256层螺旋CT在冠状动脉疾病诊断及左心功能评价中的临床价值

目的探讨256层螺旋CT在冠状动脉疾病诊断及左心功能评价中的临床价值。方法本组104例研究对象选自2016年1月至9月来我科室进行检查的疑似冠状动脉疾病患者。104例患者均应用256层螺旋CT行心脏冠状动脉CT成像(CTCA),二维经胸超声心动图(2D-TTE)检查,及冠状动脉造影(CAG)。对比分析心脏冠状动脉CT成像(CTCA)与冠状动脉造影(CAG)对冠状动脉狭窄的检出情况;并对比分析心脏冠状动脉CT成像(CTCA)与二维经胸超声心动图(2D-TTE)检查对患者LV-EDV、LV-ESV、LVEF各项心功能参数的评价情况。结果通过对患者左冠主支、左回旋支、左前降支、右冠动脉等340支血管进行检查,CTA检出146支冠状动脉狭窄,CAG检出134支冠状动脉狭窄,两种方式均显示狭窄的冠状动脉共计128支,两种检查方式冠状动脉狭窄检出情况比较差异不存在统计学意义P0.05。经CTCA与2D-TTE检查患者的LV-EDV、LV-ESV、LVEF等心功能参数的评价情况,比较差异不存在统计学意义P0.05。结论 256层螺旋CT冠状动脉成像在冠状动脉狭窄方面的诊断与常规冠状动脉造影检查结果具有较高的一致性,同时其对患者左心功能的评价具有较高的准取性,且该检查方式还具有操作简单、安全无创的优点,因此该检查方式可作为目前临床进行冠状动脉疾病诊断的首先方式。     

64层螺旋CT血管成像与冠状动脉造影对冠心病诊断价值的对比研究

目的评价64层螺旋CT在冠状动脉造影方面的诊断价值。方法58例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,分别对左主干、左前降支、回旋支和右冠状动脉及其分支的重建图像行影像学评价,所有患者均行常规选择性冠状动脉造影检查作为对照。结果58例患者共757(87.0%)节段的冠状动脉(血管直径≥1.5 mm)成像,638节段(84.3%)可用于多层螺旋CT和冠状动脉造影定量分析。冠状动脉造影共发现狭窄101节段,多层螺旋CT发现狭窄104节段,多层螺旋CT对冠状动脉狭窄诊断的敏感性为86.1%,特异性为96.8%。结论64层螺旋CT冠状动脉造影可作为诊断冠状动脉病变的一种无创筛选方法。     

右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响

目的　探讨右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响及其机制。方法　对比分析左冠状动脉狭窄患者在合并与不合并右冠状动脉病变时的左心室射血分数。结果　与相应部位单纯左冠状动脉狭窄患者相比 ,合并右冠状动脉病变患者左心室射血分数均呈不同程度地下降 ,其中在左前降支、左前降支 +左回旋支狭窄基础上合并右冠状动脉病变时左心室射血分数下降有统计学意义 (P <0 .0 5或 0 .0 1) ,左主干合并右冠状动脉狭窄患者下降幅度最大 ,但无统计学意义。结论　右冠状动脉病变可在单纯左冠状动脉狭窄的基础上使左心室收缩功能进一步恶化 ;当左冠状动脉狭窄部位为左前降支、左主干或左前降支 +左回旋支时 ,对左心室收缩功能影响更为严重     

64排128层容积CT冠状动脉成像对冠心病诊断的价值

［摘要］　目的　探讨64排128层容积CT冠状动脉成像在冠心病诊断中的应用价值。方法　随机选取117例冠心病患者行64排128层容积CT冠状动脉成像检查,以显示冠状动脉各主支及分支并对冠状动脉病变进行诊断,分析对不同部位冠状动脉病变诊断的准确性以及不同程度狭窄的敏感性、特异性。结果　冠状动脉造影检测结果显示：左前降支病变54支,左主干病变48支,双支病变32支,左回旋支病变28支,右冠病变25支。64排128层容积CT扫描检测敏感度达91.38%,准确度达92.51%;对于冠状动脉不同程度狭窄的敏感性、特异性均较高。结论　64排128层容积CT冠状动脉成像技术,由于其采用无创技术且对病变部位具有较高的敏感性及特异性,因此在冠心病临床诊断中具有较好的应用价值。     

64-MDCT冠脉成像评价左心室整体功能的应用研究

目的 分析64-MDCT和超声心动图对左心功能评价指标的相关性,探讨64-MDCT冠状动脉成像所得数据对于左心功能评价的准确性,以提供一种综合评价冠状动脉及左心功能的方法.方法 临床拟诊冠心病患者56例行64-MDCT和超声心动图心脏检查,应用心功能分析软件进行后处理,计算左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室每搏量(LVSV)、左室射血分数(LVEF),并与超声心动图测量结果进行对比分析.结果 64-MDCT冠状动脉成像同时可以完成对左心室整体功能的评价,64-MDCT与超声心动图的左心功能评价指标无统计学意义,相关性均良好.结论 64-MDCT冠状动脉成像同时可以完成左心室整体功能评价,结果准确可靠.     

