128层螺旋CT冠脉成像在冠心病患者中的临床诊断价值分析

目的:分析在冠心病诊断中应用128层螺旋CT冠脉成像检测方式的临床应用价值。方法:选取2021年1月—2023年2月平原县第一人民医院收治的100例冠心病患者。所有患者均进行128层螺旋CT冠脉成像及冠状动脉造影检查,以冠状动脉造影检查结果为金标准,分析128层螺旋CT冠脉成像的诊断价值。结果:100例冠心病患者400个节段图像监测结果显示,狭窄142处。128层螺旋CT狭窄150处。128层螺旋CT检测灵敏度为91.55%,特异度为92.25%,准确率为92.00%。Kappa=0.827,与冠脉造影结果高度一致;冠脉造影冠脉狭窄程度结果显示,轻度60处、中度45处、重度37处,正常258处;128层螺旋CT冠脉成像检测不同狭窄程度诊断准确率为90.85%(129/142)。结论:在冠心病诊断中应用128层螺旋CT冠脉成像检测方式,检测效能水平较高,可作为冠脉造影前的筛查手段。     

冠状动脉CTA成像对冠心病临床诊断价值的初步研究——附108例冠状动脉CT成像与冠状动脉造影的对照分析

目的：评价多层螺旋CT冠状动脉成像对冠状动脉病变的诊断价值。材料与方法：对108例冠心病行多层螺旋CT（MSCT）增强扫描及图像后处理,并与常规冠状动脉造影（CAG）做对照分析。结果：常规冠脉造影（CAG）诊断冠脉病变138支,包括轻度狭窄50支,中度狭窄52支,重度狭窄36支,冠脉CTA成像检出冠脉病变152支,轻度狭窄56支,中度狭窄59支,重度狭窄37支。结论：多层螺旋CT对冠状动脉粥样硬化狭窄程度的判断。几乎可以代替有严重并发症的冠状动脉造影,且基本可以准确显示各种粥样斑块的病理性质,并对斑块的稳定性做出判断,评估急性冠脉事件的发生,具有较高的临床应用价值。是安全、准确、可靠的冠心病诊断方法,为冠脉事件的预防治疗和冠脉支架植入术前提供了诸多信息。     

64层螺旋CT冠状动脉成像与冠状动脉造影诊断冠心病的对比研究

目的比较64层螺旋CT冠状动脉成像与冠状动脉造影诊断冠心病的价值。方法选择冠心病患者120例,所有患者均接受64排螺旋CT冠状动脉成像及冠状动脉造影检查,比较两种检查方法对冠状动脉狭窄的显示情况及其敏感性、特异性、阳性预测率及阴性预测率。结果 (1)以冠状动脉造影为标准,64排螺旋CT冠脉成像显示的轻度冠脉狭窄数量较多,而中度及重度冠脉狭窄的数量较少,经统计学分析,两种检查方法间无统计学差异(P>0.05)。(2)依照冠脉造影的标准,64排螺旋CT冠脉成像对冠状动脉狭窄(≥50%)诊断的敏感性及特异性为96.4%(137/142)和96.8%(274/283),阳性预测率及阴性预测率为93.8%(137/146)和98.2%(274/279)。结论 64排螺旋CT在冠脉病变的诊断中具有较高的敏感性、特异性、阳性预测率和阴性预测率。     

