心电图正常的冠心病心绞痛患者冠状动脉造影特点

目的:为了解静息心电图正常的冠心病心绞痛患者冠状动脉(冠脉)造影特点,以提高诊断水平。方法:对268例静息心电图正常的冠心病心绞痛患者的冠脉造影结果进行分析。结果:冠脉造影显示2～3支血管病变201例,占75.0％,单支血管病变58例,占21.6％。201例2～3支血管病变中173例(86.1％)血管狭窄部位相互对应。2支血管病变为前降支和右冠者多见,占47.0％(63/134),单支血管病变以前降支者多见,占46.6％(27/58)。82.8％(48/58)单支血管狭窄为50％～74％。单纯左主干病变2例。结论:冠心病心绞痛患者冠脉2～3支血管病变者心电图正常与血管狭窄部位相互对应有关,单支血管病变与狭窄程度较轻有关。对临床上心电图正常疑为冠心病的患者,应及早做冠脉造影检查以明确诊断。     

世居西藏高原藏族冠心病患者78例冠状动脉病变特点

目的:通过冠状动脉(冠脉)造影检查分析世居西藏高原藏族冠心病患者冠脉病变的特点。方法:对2009-03至2010-12完成冠脉造影并确诊为冠心病的78例世居藏族患者冠脉病变的特点进行统计与比较。结果:生活在海拔3000 m以上的世居藏族冠心病患者冠脉病变血管构成比分别为左前降支病变42.8%,右冠脉病变27.0%,左回旋支病变24.5%,中间支病变4.4%,左主干病变1.3%。病变类型构成比分别为局限性狭窄54.1%,完全闭塞18.9%,弥漫性狭窄17.0%,长管状狭窄10.1%。病变血管支数分别为单支51.3%,双支28.2%,三支20.5%。年龄<50岁、50～59岁、≥60岁三个不同年龄段以及心肌梗死者与非心肌梗死者之间病变类型及病变血管支数差异均无统计学意义。结论:世居高原藏族冠心病患者冠脉病变具有左前降支病变多见、局限性狭窄病变及单支病变多见的特点。     

45岁以下冠心病患者临床和冠状动脉造影特点分析

目的 探讨45岁以下冠心病患者的临床和冠状动脉造影特点.方法 选择2006年4月-2010年5月在本院住院治疗的冠心病患者1 795例,从中选出45岁以下冠心病的所有患者175例作为A组.选择2007年4月-2009年4月在本院住院治疗的冠心病患者898例,采取整群抽样方法从中选出60岁以上的冠心病患者464例作为B组,进行对比分析,对45岁以下冠心病的临床以及冠状动脉造影的特点进行分析总结.结果 A组男性、吸烟、吸安纳咖、血脂异常、急性心肌梗死、冠脉造影和冠心病家族史比例均明显高于B组(P＜0.05或P＜0.01),而A组高血压病、糖尿病均低于B组(P＜0.01).A组患者单支病变高于B组(P＜0.01),A组单支病变中前降支有50例(87.7%);A组三支病变、双支病变、右冠脉、旋支病变及侧支循环建立比例低于B组(P＜0.05或P＜0.01);左主干病变、前降支病变及冠脉狭窄程度两组间无统计学意义.无意义病变A组高于B组(P＜0.01).结论 45岁以下冠心病患者多数以急性心肌梗死就诊;与男性、吸烟、体力活动少、处于高度紧张和工作压力大、血脂异常及有冠心病家族史者关系密切,冠状动脉造影特点多数为局限性病变;约一半为单支病变,且以前降支单支病变为主;部分患者冠脉造影未见有意义病变,且以心肌梗死为主;2支及3支病变、右冠脉及旋支病变、侧支循环建立比例低于60岁以上冠心病患者;冠脉狭窄程度及前降支病变、左主干病变与60岁以上冠心病患者相似.     

冠心病合并2型糖尿病的冠脉造影特点分析

目的探讨冠心病合并2型糖尿病的冠脉造影特点。方法随机选择该院2017年1月—2018年3月间来该院就诊的冠心病患者100例,分为糖尿病组(观察组)和非糖尿病组(对照组),并对两组患者冠脉造影特点进行分析。结果观察组患者冠脉造影病变以多支病变及弥漫性长病变为主。而对照组冠脉造影结果以单支病变及双支病变为主,差异有统计学意义(P0.05);观察组中重度狭窄程度高于对照组,轻中度狭窄低于对照组,差异有统计学意义(P0.05)。结论冠心病合并2型糖尿病患者冠脉病变多表现为弥漫性及多支病变,血管受累广泛,病变重,预后较差,临床上要提高对该类患者的风险认识,加强管理。     