双源CT评价糖尿病合并高血压患者左心功能的临床应用价值

目的探讨双源CT冠状动脉造影评价原发性高血压(EH)、2型糖尿病(DM)及高血压合并糖尿病(EH+DM)左心功能的差异性。方法选择该院2017年9月—2018年7月心内科住院患者,确诊为EH患者68例,为EH组;DM患者64例,为DM组;69例高血压合并糖尿病患者,为EH+DM组。同期收集60名健康患者作为对照组。所有患者均行双源CT冠状动脉血管造影,并对三组患病组冠脉狭窄情况及四组的左心功能进行比较,包括左心室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室每搏输出量(LVSV)、左心室射血分数(LVEF)、心脏指数(CI)、左室心肌质量(LVMM)及左心室后壁厚度(LVPWT)。结果 EH+DM组冠脉狭窄处最多,EH组与DM组冠脉狭窄处无明显差异。DM组EF值低于对照组,EH+DM组EF值不仅低于对照组,并且低于EH组与DM组(P0.05);EH组EF值稍低于正常组,但差异无统计学意义(P0.05)。EH组及DM组LVEDV、LVESV、LVPWT以及EH+DM组LVEDV、LVESV、CI、LVPWT均高于对照组,其中EH+DM组LVEDV高于EH组与DM组,EH+DM组CI高于DM组(P0.05);EH组与DM组对照,所有的值差异无统计意义。结论高血压、糖尿病会对左心室收缩和舒张功能产生一定的影响,造成左心功能减退,尤其是糖尿病合并高血压患者左心功能减退更加明显。而双源CT冠状动脉血管造影有利于糖尿病合并高血压患者左心功能评价。     

64层螺旋CT对冠心病患者再血管化治疗后的疗效评价

目的探讨64层螺旋CT追踪观察冠心病患者冠状动脉再血管化治疗后冠状动脉再狭窄的发生和心功能的变化。方法对28例冠状动脉旁路移植术患者和114例支架植入术患者进行64层螺旋CT冠状动脉造影和左心功能分析;观察吻合口的形态和桥血管/支架再狭窄的发生,计算左心功能指标,用以评价并比较二种冠状动脉再血管化治疗方法的疗效。结果冠心病患者在接受冠状动脉旁路移植术和支架植入术后左心室射血分数和每搏输出量明显增高;1年以后支架植入术后再狭窄发生率高于冠状动脉旁路移植术后;冠状动脉旁路移植术后3年以上者左心室射血分数和每搏输出量明显高于支架植入术后。结论64层螺旋CT心脏检查在冠心病患者再血管化治疗后疗效评价和随访中具有重要意义。     

64排螺旋CT定量评价冠状动脉狭窄患者左心功能的临床价值

目的探讨64排螺旋CT（64-MDCT）定量评估冠状动脉狭窄患者左心功能的临床价值。方法选择128例不同程度冠状动脉狭窄患者,同期行64-MDCT及经胸二维超声心动图（2D-TTE）检查,对其左心室容量及室壁厚度进行回顾性分析,将两种方法所得的数据进行比较。结果64-MDCT和2D-TTE所测得左心室射血分数分别为（58．20±7．59）％和（55．59±4．74）％,室壁增厚率分别为（62．92±25．77）％和（56．33±20．43）％,两组比较有统计学差异（P均〈0．05）。结论64-MDCT在对心脏冠状动脉进行评价的同时,能够准确测量左心功能,并与2D-TTE有很好的相关性。     

双源CT对左心室功能评价的应用

目的探讨双源CT对左心室功能测定的可行性和准确性。方法临床行双源CT冠状动脉成像检查,并具有超声心动图检查结果的患者80例。采用回顾性心电门控技术将原始数据重建成20组,调入心功能分析软件包进行分析。得出左心室舒张末期容积(end-diastolic volume,EDV),收缩末期容积(end-systolic volume,ESV),每搏输出量(stroke volume,SV)和射血分数(ejection fraction,EF)。将双源CT心功能各测量值与超声心动图结果比较。结果 80例中,采用双源CT心功能测量与超声心动图左心功能各指标(EDV,ESV,SV,EF)相关性高,r值分别为:0.858、0.891、0.766和0.735,P值均>0.05,差异无统计学意义。结论双源CT在左心功能评价方面准确、可靠,一次双源CT冠状动脉成像检查可以同时评估冠状动脉狭窄情况和左心功能。     