冠状动脉CTA在评估冠心病病变部位及程度的应用价值及其与瓣膜钙化的关系

目的：探讨冠状动脉CTA在评估冠心病病变部位及狭窄程度的应用价值及其与瓣膜钙化的关系。方法：以2019年5月至2022年2月深圳市人民医院疑似冠心病患者395例为研究对象,采用飞利浦128排螺旋CT及冠状动脉造影（CAG）对所有患者进行检查。以CAG检测结果为金标准,Kappa检验对比CTA与CAG对冠心病病变部位及程度的诊断一致性。将确诊的286例冠心病患者分为瓣膜钙化组（n=87）与非瓣膜钙化组（n=199）,检测主动脉瓣开口面积,Agataston方法计算钙化积分,Kruskal-Wallis H检验分析瓣膜钙化组钙化积分与主动脉瓣狭窄的相关性。结果：CTA与CAG诊断冠心病患者冠状动脉病变部位在前降支、回旋支、右冠脉的Kappa值分别为0.821、0.706、0.833,冠状动脉CTA对冠心病病变部位的诊断灵敏度、特异度分别为95.88%、78.95%。CTA与CAG诊断冠心病患者冠状动脉无狭窄、轻度狭窄、中度狭窄、重度狭窄的Kappa值分别为0.764、0.723、0.788,冠状动脉CTA对冠状动脉狭窄程度的诊断灵敏度、特异度分别为90.7%、72.73%。KruskalW...     

128层螺旋CT在不同程度冠状动脉狭窄诊断中的应用价值

目的:探讨不同程度冠状动脉狭窄患者行128层螺旋CT诊断的临床效果。材料与方法:回顾分析我院收治的98例冠心病患者为研究依据,对上述患者分别给予128层螺旋CT和常规冠状动脉造影检查,比较两种检查手段对不同程度冠状动脉狭窄检查结果。结果:传统动脉造影诊断轻度、中度、重度狭窄分别为102段、98段、195段;128层螺旋CT冠状动脉成像诊断轻度、中度、中度敏感度分别为55.86%、60.31%、79.45%;诊断正确率分别为:91.79%、93.33%、94.23%;诊断特异性分别为:97.69%、98.18%、96.06%。结论:128层螺旋CT对不同程度冠状动脉狭窄具有较高的准确性,是一种简单易行、安全可靠的无创检查手段,成为冠心病高危人群检查的首选方法。     

现代无创检查技术在冠心病临床诊治中的作用

本研究主要通过对SPECT心肌灌注、冠脉钙化积分及多层螺旋CT冠脉成像等检查,结合冠状动脉造影结果评估其对早期冠心病的临床应用价值。1资料与方法本组60例为本院2005年6月~2006年12月住院患者中诊断为冠心病或可疑冠心病者,入选患者均行ECT、冠脉钙化积分、冠脉CTA等多项无创性检查,并经冠脉造影检查。60例中男48例,女12例,年龄44~75岁。冠状动脉造影(CAG):采用Judkins法,分别行左右冠状动脉造影。冠心病诊断标准为:至少1支冠状动脉或其主要分支血管腔(直径≥2.0 mm)狭窄≥50%为阳性病变。冠状动脉狭窄程度分为以下3级:正常或轻度狭…     

冠脉CTA对冠心病并发心绞痛的诊断价值分析

目的:探讨冠脉CT血管成像(CTA)技术在冠心病并发心绞痛患者诊断中的应用价值。方法:选取2022年8月—2023年8月南漳县中医医院收治的68例疑似冠心病并发心绞痛患者为研究对象,均行冠脉CTA检查,以冠状动脉造影(CAG)结果为金标准,分析冠脉CTA对冠心病并发心绞痛的诊断效能。结果:以CAG检查为金标准,冠脉CTA诊断冠心病并发心绞痛的灵敏度为89.58%,特异度为90.00%,准确率为89.71%;冠脉CTA诊断冠脉狭窄程度的总符合率为91.18%,其中轻度狭窄、中度狭窄、重度狭窄以及闭塞诊断符合率分别为94.44%、91.30%、90.91%、80.00%。冠心病并发心绞痛组冠脉狭窄程度、斑块负荷水平均高于单纯冠心病组(P<0.05)。结论:冠脉CTA可提高冠心病并发心绞痛的诊断效能,且能准确评估冠脉狭窄程度及斑块负荷,对冠心病并发心绞痛的定性、定量评估具有较高应用价值。     

轻度肾功能不全与冠状动脉狭窄程度的关系

目的　探讨轻度肾功能不全与冠状动脉狭窄程度的关系。方法　对 6 4例冠状动脉狭窄患者行冠脉造影 ,按入院时血清肌酐是否 >10 6 .0 8μmol/L分为肾功能正常组及肾功能不全组 ,冠状动脉狭窄程度用造影图像处理系统测量 ,并以病变损害的程度评分。分析轻度肾功能不全和冠脉狭窄程度的定性及定量关系。结果　轻度肾功能不全独立于其他冠心病易患因素 ,与冠脉狭窄程度相关。结论　轻度肾功能不全可以作为评估冠心病严重程度的参考指标之一。     