老年冠心病合并糖尿病患者的临床及冠状动脉病变特点

目的探讨老年冠状动脉粥样硬化性心脏病(冠心病)合并糖尿病患者临床特点及冠状动脉(冠脉)病变特征分析。方法选取商洛市山阳县人民医院于2014年1月~2017年6月经冠脉造影诊断为冠心病,且年龄65岁的患者250例,按照是否合并糖尿病分为糖尿病组和非糖尿病组各125例。统计患者一般临床资料及入院24 h内实验室结果。根据冠脉狭窄直径≥50%累及左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)或左主干(LM)分为单支、双支(累及左主干为双支)及三支病变组。根据Gensini积分标准对每例患者进行评分。结果冠心病合并糖尿病组空腹血糖(FPG)较非糖尿病组明显升高(P0.001)。糖尿病组冠脉三支病变发生率高于非糖尿病组(P0.001),单支病变、两支/左主干病变发生率低于非糖尿病组(P0.001)。与非糖尿病组相比,糖尿病组冠脉病变部位累及LAD、LCX和RCA更多,两组比较差异有统计学意义(P0.05)。与非糖尿病组比较,糖尿病组冠脉病变支数更多、Gensini积分更高(P0.001)。结论冠心病合并糖尿病患者冠脉病变更广泛和严重,具有更高致死风险。     

稳定型心绞痛和不稳定型心绞痛与同型半胱氨酸水平的相关性

目的探讨稳定型心绞痛和不稳定型心绞痛与同型半胱氨酸水平的相关性。方法选取128例入院患者的临床资料进行回顾性分析,其中78例患者经冠脉造影或冠脉CTA确诊为冠心病,50例患者经冠脉造影或冠脉CTA检查确诊无冠心病作为对照组,测定其血清同型半胱氨酸水平。将78例冠心病患者根据冠状动脉发生病变的支数分为单支病变组和多支病变组,不同病变支数患者比较其同型半胱氨酸水平。根据冠状动脉的狭窄程度对78例冠心病患者分为中度狭窄组和重度狭窄组,对比不同狭窄程度患者的同型半胱氨酸水平。结果对照组患者的同型半胱氨酸水平明显低于冠心病组(P0.05),其中稳定型心绞痛组患者的同型半胱氨酸水平明显低于不稳定型心绞痛组(P0.05),单支病变组患者的同型半胱氨酸水平明显低于多支病变组(P0.05),中度狭窄组患者的同型半胱氨酸水平明显低于重度狭窄组(P0.05),冠脉病变程度和同型半胱氨酸水平呈正相关。结论无冠心病对照组较冠心病组患者的同型半胱氨酸水平均明显降低;稳定型心绞痛较不稳定型心绞痛的同型半胱氨酸水平明显降低,冠状动脉病变支数、冠脉病变程度与高同型半胱氨酸水平存在密切的联系,同型半胱氨酸水平与冠脉狭窄病变程度呈正相关。     

平板运动试验阴性的冠心病患者62例冠状动脉造影分析

目的 :为了解平板运动试验阴性的冠心病患者临床与冠脉病变特点 ,以提高诊断水平。方法 :对平静心电图正常及平板运动试验阴性而冠状动脉造影确诊为冠心病的 6 2例患者的临床资料及冠状动脉造影结果进行分析。结果 :冠心病危险因素 :高脂血症 40例 （6 5 %） ,高血压病 2 8例 （45 %） ,糖尿病 16例 （2 6 %） ,吸烟者 30例 （48%）。冠状动脉造影显示 2～ 3支血管病变占 6 5 %（40 / 6 2 ） ,包括左主干受累 4例 ;单支血管病变占 36 %（2 2 / 6 2 ）。 2～ 3支血管病变 40例中 34例 （85 %）血管狭窄部位相互对应。2支血管病变为前降支和右冠者多见 ,占 5 4%（14/ 2 6 ） ,单支血管病变以前降支者多见 ,占 5 9%（13/ 2 2 ）。73%（16 / 2 2 ）单支血管狭窄为 5 0 %～ 74%。结论 :对临床疑为冠心病的患者 ,即使平板运动试验阴性也应及早作冠脉造影检查以明确诊断。     

冠心病患者抑郁障碍与冠脉病变狭窄程度的相关研究

目的观察冠心病患者抑郁障碍与冠脉病变狭窄程度的关系。方法对108例冠脉造影证实为冠心病患者采用zung抑郁自评量表(SDS)测试评分,同时对冠脉病变狭窄程度进行Leaman评分,分析SDS评分与冠脉病变评分的关系。结果 108例冠心病患者中有47.2%存在抑郁障碍,无抑郁组以单支冠状动脉病变为主,轻中度抑郁组以单支和双支冠脉病变为主,严重抑郁组以3支冠脉病变为主,抑郁组Leaman冠脉病变评分明显增高(P0.01),SDS评分与Leaman冠脉病变评分呈正相关(r=0.637,P0.01)。结论冠心病患者存在不同程度的抑郁,抑郁程度与冠脉病变狭窄程度正相关。临床可根据SDS评分评定抑郁障碍,从而指导和进行综合性治疗。     