比较64层螺旋CT与超声心动图对左心室功能的评价

目的研究64层螺旋CT与超声心动图测量左心室功能参数的一致性与相关性,评价螺旋CT评估左心室功能的临床应用价值。方法选取2013年5月~2014年6月于深圳市西丽人民医院先后进行超声心动图及冠状动脉CT血管造影(CT angiography,CTA)检查、且间隔时间48 h的冠心病患者共67例,其中男性42例,女性25例,年龄52~78岁。应用心功能分析软件测量左室功能参数:收缩末期容积(ESV)、舒张末期容积(EDV)及射血分数(EF),并与超声心动图结果比较。结果 67例患者检查均获得成功,64层螺旋CT测量左心室功能参数包括收缩末期容积、舒张末期容积及射血分数分别为:(135.72±63.59)ml、(58.41±23.65)ml和(63.73±11.03)%;超声心动图测量值分别为:(103.21±48.13)ml、(35.65±7.42)ml和(65.16±8.65)%。两种检测方法测量EDV、ESV及EF测量值呈正相关(r值分别为0.85、0.87及0.76)。结论与超声心动图比较,64层螺旋CT冠状动脉成像可以评价左心室功能,是冠心病患者的一个可行的替代方案。     

Exertion isotope tests in coronary insufficiency. Comparison with isotopic ventriculography and myocardial scintigraphy

Very few studies have been described comparing the value of exercise myocardial scintigraphy and left ventricular angioscintigraphy. The authors designed a study comparing these two investigations with conventional exercise stress testing and coronary angiography. The isotopic investigations were carried out within 48 hours of coronary angiography. A total of 143 patients undergoing coronary angiography (35 normal, 108 coronary patients: 36 single vessel, 36 double vessel and 36 triple vessel disease) were included in this study. The lesions were located of the LAD (77 cases), left circumflex (77 cases) and right coronary arteries (62). The sensitivity and specificity of both radionuclide investigations were evaluated to assess their diagnostic value; the best results were obtained with myocardial scintigraphy (sensitivity 86 p. 100; specificity 100 p. 100); angioscintigraphy had a sensitivity of 71 p. 100 and specificity of 97 p. 100, and conventional exercise stress testing of 42 p. 100 and 70 p. 100 respectively. The sensitivity seemed to increase with the degree of stenosis; although the sensitivity of myocardial scintigraphy increased progressively, that of angioscintigraphy doubled in cases of stenosis 90 p. 100 (stenosis less than 90 p. 100, sensitivity = 37 p. 100; stenosis greater than 90 p. 100, sensitivity = 73 p. 100). The sensitivity of myocardial scintigraphy with respect to the severity of the coronary artery disease was best in cases of right coronary artery stenosis (sensitivity in cases of RCA stenosis = 74 p. 100; sensitivity in LAD stenosis = 58 p. 100; sensitivity in left circumflex stenosis = 43 p. 100). The sensitivity of left ventricular angioscintigraphy was best in LAD stenosis (RCA stenosis = 50 p. 100, LAD stenosis = 64 p. 100, left circumflex stenosis = 36 p. 100). The sensitivity of both investigations was poor in left circumflex artery stenosis even when severely diseased. The sensitivity of both investigations was better in diffuse coronary artery disease: myocardial scintigraphy (single vessel disease: 72 p. 100, double vessel disease: 92 p. 100, triple vessel disease: 94 p. 100), left ventricular angioscintigraphy (61 p. 100, 69 p. 100, and 83 p. 100 respectively). Although the association of these two radioisotopic investigations does not improve diagnostic sensitivity, it does provide more information about the localisation and extension of the coronary artery disease especially in LAD and right coronary artery stenosis. These results suggest that these investigations are complementary in the evaluation of patients with coronary artery disease.(ABSTRACT TRUNCATED AT 400 WORDS)     

Usefulness of transthoracic color Doppler echocardiography for the identification of left anterior descending coronary artery stenosis.

We briefly describe our experience with transthoracic Doppler echocardiography for the direct evaluation of mid-distal left anterior descending coronary artery (LAD) stenosis. Three patients with previous myocardial infarction, scheduled for coronary flow reserve evaluation, underwent Doppler analysis of the mid-distal LAD. In all 3 cases, the mid-distal LAD stenosis was accurately quantified by the Doppler spectrum as confirmed by quantitative coronary angiography. Our study demonstrated the feasibility of transthoracic Doppler echocardiography in the discrimination of significant and non-significant mid-distal LAD stenosis. Limitations of such a technique could be related to the variable coronary anatomy and to the severity of the atherosclerotic process.     