冠脉CTA在冠心病临床诊断中的应用价值研究

目的:研究冠脉CTA在冠心病临床诊断中的应用价值。方法:对2017年1月-2019年1月本院收治的95例冠心病患者的临床资料以及冠脉CTA、冠状动脉造影检查结果进行回顾性分析,以冠状动脉造影为金标准,观察比较两种检查结果,并分析冠脉CTA检查的临床诊断价值。结果:95例患者中,冠脉CTA共检出87例,检出率为91.58%,冠状动脉造影共检出86例,检出率为90.53%,两种检查结果相当,比较差异无统计学意义(P0.05),具有可比性;同时冠脉CTA检出轻度狭窄9例(10.34%),中度狭窄40例(45.98%),重度狭窄32例(36.78%),闭塞6例(6.90%);冠脉CTA诊断灵敏度为93.10%,特异度为37.50%,阳性预测值为93.10%,阴性预测值33.33%,诊断符合率为88.42%。结论:冠脉CTA在冠心病临床诊断中具有显著的诊断价值,能有效显示出冠状动脉狭窄情况,其诊断符合率高,能为临床治疗提供可靠依据,临床中具有一定的推广应用价值。     

256排Revolution CT在冠心病诊断中的应用价值

目的:分析在冠心病诊断中采取256排Revolution CT的价值。方法:选自2019年8月—2020年8月在我院经冠状动脉造影证实为冠心病的60例患者。所有患者均接受256排Revolution CT检查,将冠状动脉造影结果作为金标准,探讨256排Revolution CT对冠心病的诊断价值。结果:共检查242支血管,冠状动脉造影检出冠脉狭窄数量为128支,256排Revolution CT检出冠脉狭窄数量为121支,256排Revolution CT对冠心病的诊断敏感度、特异度分别为91.41%(117/128)、96.49%(110/114)。256排Revolution CT对轻度、中度、重度冠脉狭窄程度的检出率分别为94.12%、100.00%、100.00%,检查符合率分别为88.24%、96.00%、94.44%。结论256排Revolution CT应用于冠心病诊断中准确性较高,可为临床诊断提供有效依据,具有良好的诊断价值。     

16层螺旋CT冠状动脉成像的临床研究

目的探讨16层螺旋CT冠状动脉成像方法及评估其临床应用价值。方法应用西门子SOMATOM16层螺旋CT对21例可疑或已诊断冠心病人进行扫描,获取相关数据,应用后处理工作站对其进行容积再现图像（VRT）、最大密度投影（MIP）、曲面重建（CPR）、平面重组（MPR）成像,分析冠状动脉狭窄程度及狭窄原因,再与该21例病人的CAG结果进行对比。结果16层螺旋CT判断冠状动脉轻度、中度及高度狭窄的敏感度,特异度,阳性预测值,阴性预测值分别为84．6％、40．0％、55．0％、75．0％、88．2％、69．6％、72．7％、88．9％、90．0％、87．5％、78．3％、94．6％;未钙化斑块致冠脉中高度狭窄程度结果与CAG评价结果一致性为94．7％;而钙化斑块对冠状动脉狭窄程度评价有一定局限性。结论16层螺旋CT冠状动脉成像用于可疑冠心病筛查及冠心病的诊断有很高的临床价值。且相对CAG检查是一种无创安全可靠价廉的检查方法,适合推广。     

