颈动脉粥样硬化与冠心病的相关进展

随着冠心病研究的深入,冠心病与颈动脉粥样硬化的相关性研究越来越受到人们的重视,现主要论述颈动脉粥样硬化与冠心病的相关性方面的进展。     

Prognostic Value of Dobutamine Stress Echocardiography in Patients Undergoing Diagnostic Coronary Arteriography

There are only a few studies addressing the prognostic value of dobutamine stress echocardiography in patients with suspected coronary artery disease and none have assessed its value compared with coronary arteriography. Accordingly, graded dobutamine stress echocardiography was performed in 121 patients who underwent coronary arteriography based on symptoms and the findings of treadmill exercise electrocardiography. During the follow-up period of mean (SD) months (15 ± 9) there were 41 cardiac events (death [n = 5], acute myocardial infarction [n = 2], unstable angina [n = 29], and congestive heart failure [n = 5]). There were a greater number of patients with inducible wall motion abnormality (88%) on dobutamine stress with cardiac events compared with those without (55%, p <0.001). The wall motion score indexes at rest (1.6 ± 0.6) and at peak stress (2.1 ± 0.8) were worse in patients with cardiac events compared with those without (1.2 ± 0.3, p <0.001 and 1.5 ± 0.6, p <0.001, respectively). When multivariate analysis was performed using clinical, exercise, echocardiographic, and coronary arteriographic data the independent predictors of cardiac events were exercise duration (p = 0.01), presence of inducible wall motion abnormality (p = 0.03), and wall motion score index at peak stress (p <0.001). Thus, dobutamine stress echocardiography is a powerful predictor of future cardiac events in patients undergoing exercise testing and coronary arteriography for evaluation of chest pain and is superior to both exercise electrocardiography and coronary arteriography for the prediction of subsequent cardiac events.

Graded dobutamine stress echocardiography was performed in 121 patients undergoing diagnostic coronary arteriography for suspected coronary artery disease based on symptoms and findings of exercise electrocardiography. Stepwise Cox regression analysis using clinical, exercise electrocardiographic, echocardiographic, and coronary arteriography variables revealed that wall motion score index at peak stress (p <0.001), inducible ischemia (p = 0.03), and exercise duration (p = 0.04) were the only independent predictors of cardiac events.     

颈动脉粥样斑块及内中膜厚度与冠心病的关系

目的 :探讨颈动脉内中膜厚度 (IMT)以及粥样斑块发生率情况与冠心病的关系。方法 :采用冠状动脉造影术筛选冠心病及非冠心病组 ,对 114例经选择性冠状动脉造影检查的患者行颈动脉超声检查 ,测量IMT以及观察粥样斑块发生率情况。结果 :对照组及冠心病组IMT为 0 6 7± 0 10mm及 0 85±0 2 6mm ,斑块发生率为 10 % (4 /4 0 )及 6 3.5 % (4 7/74) ,组间相比均具有显著性差异 ,P <0 0 0 1,以IMT≥ 0 85mm及 /或出现粥样斑块来预测冠心病 ,特异性 85 % ,敏感性 71.6 % ,阳性预测率 89.8%。结论 :颈动脉与冠状动脉粥样硬化间存在着密切关系 ,通过颈动脉超声检查可预诊冠心病的存在     

颈动脉超声预测冠心病的研究进展

颈动脉超声是一种安全、有效、非侵入性评价临床及亚临床动脉粥样硬化的一种检测手段。大量研究证实颈动脉内膜-中膜厚度与冠状动脉粥样硬化的出现密切相关。有经验精细的颈动脉超声检查及内膜-中膜厚度测值能作为动脉硬化性疾病特别是心血管事件的替代指标。     

Exaggerated carotid sinus massage responses are related to severe coronary artery disease in patients being evaluated for chest pain