121例心肌梗塞左心室乳头肌的病理分析

本文对１２８例冠心病左心室乳头肌的病变，结合临床进行了分析和讨论。其中左心室乳头肌查见不同程度的心肌梗塞１２１例（９４．５％）、冠状动脉多支粥样硬化Ⅳ级狭窄９８例（７６．５％）；９８例中乳头肌查见单一急性心肌梗塞（ＡＭＩ）２１例（２１．４％）、ＡＭＩ＋陈旧性心肌梗塞（ＯＭＩ）６４例（６５．３％）、单一ＯＭＩ１３例（１３．３％）。这显示冠状动脉粥样硬化多支Ⅳ级狭窄中乳头肌绝大多数有陈旧性合并ＡＭＩ。冠状动脉主干在粥样硬化狭窄的基础上并发血栓形成常导致乳头肌ＡＭＩ。本组２３例心脏破裂患者中有２０例在乳头肌查见有急性贯通性心肌梗塞。２５例左心室室壁瘤中左心室乳头肌查见ＯＭＩ＋ＡＭＩ１６例（６４％）占大多数。本文对左心室乳头肌病变与二尖瓣功能损伤的关系也进行了讨论。     

Left anterior descending artery length in left and right coronary artery dominance

BACKGROUND: Coronary stenosis of the left anterior descending artery (LAD) is respected by cardiologists because of its negative influence on morbidity and mortality. An important anatomical consideration is the length of the LAD. OBJECTIVE: To investigate the relationship between length of LAD and coronary dominance. DESIGN: Retrospective comparison of 100 consecutive angiograms with left coronary dominance with 100 consecutive angiograms with right coronary dominance. The relationship between the length of the LAD and coronary dominance was analyzed. METHODS: We retrospectively compared 100 consecutive angiograms with left coronary dominance (the posterior descending artery being supplied by the circumflex artery) with 100 consecutive angiograms with right coronary dominance (the posterior descending artery being supplied by the right coronary artery). LADs were categorized into three types: type A, LAD terminating before the cardiac apex; type B, LAD reaching the apex but not supplying the inferoapical segment of the left ventricle; and type C, LAD wrapping around the apex and supplying the inferoapical segment. LAD typing was also analyzed in relation to gender. RESULTS: It was found that the LAD wrapped around the apex in 87% of cases of left coronary dominance but only in 47% of patients with right coronary dominance, and that the long LADs were more frequently seen in women than in men, irrespective of coronary dominance. CONCLUSIONS: We found that the LAD in left coronary dominance is usually long and wraps around the apex, and believe that angiographic interventions in such cases have important clinical significance.     

右冠状动脉狭窄程度对左冠状动脉狭窄患者左室射血分数的影响

目的研究右冠状动脉不同程度狭窄对左冠状动脉狭窄患者左室射血分数（LVEF）的影响。方法根据左冠状动脉病变部位不同,将1 000例左冠状动脉狭窄患者分为左前降支（LAD）狭窄,左回旋支（LCX）狭窄,左主干（LM）狭窄,左前降支+左回旋支（LAD+LCX）狭窄4个系列。每个系列再根据右冠状动脉（RCA）病变程度不同分为RCA正常组（直径狭窄<50%）、RCA非闭塞组（99%>直径狭窄≥50%）和RCA闭塞组（直径狭窄≥99%）,比较分析3组间LVEF的差异。结果在LAD,LCX,LM,LAD+LCX狭窄时,与RCA正常组LVEF相比,RCA非闭塞组LVEF分别下降0.9%,0.3%,3.4%和2.8%;RCA闭塞组LVEF分别下降10.9%,3.7%,6.5%和5.2%。LAD狭窄时,RCA非闭塞组和RCA闭塞组之间LVEF有统计学差异（P<0.01）。结论右冠状动脉病变可在左冠状动脉狭窄的基础上使左室射血分数进一步下降;当左冠状动脉狭窄为闭塞性病变时,影响更为明显。     