128层螺旋CT在冠心病诊断中的应用研究

目的研究128层螺旋CT冠脉成像对冠心病的冠状动脉狭窄,特别是细小分支狭窄的临床诊断价值和准确度。方法以传统X线冠状动脉造影(CAG)为金标准,与同期2～7d内行64排128层螺旋CT的图像进行对比研究。结果本研究中CT图像能够满足冠状动脉管腔评价的节段占96.50%,CT图像满足诊断要求的节段中,常规冠状动脉造影共发现中度和中度以上狭窄120节段,其中重度狭窄34节段。本组病例中以CAG作为金指标,显示重度狭窄的敏感度和特异度分别为99.8%和96.6%,阳性预测值和阴性预测值分别为99.8%和96.5%。结论对于达到扫描评价条件的冠脉图像,128层螺旋CT可作为冠心病临床诊断及介入治疗的一种无创筛选方法;能较可靠地排除临床表现不明确的冠心病患者,尤其是评价左主干、左前降支和回旋支的近端准确度非常高。     

Evaluation of left ventricular myocardial mechanics by three-dimensional speckle tracking echocardiography in the patients with different graded coronary artery stenosis

To investigate the relationship between left ventricular (LV) myocardial mechanics evaluated by three-dimensional speckle tracking echocardiography (3D-STE) and degree of coronary artery stenosis in patients with coronary artery disease (CAD). Ninety-seven suspected CAD patients without LV regional wall motion abnormality (RWMA) observed visually form traditional echocardiography were divided into four groups according to coronary artery angiography (CAG): 23 patients in slight stenosis group [stenosis rate (SR)?≤25%], 26 patients in mild stenosis group (25<?SR?≤50%), 28 patients in moderate stenosis group (50<?SR?≤75%), and 20 patients in severe stenosis group (SR?>75%). Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), area strain (AS) and three dimensional strain (3D-Strain) were obtained. The parameters from 3D-STE were compared between different groups and then the diagnostic value of global strains indicating different graded coronary artery stenosis was analyzed by the receiver operating characteristic curve. (1) There were significant difference in GLS, GCS, GRS, GAS and 3D-Strain between the severe stenosis group and any other group while all 3D-STE parameters except GCS in the moderate stenosis group were remarkably different from those respectively in mild group. (2) Receiver operator characteristic curve (ROC) analysis showed that the area under the curve of GLS, GRS, GCS, GAS, 3D-Strain were 0.899, 0.873, 0.723, 0.856 and 0.863 respectively for the identification of stenosis rate?>50%, and 0.896, 0.866, 0.797, 0.909 and 0.899 respectively for the identification of severe stenosis. GAS less than ?29.13% allowed a sensitivity of 95% and a specificity of 71.4%, while 3D strain less than 41.35% allowed a sensitivity of 90% and a specificity of 80.5% for evaluating serve coronary artery stenosis. The myocardial mechanics from 3D-STE in the CAD patients were characteristic. It could be expected to identify serve coronary stenosis with a good sensitivity and an acceptable specificity by using GAS or 3D-strain especially in the suspected CAD patients without RWMA on conventional echocardiography.     

心房颤动患者64层CT冠脉成像的扫描方法及后处理技术探讨

目的探讨心房颤动(房颤)患者64层螺旋CT冠状动脉成像的扫描方法及后处理技术的应用价值。方法所有31例房颤心律患者均进行64层螺旋CT扫描并采用绝对值时间法重组心脏容积数据,对其中12例患者心电信号进行编辑,再结合回顾性心电门控技术和后处理工作站进行冠状动脉成像。分析31例心房纤颤患者的冠状动脉CT血管成像(CTA)图像质量,利用血管分析软件判断血管有无狭窄并测量狭窄程度,其中10例患者的冠状动脉CTA结果与冠状动脉导管造影(CAG)进行了对照分析。结果 31例患者中364段血管节段成像质量分析结果:质量优、良、中和差分别为194段(53.3%)、82段(22.5%)、41段(11.3%)和47段(12.9%);成像质量优良率为276段(75.8%)。10例与CAG进行对照,共分析冠状动脉血管125段,CTA诊断血管狭窄程度≥50%的敏感度为85.0%(17/20),特异度为95.2%(100/105)。结论 64层螺旋CT能够对房颤患者进行冠状动脉CTA检查,结合心电编辑、回顾性心电门控和工作站后处理技术,可以重建出较高质量的冠状动脉图像。     

Diagnostic value of transthoracic echocardiography compared to electrocardiogram in predicting coronary artery stenosis among patients after cardiac arrest