Background: Previous studies have reported that carotid sinus massage responses are associated with advancing age and carotid or coronary artery disease. Hypothesis: This study was undertaken to investigate the potential role of carotid sinus hypersensitivity as a marker for the presence of coronary artery disease, and especially left main stem disease, in patients who were referred for evaluation of chest pain. Methods: Toward this end, carotid sinus stimulation with simultaneous recordings of the electrocardiogram and aortic pressure was performed before coronary arteriography in 150 selected consecutive patients (mean age 59.4 ± 9 years) who were referred for evaluation of chest pain. Results: Coronary artery disease was present in 118 patients (78.7%); of these, 35 had single‐vessel disease, 35 had double‐vessel disease, 33 had triple‐vessel disease, and 15 had left main stem with or without such vessel disease. Carotid sinus hypersensitivity was found in 40 patients (26.6%). The incidence of hypersensitivity in patients with single‐, double‐, or triple‐vessel disease and left main stem disease was 8.5, 14.2, 57.5, and 73.3%, respectively. Stepwise multiple logistic regression analysis revealed that left main stem disease was significantly and independently related to the presence of carotid sinus hypersensitivity (p < 0.05). In addition, the presence of hypersensitivity had 73.3% sensitivity, 86.2% specificity, and 96.3% negative predictive value for the presence of left main stem disease. Conclusion: In patients being evaluated for suspected ischemic heart disease, carotid sinus massage responses are related to severe coronary disease. The absence of hypersensitivity may reflect absence of left main stem disease.     

Prevalence and One-year Outcome of Carotid Sinus Hypersensitivity in Unexplained Syncope: A Prospective Cohort Study from South India

Background

Carotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now.

冠心病病人血清脂联素水平的探讨

目的探讨冠心病病人血清脂联素的水平及其与肿瘤坏死因子-α（TNF—α）、胰岛素之间的关系。方法38例冠心病病人和52名健康对照者常规测量体重、身高，计算体重指数。抽取空腹静脉血检测其血糖、血脂、空腹胰岛素、TNF-α、脂联素水平。结果冠心病组血清脂联素水平显著低于对照组，血清脂联素水平与TNF-α、空腹胰岛素、空腹血糖、三酰甘油呈负相关，与高密度脂蛋白胆固醇呈正相关。结论在冠心病病人中，脂联水平下降并与动脉粥样硬化之间存在一定的相关性。     

老年冠心病患者血清RBP4水平与氧化应激、颈动脉粥样硬化的关系研究

目的：探讨冠心病患者血清视黄醇结合蛋白4（retinal binding protein 4, RBP4）水平的变化,及其与氧化应激、颈动脉粥样硬化的关系。方法：选取老年冠心病患者100例及健康体检者100例,采用酶联免疫吸附法测定血清RBP4水平,黄嘌吟氧化酶法及硫代巴比妥酸显色法分别测定血清超氧化物歧化酶活性和丙二醛水平,高分辨彩色血管多普勒超声仪测量颈动脉粥样斑块面积和内-中膜厚度（IMT）。结果：冠心病组血清RBP4（35.10±5.76 vs. 27.82±4.90 ng/mL）和丙二醛（14.21±1.22 vs. 9.89±1.64 ?mol/L）水平,以及颈动脉粥样斑块面积（15.27±1.16 vs. 10.13±2.53 mm2）、IMT（1.19±0.13 vs. 1.03±0.16 mm）均明显高于健康体检者组（P<0.01）,血清超氧化物歧化酶活性（76.49±13.82 vs. 93.29±12.11 kU/L,P<0.01）则明显低于健康体检者组。血清RBP4水平与丙二醛（R = 0.486）、颈动脉粥样斑块面积（R = 0.354）及IMT（R = 0.388）呈正相关（P<0.05）,与血清超氧化物歧化酶活性呈负相关（R = 0.343,P<0.05）。结论：老年冠心病患者血清RBP4水平明显升高,并且升高的RBP4水平与氧化应激损伤及颈动脉粥样硬化程度呈正相关。     

无顶冠状静脉窦综合征的超声影像学及临床特征分析

目的:分析无顶冠状静脉窦综合征(unroofed coronary sinus syndrome,UCSS)患者超声影像学及临床特征.方法:回顾我院2007年1月至2020年1月临床确诊的140例UCSS患者超声影像资料,对其超声影像特征、合并畸形及继发改变进行分析.结果:140例UCSS患中,女性占62.1％(87/...     