多排螺旋CT冠脉成像与冠脉造影对冠心病诊断的对比研究

目的初步评价多排螺旋CT（MSCT）在冠状动脉成像中的临床应用价值。方法18例疑诊冠状动脉狭窄患者行MSCT扫描,利用影像曲面重建,3D重建,了解冠状动脉病变情况,并与冠状动脉造影（CAG）对比。结果18例76支血管同时经MSCT和CAG成像。CAG发现狭窄27支,其中左前降支（LAD）病变11支,回旋支（LCA）病变3支,左主干（LMA）2支,右冠（RCA）病变9支,桥支病变2支。MSCT发现狭窄24支,其中LAD病变11支,LCA病变3支,LMA病变1支,RCA病变7支,桥支病变2支。MSCT与CAG结果相符的病变血管22支,MSCT成像的敏感性为82%（22/27）,特异性96%（47/49）。结论在控制心率的情况下MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

Evaluation of myocardial bridging of the left anterior descending coronary artery by 64-slice multidetector computed tomographic angiography

The purpose of this study was to use the unique characteristics of multidetector computed tomographic coronary angiography to evaluate the prevalence and characteristics of myocardial bridging (MB) in a large series of patients and to assess the relation between atherosclerosis and MB. Three hundred consecutive coronary angiograms obtained by 64-slice multidetector computed tomography were evaluated retrospectively. For comparison of symptoms and concomitant atherosclerosis, 245 patients were included in the study and categorized into group 1 (n = 108) with MB and group 2 (n = 137) with no MB in the left anterior descending coronary artery (LAD). Axial and multiplanar reformatted images of all arteries were analyzed for the presence of measurable obstructive coronary disease (>25% stenosis) and minor luminal (<25% stenosis) calcified and noncalcified plaque and for MB in the LAD. Longitudinal and cross-sectional views were used for MB measurements. MB was found in 44% of patients (108 of 245) and was present equally in men and women (45% and 41%, p = NS). The mid LAD was the most common location (66%, p <0.001). There were no atherosclerotic lesions within the MB segments. The presence of MB did not influence the presence or severity of atherosclerotic lesions in the nonbridged segments of the LAD. In conclusion, MB as demonstrated by 64-slice multidetector computed tomographic coronary angiography is more common than previously reported by coronary angiography. The bridged segment appears to be free of atherosclerosis.     

Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries

BACKGROUND AND AIM OF THE STUDY: A number of clinical and experimental studies have suggested that aortic valve stenosis (AS) is a manifestation of atherosclerotic process. Previous studies have revealed a decreased coronary flow velocity reserve (CFR) in AS patients in consequence of left ventricular hypertrophy. The hypothesis was tested that the elastic properties of the descending aorta of AS patients might indicate signs of stiffness of the aorta. METHODS: The CFR and indices of aortic distensibility as functional markers of the descending aorta were compared in three different patient populations: (i) control subjects without valvular and coronary artery disease; (ii) patients with AS with normal epicardial coronary arteries; and (iii) patients with significant left anterior descending coronary artery (LAD) stenosis. CFR measurements were carried out according to a standard protocol, using vasodilatory stimulation with dipyridamole (0.56 mg/kg for 4 min), and peak diastolic velocity measurements at 6 min. The elastic properties of the aorta were calculated from echocardiographic parameters and blood pressure data. RESULTS: The CFR in AS patients was decreased to a similar extent as in patients with LAD stenosis. The aortic distensibility indices were similarly significantly increased in patients with AS and normal epicardial coronary arteries and with LAD stenosis, as compared with controls. CONCLUSION: These results indicate that the descending aorta exhibits appreciable increased stiffness in AS patients with normal epicardial coronary arteries.     

Single vessel coronary disease. I. Differences in clinical and prognostic aspects and in surgical results in isolated lesions of the anterior descending branch and of other coronary branches]

This study includes 290 patients having a 75% or greater stenosis of a sinlge coronary vessel, divided into two groups: 205 cases with isolated lesions of the left anterior descending coronary artery (LAD) and 85 with a stenosis of the circumflex (CF) or of the right (RCA) coronary artery. The following data have been compared in the two groups: -- characters of angina; -- results of stress testing; -- extent of left ventricular contraction impairment; -- natural history of unoperated patients; -- surgical risk; -- long term survival of operated patients; -- effect of medical or surgical treatment on symptoms. Results were as follows: -- LAD patients had slightly more severe symptoms and lower exercise tolerance than CF and RCA patients; -- no significant differences were noted as regards left ventricular contraction; -- five year survival rates were only slightly different both regarding unoperated patients (80 +/- 5% survival in LAD disease group; 86 +/- 5% in CF and RCA disease) and operated cases (83 +/- 5% in LAD lesions, 86 +/- 7% in CF and RCA disease); -- surgical risk was relatively low in both groups; -- progress of symptoms after bypass surgery was very favourable. Based on these results, indications for surgery in single coronary vessel disease are discussed.