CT血流储备分数不同操作者间测量一致性及诊断准确性研究

目的：评价CT血流储备分数（CT-FFR）不同操作者测量的一致性及诊断准确性。方法：前瞻性入选冠状动脉CT血管成像（CCTA）证实冠状动脉狭窄30%～90%且于1周内行冠状动脉造影及血流储备分数（FFR）测量的患者。FFR<0.8诊断为缺血。两操作者分别测量CT-FFR,计算Kappa值,评价二者测量CT-FFR诊断缺血的一致性。采用ROC曲线评价血管水平CCTA及CT-FFR对缺血病变的诊断效能。结果：共纳入152例患者173支冠状动脉血管,其中FFR<0.8血管85支（49.1%）,FFR≥0.8血管88支（50.9%）。两操作者测量CT-FFR差值为0.032(0.008,0.092);FFR<0.8血管的两操作者测量差值显著高于FFR≥0.8血管[0.078(0.016,0.128)vs. 0.013(0.007,0.048),P<0.001]。两操作者测量CT-FFR诊断缺血的Kappa值为0.86;诊断缺血的AUC分别为0.913(95%CI:0.861～0.950)和0.948(95%CI:0.903～0.976),差异无统计学意义（P=0.079...     

基于减影技术的冠状动脉CT血流储备分数对钙化所致狭窄血流动力学的诊断价值

目的 探讨基于减影技术的冠状动脉CT血流储备分数(CT-FFR)诊断钙化病变所致冠状动脉血流动力学狭窄的价值。方法 前瞻性纳入2020年3月至2022年3月中国医学科学院北京协和医院就诊并确诊或拟诊冠心病患者22例,42处病变纳入分析。准备行有创冠状动脉造影检查的患者,提供减影冠状动脉CT血管造影(CCTA)检查,CCTA图像重建算法采用混合迭代重建。存在钙化所致冠状动脉中重度狭窄患者提供FFR检查,FFR值≤0.80定义为血流动力学显著狭窄。以FFR为金标准,计算CCTA、减影CCTA、CT-FFR和减影CT-FFR诊断钙化斑块所致血流动力学狭窄效能。结果 以病变为单位分析显示,4种图像中减影CT-FFR的诊断效能最高,敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100.0%、62.1%、54.2%、100.0%和73.8%,ROC曲线下面积为0.83。以患者为单位分析显示,4种图像中减影CT-FFR的诊断效能最高,敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100.0%、33.3%、55.6%、100.0%和63.6%,ROC曲线下面积为0.77。结论 减影CT-F...     

基于冠状动脉CT血流储备分数预测老年冠心病患者远期结局的研究

目的 评估冠状动脉CT血流储备分数(CT-FFR)在预测老年冠心病患者远期结局中的价值。方法 回顾性分析2018年4月至2019年3月在东部战区总医院放射诊断科的一项前瞻性队列研究中收治的临床可疑冠心病患者1133例,最终纳入330例老年冠心病患者。根据患者是否发生主要不良心血管事件(MACE)分为无MACE组295例和MACE组35例。患者基于冠状动脉CT血管成像(CCTA)数据分析所有病变血管的斑块特征并测量CT-FFR值。通过Cox比例风险回归模型、Kaplan-Meier生存曲线及ROC曲线分析斑块特征及CT-FFR与MACE之间的关系。结果 MACE组冠状动脉狭窄≥50%、CT-FFR≤0.8比例显著高于无MACE组(P<0.01)。单因素Cox分析显示,狭窄程度≥50%及CT-FFR≤0.8是发生MACE的危险因素(P<0.01),经多因素Cox分析校正后,仅CT-FFR≤0.8是发生MACE的独立危险因素(HR=17.037,95%CI:5.060～57.358,P=0.000)。此外,基于CT-FFR的风险预测模型显著优于基于CCTA狭窄程度的风险预测模型(...     