Carotid Endarterectomy: Current Concepts and Practice Patterns

Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS.Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA.Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS.Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA.Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon.     

Inability to Cannulate the Coronary Sinus in Patients with Supraventricular Arrhythmias: Congenital and Acquired Coronary Sinus Atresia

We report 4 cases of congenital and acquired coronary sinus ostial atresia incidentally found during electrophysiologic assessment for supraventricular arrhythmias. Congenital variants consisted of coronary sinus drainage predominantly via persistent left superior vena cavae and partial coronary sinus unroofing into the left atrium. The acquired variant was inadvertently produced during surgery for cor triatriatum. A variety of electrophysiologic substrates including right and left-sided accessory pathways and both typical and atypical AV nodal reciprocating tachycardia were identified. Approaches to imaging and accessing the coronary sinus when the os cannot be cannulated are discussed, including a search for right atrial accessory venous collaterals, venography to rule-out a persistent left superior vena cava, and coronary angiography.     

颈动脉内-中膜厚度及纤维蛋白原检测在急性冠脉综合征诊断中的价值

目的研究超声检测颈动脉内-中膜厚度(IMT)、粥样斑块形成及血浆纤维蛋白原预测急性冠脉综合征(ACS)的临床价值。方法在我院接受冠状动脉造影检查者108例,经冠状动脉造影确诊冠心病患者75例,分为急性心肌梗死组(AMI)、不稳定型心绞痛组(UA)、慢性稳定型心绞痛组(CAD)。对照组33例。采用超声检测颈动脉粥样硬化程度。结果颈动脉IMT≥0.9 mm及斑块形成或者血浆纤维蛋白原(Fb)与急性心肌梗死的发生正相关,OR值及其9 5%CI分别为3.5 8 6(1.1 4 8~1 1.2 0 2),4.0 0 5(1.242~12.909),2.851(1.006~8.080),P<0.05。颈动脉斑块负荷与冠脉血管病变支数呈正相关(r=0.194,P<0.05)。结论矫正年龄、性别、血糖、血脂等危险因素影响后,颈动脉IMT≥0.9 mm及斑块形成或者血浆Fb仍然是急性心肌梗死发生的危险因素,通过颈动脉粥样硬化程度可预测ACS及其冠状动脉病变严重程度。     

高血压与颈动脉粥样硬化的研究进展

高血压与颈动脉粥样硬化之间存在许多相关联系,高血压在动脉粥样硬化的发生中起重要作用。现综述高血压与颈动脉粥样硬化斑块产生的相似危险因素,动脉粥样硬化斑块与高血压的共同发生机制以及通过超声动态观察动脉粥样硬化的进展与消退,对高血压高危人群发生心、脑血管事件的预测具有重要意义。     

颈动脉粥样硬化与冠心病关系的探讨

目的:研究颈动脉粥样硬化与冠心病的关系.方法: 超声检查205例冠心病(冠心病组)和41例风湿性心脏病或其它体检患者(非冠心病组)的颈动脉,测量血管的直径、内-中膜的厚度(intima-media thickness, IMT),血流的速度等参数,观察斑块的有无及形成情况,了解颈动脉粥样硬化与冠心病以及非冠心病患者的关系.结果:确诊冠心病的患者205例中颈动脉超声有病变者195例,占 95.12%.其中冠状动脉三支病变者97例中颈动脉有病变者96例,达98.97%.41例非冠心病患者中颈动脉有病变者 11例,占26.83%,颈动脉无病变者30例,占73.17%.结论:冠心病和颈动脉粥样硬化存在着明显的相关性,颈动脉超声诊断技术对诊断冠心病有重要意义.     

Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures

Vascular closure devices (VCDs) were introduced in the early 1990s with the goal of limiting the time, labor, bed rest, and patient discomfort associated with manual compression (MC) for hemostasis after cardiovascular interventions. However, its advantage over MC has not been extensively studied after interventional procedures. The aim of this study was to do prospective, randomized study comparing the safety and efficacy of the Angio-Seal (AS) to that of MC in patients undergoing transfemoral coronary and peripheral vascular interventional procedure.A prospective, randomized trial was undertaken on consecutive series of patients admitted to King Fahd Hospital of the University for transfemoral coronary and peripheral vascular interventional procedures over 1 year. The study was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving AS with those undergoing MC. All patients were on antiplatelets and received heparin during the procedure.During the study period, 160 patients were included, 80 in each group. There was a significant difference in mean time to hemostasis in minutes (15.83 ± 1.63 minutes for MC and 0.42 ± 0.04 minutes for the AS; p < 0.001), time to ambulation in minutes (280 ± 15 for MC and 120 for AS; p = 0.04) and in minor complications (33.8% in MC vs. AS 5%; p < 0.001). However, the major complication rate did not significantly differ between the two groups (0% in AS vs. 2.5% in MC; p = 0.15).AS was found to achieve rapid closure of the femoral access site safely in patients undergoing coronary and peripheral vascular interventional procedures under antiplatelets and systemic heparinization.     

Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography

Background and Aims:Coronary artery disease (CAD) is usually caused by atherosclerosis, which is associated with general obesity and stronger associations with localized ectopic fat depots have been reported. We measured body ectopic fat distribution in Chinese patients to determine the association with coronary artery atherosclerosis (CA).Methods:Patients undergoing coronary computed tomography angiography (CCTA) who agreed to participate in the study (n = 750, 50.4% men, mean age 64.8 years) had cardiovascular disease and risk assessment. Body ectopic fat depots were measured from CT and their association with CA, determined from CCTA, was evaluated by univariate and multivariate logistic regression models.Results:CAD with CA (CAD-CA) was present in 57.2% of participants with CAD of moderate/severe CA (CAD-msCA) present in 23.5% and both were significantly more frequent in men than in women. Overall, men had greater body mass index (BMI) but there was no difference in waist circumference (WC) between genders. However, significantly higher visceral adipose tissue (VAT) and periaortic fat volume (PAFV) were observed in men, whereas women had significantly higher abdominal subcutaneous adipose tissue (SAT). With increasing age, there was a significant decline in BMI, WC and SAT in men, but a significant increase of WC and VAT, PAFV and epicardial fat volume (EFV) in women. A high proportion of non-calcified plaques was observed in CAD-CA, 55.3% in CAD of minimal/mild CA (CAD-mmCA) with 38.7% exclusively non-calcified plaques, and 59.7% in CAD-msCA with multiple type plaques containing non-calcified ones. Multivariate logistic regression showed a significant association of PAFV with CAD-CA and CAD-msCA that was independent of general obesity and clinical risk factors, and independent of abdominal obesity in the highest PAFV quartile patients. VATA was associated with an increased prevalence of CAD-msCA in the patients in the upper 2 VATA quartiles that was independent of clinical risk factors and both general and abdominal obesity.Conclusions:We found age and gender differences of body ectopic fat distribution in Chinese patients with higher VAT and PAFV in men and higher SAT in women. With increased age, there was a decline of WC and SAT in men but not in women and an increase in WC, VAT and PAFV in women but not in men. PAFV was significantly associated with overall CAD-CA and CAD-msCA, while VAT was associated with CAD-msCA.