,女性1例)。结论 CT血管成像三维重建技术能够较好地反映布加综合征影像学特征,对布加综合征的临床诊疗具有较好的指导意义。     

MR 3D-ASL联合MRA诊断TIA的价值分析

目的探讨磁共振三维动脉自旋标记(MR 3D-ASL)技术联合磁共振血管成像(MRA)诊断短暂性脑缺血发作(TIA)的价值。方法回顾性分析2015年6月至2018年6月于我院确诊的72例TIA患者的临床资料。所有患者均接受MRA和MR 3D-ASL检查,观察MRA图像中血管形态和MR 3D-ASL图像中灌注异常情况,检测异常区和对侧镜像区相对脑血流量(rCBF)值,比较两者联合检查和单一检查诊断TIA的准确性。结果MRA与3D-ASL诊断TIA的准确率比较差异无统计学意义(χ^2=0.120,P>0.05),两者联合检查准确率明显高于MRA、3D-ASL单一检查(χ^2=5.763、4.255,P<0.05);3D-ASL定量分析显示,灌注异常区ROI的rCBF为(26.41±8.06)m L/(100 g˙min),明显低于对侧镜像区域[(37.59±10.25)mL/(100g˙min)],差异有统计学意义(t=7.275,P<0.05)。结论MR3D-ASL和MRA可分别显示灌注异常和血管异常,对TIA均有一定的诊断价值,且MR 3D-ASL能定量分析TIA患者脑组织血液灌注程度,两者联合应用可明显提高TIA的诊断准确率。