基于冠状动脉CT血管成像的冠状动脉生理学研究进展

冠状动脉CT血管成像（CCTA）是评价冠状动脉解剖学狭窄的重要手段，对冠状动脉粥样硬化性心脏病的诊断具有较高的阴性预测价值，但其不能准确地判断冠状动脉狭窄的生理学意义。近年来，国内外涌现出一系列基于CCTA的无创冠状动脉生理学评估手段，包括：基于CCTA的血流储备分数（CT-FFR）及其衍生指标、基于CCTA的瞬时无波形比值（iFRCT）等，有望实现冠状动脉功能学缺血程度与解剖学狭窄程度的一站式评估，对冠心病的早期筛查和精准诊疗具有重要意义。本文基于CCTA的冠状动脉生理学研究进展展开综述。     

不同年龄段糖尿病患者冠状动脉CT血管成像的血管特征及检查时机

目的探讨不同年龄段糖尿病(DM)患者冠状动脉CT血管成像(CCTA)的血管特征及检查时机的选择。方法 536例疑似冠心病的DM患者按年龄段进行分组,40~60岁163例,61~80岁299例,≥81岁74例,引发冠心病的高危因素包括高血压、高脂血症、肥胖、吸烟等,比较不同年龄组和同一高危因素不同年龄组患者冠状动脉狭窄程度以及钙化积分的差异。结果三组男性比例均大于女性;平均年龄、患高血压、高血脂、吸烟、DM病程因素比较差异有统计学意义(P0.05),而性别比、肥胖度(BMI)方面比较差异无有统计学意义(P0.05);对于40~60岁患者,冠状动脉主要以轻度狭窄为主(52.00%),单支病变所占比例(30.67%)最大,钙化水平主要是轻度钙化(39.88%),61~80岁患者中冠状动脉主要以轻度和中度狭窄为主,双支病变(32.56%)、中度钙化(33.78%)为主;≥81岁患者中,重度狭窄、多支病变、重度钙化尤为显著。相关性分析显示,血管钙化程度、病变累及支数、血管狭窄水平与年龄均程正相关(r=0.723,0.608,0.522,均P0.05)。结论对于不同年龄段DM患者均应早期进行冠脉检查,并定期进行相关检查,积极治疗,防止症状进一步恶化。     

动态CT心肌灌注显像与CT血流储备分数对冠心病诊断价值的比较

目的 分析动态CT心肌灌注显像（CTP）对功能性显著狭窄冠心病的诊断价值,比较两种定量分析指标[心肌血流量（MBF）比值与心肌血流储备（MFR）比值]评判心肌灌注显像结果的准确性,并比较CTP与冠状动脉CT血流储备分数（CT-FFR）对功能性显著狭窄冠心病的诊断价值。方法 对疑似冠心病的患者行冠状动脉CT血管造影（CCTA）和CTP检查。CCTA图像采集后行CT-FFR检测,CTP在静息相、腺苷三磷酸（ATP）诱导负荷相采集图像,用西门子CT灌注软件进行图像分析。所有患者均接受有创冠状动脉造影（ICA）检查,并进一步行定量血流分数（QFR）检测以作为参考标准。利用负荷状态各节段的MBF与最大值比值算得的MBF比值以及由各节段负荷相与静息相MBF比值算得的MFR与所有节段平均值的比值得到的MFR比值,两种CTP的定量指标评估冠状动脉狭窄所致的心肌缺血,CT-FFR评估各支冠状动脉功能性狭窄的情况。通过分析各种评估方式的受试者工作特征曲线,计算敏感度、特异度、准确度等诊断效能指标以及与QFR结果的一致性,对各评估方式进行比较。结果 研究共纳入48例患者,分析132支血管,其中男23例,平均...     