BackgroundIn the absence of ST-segment elevation (STE) in post-return of spontaneous circulation (ROSC) electrocardiogram (ECG), coronary angiography (CAG) is required in patients with suspected coronary artery disease (CAD). However, it is a challenge to identify patients with CAD after cardiac arrest (CA). Recent European Society of Cardiology guidelines recommends transthoracic echocardiography in patients presenting with cardiac arrest. We aimed to assess the diagnostic value of regional wall motion abnormalities (RWMAs) on transthoracic echocardiography (TTE) compared to ECG in diagnosing significant coronary artery stenosis in CA patients.MethodsThis is a retrospective, observational study of adult CA patients with presumed cardiac etiology who underwent CAG from a single tertiary care hospital. We compared the predictive value of RWMA on TTE and STE on ECG in significant stenosis of ≥70% of the coronary artery diameter. The primary outcome was significant stenosis on CAG.ResultsThere were 145 patients included in this study and CAG revealed significant stenosis in 76 (52.4%) patients. Among the 76 patients with significant stenosis, 68 (89.5%) had RWMA on TTE and 41 (54.0%) had STE. RWMA on TTE (OR 3.67; 95% CI 1.52–8.85) was independently associated with significant stenosis. Combining both RWMA on TTE and STE on ECG improved performance in the receiver operating characteristic curve analysis (area under the curve 0.722) for predicting significant stenosis compared to using only ECG alone (p = 0.001).ConclusionsRWMAs on TTE was independently associated with significant stenosis. The RWMA and STE combination had better predictive performance than using only STE on ECG to predict significant stenosis.     

负荷超声心动图检测冠心病室壁运动异常及室壁冠脉血供对应关系的研究

目的 比较多巴酚丁胺负荷超声心动图(DSE)诱发的节段性室壁运动异常(RWMA)与冠状动脉造影结果,研究RWMA与冠脉血供分布的对应关系。方法 对63例临床疑为冠心病的患者进行DSE和冠状动脉造影检查,将左室分为16个节段进行分析,判定RWMA的部位和范围。结果 ①63例患者冠脉造影阳性48例,单支病变38例,双支病变8例,三支病变2例。对38例单支病变中的32例DSE阳性患者进行RWMA与左室壁冠脉血供对应关系分析,提示冠脉的三大主支狭窄各有相应的左室节段发生BWMA,与美国超声心动图协会(ASE)的结论相似,而右冠脉的供血区域较广于ASE提出的供血区域。②63例患者中DSE检测单支、双支及三支的敏感性分别为84.2％,87.5％和100％。检测出左前降支、右冠脉病变的敏感性(82.1％,76.4％)高于左旋支(33.3％),P<0.05。结论 通过分析DSE诱导的RWMA,可无创估测冠脉狭窄的部位、范围及严重程度,DSE是诊断冠心病的一种可靠而敏感的方法。     

The assessment of non culprit coronary artery lesions in patients with ST segment elevated myocardial infarction and multivessel disease by control angiography with quantitative coronary angiography

Conflicting data is present in the literature about patients who are treated with percutaneous coronary intervention (PCI) due to the exaggeration of the non culprit artery. The precise understanding of the non culprit artery in the setting of ST segment elevated myocardial infarct (STEMI) is important since the time and modality of the treatment is planned accordingly. The aim of this study is to evaluate the lesions in the non culprit coronary artery during primary PCI and control coronary angiography (CAG) using quantitative coronary angiography (QCA) in multivessel STEMI patients. In this study, multivessel disease STEMI patients whom underwent primary PCI between January 2010 and March 2011 were included. Critical stenosis degree was accepted as ≥70?% in the non culprit artery. All patients were evaluated with control CAG 1 month after primary PCI. Assessment with CAG was performed by two blinded cardiologists. QCA program was used to evaluate reference artery diameter (RAD), minimum luminal diameter (MLD) and degree of stenosis. With regard to the degree of stenosis, significant reduction was accepted as ≥15?% while % 5–15 decrease was accepted as moderate. Of the 81 patients, 61 were males and 20 were females (mean age 58.1?±?10). In the control CAG, the degree of non culprit artery stenosis was found to be decreased (p?<?0.001) while RAD and MLD were increased (p?<?0.001 and p?<?0.001 respectively). Significant decrease in critical non culprit artery lesions was detected in 22 patients (20.9?%) meanwhile moderate reduction was observed in 26 patients (24.7?%). In 14 patients (13.3?%), non culprit artery lesions accepted as critical during primary PCI were found to be non critical during the control CAG. Planned intervention was cancelled and medical treatment was initiated in those 14 patients. Our data indicated using QCA, approximately the half of non culprit lesions were found less critical during control CAG when compared to primary PCI. Therefore, it is concluded that complete revascularization during primary PCI should be avoided in multivessel STEMI patients and critical non culprit artery lesions should be re-evaluated with later control CAG.     