冠状动脉CT血管成像的临床应用现状与进展

正随着CT技术的飞速发展,64排CT以及更先进的CT设备已广泛应用于心血管检查,冠状动脉CT血管造影(coronary CT angiography,CCTA)已成为冠心病无创性检查的重要手段。近年来,对CCTA的研究,已从评价管腔狭窄发展到评价斑块的易损性,从单纯评价冠状动脉病变解剖发展到评价血管功能和病变血管的血流动力学意义,从病变的诊断发展到指导治疗决策和预后的评价[1-6]。随     

LAD纵深型心肌桥形态与CT-FFR的关系研究

目的:通过冠状动脉CT血管造影(coronary CT angiography, CCTA)检查探讨左冠状动脉前降支(left anterior descending coronary artery, LAD)纵深型心肌桥(myocardial bridging, MB)形态与CT血流储备分数(CT-FFR)的关系。方法:回顾性分析2018年1月—2022年4月包头医学院第一附属医院影像科323例LAD纵深型MB患者的解剖学信息，并以CT-FFR≤0.80为心肌缺血的指标，将患者分为CT-FFR正常组(237例)及CT-FFR异常组(86例)。采用t检验分析比较2组各MB参数的差异，采用岭回归模型分析CT-FFR值的影响因素，通过ROC曲线分析差异有统计学意义的参数。结果:2组MB入口处位置、出口处位置、长度、肌肉指数、收缩期压迫程度及壁冠状动脉(mural coronary artery, MCA)最狭窄处面积、入口处面积、出口处面积差异均有统计学意义(P<0.05)。岭回归方程显示，MB出口位置、长度及肌肉指数对CT-FFR值具有负向影响(P<0.05),MCA面积对C...     

冠状动脉多支血管病变与冠状动脉钙化积分的关系

目的研究冠状动脉多支病变与冠状动脉钙化积分的关系,为临床冠脉介入治疗决策提供依据。方法选取我院2013年6月~2014年12月收治的行状动脉造影术患者150例,将其随机分为单支血管病变组、两支血管病变组、三支血管病变组,各50例;计算各组患者的冠状动脉钙化积分,并比较各组之间的差异。结果通过研究发现三组患者中,单支血管病变组钙化积分与两支血管病变组比较显著降低,差异有统计学意义(P0.05);三支血管病变组钙化积分较两支血管病变组显著升高,差异有统计学意义(P0.05);三支血管病变组钙化积分较单支血管病变组显著升高,差异有统计学意义(P0.05)。结论冠状动脉多支血管病变与冠状动脉钙化积分之间呈正相关,冠状动脉钙化积分可作为临床预测冠状动脉多支病变的预测因子,为临床诊断和治疗提供依据。     

非糖尿病合并冠心病患者血浆骨桥蛋白与冠状动脉严重程度的相关性

目的 探讨非糖尿病合并冠心病患者血浆骨桥蛋白水平与冠状动脉严重程度的相关性。方法 入选166例因稳定型心绞痛入院的非糖尿病患者,采集一般临床资料和常规化验指标结果,通过酶联免疫吸附试验检测外周血骨桥蛋白水平。行冠状动脉造影明确冠心病,按照冠状动脉病变血管数进行严重程度分组：无冠状动脉病变组、单支冠状动脉病变组、双支冠状动脉病变组、三支冠状动脉病变组。冠状动脉钙化积分通过64排螺旋CT扫描机测定。按冠状动脉钙化积分分组：无钙化组（＜10）、轻度钙化组（11～100）、中度钙化组（101～400）和重度钙化组（＞400）。结果 随着冠状动脉狭窄程度和钙化程度的加重,血浆骨桥蛋白水平呈升高趋势。血浆骨桥蛋白水平与非糖尿病合并冠心病患者冠状动脉狭窄严重程度（r0.50,P<0.01）及冠状动脉钙化积分呈正相关（r0.38,P<0.01）。结论 血浆骨桥蛋白水平可能是非糖尿病合并冠心病患者冠状动脉狭窄及钙化程度的独立危险因素。     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.