双源 CT 和冠状动脉造影评估冠状动脉支架内再狭窄的比较研究

目的：研究双源 CT（DSCT）和冠状动脉造影（CAG）评估冠状动脉支架内再狭窄的一致性及前者取代后者的可行性。方法137例患者193枚支架均行 CAG 检查及 DSCT 检查判断是否存在支架内再狭窄（ISR）,以 CAG 结果为金标准,比较 DSCT 评估支架狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性。结果137例患者193枚支架,CAG 评估为 ISR 共计61枚,DSCT 正确判断57枚,其敏感性89．4％、特异性88．5％、阳性预测值80．3％、阴性预测值96．7％、准确性90．7％;在 P ＜0．05水准上检验得 Kappa 值为0．5463,DSCT 评估与 CAG 评估 ISR 有较好的一致性;146枚直径≥3．0 mm 支架,CAG 判断46枚 ISR,DSCT 准确判断44枚,其敏感性95．6％、特异性90％、阳性预测值81．5％、阴性预测值97．8％、准确性91．8％;直径＜3．0 mm 的47枚支架,CAG 判断15枚 ISR,DSCT 正确判断13枚,其敏感性86．7％、特异性87．5％、阳性预测值76．5％、阴性预测值93．3％、准确性87．2％。结论DSCT评估 ISR 与 CAG 相比有很好的一致性,但受支架置入部位及大小影响判断,易出现误判及判断 ISR 程度较重,但在大寸径的支架通畅情况的评估基本可以取代 CAG。     

超声心动图在评估非ST抬高型心肌梗死老年患者梗死相关动脉中的临床价值

  目的  研究超声心动图（2DE）在评估老年非ST抬高型心肌梗死（NSTEMI）患者梗死相关动脉及病情严重程度中的临床价值。  方法  回顾性分析医院2016年6月~2020年6月126例NSTEMI患者的影像学资料,其均进行2DE及冠状动脉造影（CAG）检查。将CAG检查提示至少1支动脉狭窄程度 > 50%的124例患者作为研究对象,统计其2DE检查中是否出现左室壁节段运动异常（RWMA）,比较RWMA者与未出现RWMA者动脉病变特点;将86例2DE检查提示RWMA的患者作为研究对象,以其CAG诊断梗死相关动脉作为“金标准”,分析2DE在确认梗死相关动脉中的应用价值;以Killip分级作为AHF患者病情严重的划分标准,比较不同分级患者2DE检查中动脉壁内膜中膜厚度。  结果  124例患者中2DE检查中出现RWMA的患者共85例,未出现RWMA的患者共39例,两组单支病变、双支病变及多支病变占比的差异均有统计学意义（P < 0.05）;2DE检查出现RWMA的患者共86例,86例患者中均可通过CAG准确判断梗死相关动脉,其中左前降枝动脉者26例,右冠状动脉者40例,左回旋支者20例,以CAG为“金标准”,经RWMA推测梗死相关动脉的准确率为95.35%;Killip分级Ⅰ~Ⅱ级的轻度组患者内膜中膜厚度显著低于Ⅲ~Ⅳ级患者（P < 0.05）。  结论  借助2DE可有效判断NSTEMI患者病情严重程度,确认梗死相关动脉,在指导临床调整治疗方案,判断患者病情中具有良好的价值。