心血管病危险因素与冠脉病变支数关系的分析

目的探讨冠心病患者冠状动脉血管病变支数与临床危险因素之间的关系。方法回顾性分析349例在我院心内科经冠脉造影诊断为冠心病患者的临床资料,依据冠状动脉造影结果分为单支病变组和多支病变组。应用SPSS13．0分析患者血管病变支数与年龄、性别、冠心病危险囚素（吸烟、高血压、糖尿病、高脂血症）的关系。结果多支冠脉血管病变组吸烟检出率为42％,单支冠脉血管病变组吸烟检出率为30％,两组比较差异有统计学意义（P〈0．05）;多支冠脉血管病变组患者糖尿病检出率为27％,单支冠脉血管病变组患者糖尿病检出率为13％,两组比较差异有统计学意义（P〈0．01）;多支冠脉病变组患者TC升高[（5．06±1．21）mmol／L],与单支冠脉血管病变组比较差异有统计学意义（P〈0．01）;单支冠脉病变患者LDL—C升高[（2．84±0．11）mmol／L],多支冠脉病变组LDL—C升高[（3．06±0．42）mmol／L],两组比较差异有统计学意义（P〈0．01）。多支冠脉血管病变患者平均年龄明显高于单支冠脉血管病变患者,差异有统计学意义（P〈0．01）;多支冠脉血管病变患者高血压检出率57％,单支冠脉血管病变患者高血压检出率47％,两组间比较差异无统计学意义（P〉0．05）;性别构成比、HDL—C水平两组间比较差异无统计学意义（P〉0．05）。结论吸烟或糖尿病患者,以及TC升高、LDL—C升高患者易发生多支冠脉血管病变;随着年龄的增长,患冠心病多支病变比例明显增高。     

冠心病合并糖尿病患者冠脉造影特点及冠脉支架置入术疗效分析

目的分析探讨冠心病合并糖尿病患者冠脉造影特点及冠脉支架置入术的临床疗效。方法选取我院于2015年11月-2017年2月收治的冠心病合并糖尿病患者65例和单纯冠心病患者65例,分别作为实验组和对照组,两组患者均行冠脉造影,并实施临床常规冠状动脉支架置入术治疗,记录并比较两组患者的冠脉造影特点、治疗有效率以及并发症发生情况等临床指标。结果两组患者的冠脉造影特点比较,实验组患者三支病变、多支多节段病变居多,发病率较高分别为32.31%、36.92%;对照组患者单支病变、双支病变居多,发病率较高分别为41.54%、38.46%;两组患者均有不同程度的血管狭窄,实验组患者的血管狭窄程度较对照组显著更严重(P0.05)。两组患者的临床疗效、并发症发生情况比较,两组患者手术治疗有效率均为100%,无手术失败例,比较无显著差异(P0.05);两组患者的复查结果显示,均无复发例,比较无显著差异(P0.05);两组患者在术后,均未出现严重并发症,实验组有3例患者出现心绞痛,对照组无并发症发生。结论冠心病合并糖尿病患者较单纯冠心病患者的冠脉病变更复杂、严重,但实施冠脉支架置入术均得到了有效的治疗,术后复发率,低取得了不错的临床疗效,且无严重并发症发生,具有较高安全性,值得临床推广应用。     

左、右冠状动脉病变心肌缺血症状的对比

目的:比较冠状动脉粥样硬化性心脏病(CHD)右冠状动脉(RCA)病变与左冠状动脉(LCA)病变心肌缺血症状的差异。方法:将408例CHD患者分为急性心肌梗死(AMI)组和心绞痛(AP)组。在AMI组中,比较RCA病变与LCA病变在AMI前心肌缺血症状的差异。在AP组中,根据冠状动脉造影结果分为单支血管病变和多支血管病变两个亚组,统计各亚组RCA与LCA病变检出率的差异。结果:在AMI组中,LCA病变组在AMI前有心肌缺血症状的患者明显较RCA病变组多(P<0.05)。在AP组中,多支病变亚组中RCA病变检出率和LCA病变检出率差异不明显(P>0.05),而单支病变亚组中RCA病变检出率明显低于LCA病变检出率(P<0.001)。结论:RCA病变时心肌缺血症状少,甚至缺乏,不易被发现。     

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。     

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     

Aortic pulse pressure is associated with the localization of coronary artery disease based on coronary flow lateralization

BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (CAD). Besides, the left coronary artery (LCA) has a predominantly diastolic flow while the right coronary artery (RCA) receives systolic and diastolic flow. Thus, we hypothesized that increased systolic-diastolic pressure difference had a greater atherogenic effect on the RCA than on the LCA.MethodsA random sample of 433 CAD patients (145 females, 288 males, mean age 65.0 ± 11.1 years) undergoing coronary angiography at Staten Island University Hospital between January 2005 and May 2008 was studied. Coronary lesion was defined as a ≥50% luminal stenosis. Patients were divided into three groups, with isolated LCA lesions (n = 154), isolated RCA lesions (n = 36) or mixed LCA and RCA lesions (n = 243).ResultsAPP differed significantly between groups, being highest when the RCA alone was affected (67.6 ± 20.3 mm Hg for LCA vs. 78.8 ± 22.0 for RCA vs. 72.7 ± 22.6 for mixed, P = 0.008 for analysis of variance (ANOVA)). Age and gender were not associated with CAD location. Heart rate was associated with CAD location, lowest in RCA group, and negatively correlated with APP. However, left ventricular ejection fraction (LVEF) was lower in the mixed CAD group and positively correlated with APP. The association between APP and right-sided CAD persisted in multivariate logistic regression adjusting for confounders, including heart rate, LVEF and medication use. A similar but less significant pattern was seen with brachial arterial pressures.ConclusionsAortic pulse pressure may affect CAD along with coronary flow phasic patterns.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.87.     

单纯右冠状动脉狭窄对左心室功能的影响

目的:探讨单纯右冠状动脉（RCA）狭窄不同狭窄程度和狭窄节段对左心室功能的影响。方法:将冠状动脉造影证实为单纯RCA狭窄的患者99例,按不同狭窄程度、不同狭窄节段和不同冠脉优势型进行分组,并与494例无冠状动脉狭窄的对照组比较,经左心室造影测定的左室射血分数（LVEF）和左室舒张末压（LVEDP）。结果:与对照组患者相比,轻度、中度和重度单纯右RCA狭窄患者的LVEF变化不显著,完全闭塞患者的LVEF显著下降（P<0.05）;右冠中段、右冠远段、后降支和侧后支病变患者的LVEF均无有意义变化,右冠近段病变患者LVEF下降有统计学意义（P<0.05）。单纯RCA狭窄患者中,右冠优势组LVEF略低于均衡优势组和左冠优势组,但差异未达显著水平。单纯RCA狭窄对LVEDP的影响并不明显。结论:单纯RCA主干近段狭窄和单纯RCA完全闭塞对左室收缩功能可产生一定程度的损害。     

Hypoplastic left coronary artery. In association with occlusive intimal thickening of a coronary artery with ectopic ostium and with atresia of the left coronary ostium

Two cases of hypoplastic coronary artery (HCA) are presented. Case 1, a 13 year old girl, died suddenly during a long distance race. She had HLCA with marked intimal thickening and an ectopic left coronary ostium above the commisure between the non-coronary and left coronary cusp at post mortem examination. The right coronary artery (RCA) was enlarged and also supplied parts of the area normally supplied by the left coronary artery (LCA). Pathological findings revealed a normal RCA and an extremely hypoplastic LCA with occlusive proliferation of the intima and a myocardial infarction of the left ventricle. Case 2, a 6 year old girl, had a history of effort angina. Selective coronary angiography was performed which failed to demonstrate the orifice of the LCA by aortography. However, the hypoplastic LCA was visualized by RCA angiography as a consequence of anomalous collaterals from the atrioventricular branch of the RCA. We postulate that HCA results from various conditions, including stenosis of the coronary artery orifice, an aberrant course between the pulmonary artery and aorta and ectopic positioning of the coronary artery ostium. In addition, HCA may also be associated with occlusive coronary artery abnormalities.     

Differential diagnosis of lesions of the left coronary artery trunk and multiple hemodynamically-significant stenoses of the coronary arteries

Clinical manifestations were compared in coronary patients with different sites and spread of coronary atherosclerosis, in order to assess the feasibility of differential diagnosis of left coronary arterial (LCA) trunk lesions versus multiple coronary arterial stenoses. Four groups of patients were examined: isolated third- or fourth-degree LCA trunk stenosis (15 patients, group 1); third- or fourth-degree stenosis of the anterior interventricular branch (AIVB) and the circumflex branch (CB) (44 patients, group 2); third- or fourth-degree stenosis of AIVB, CB or the right coronary artery (RCA) (77 patients, group 3); and third- or fourth-degree stenosis of AIVB, CB, the diagonal branch or RCA (33 patients, group 4). The clinical condition of patients with isolated LCA branch lesions was much worse than that of patients with multiple coronary arterial stenosis. Differential diagnosis is based on the severity of the pain syndrome, the spread of ischemic zone on resting ECG, the scope of past myocardial infarction, stress tolerance and the magnitude of ST depression in response to exercise.     

右冠状动脉长度与发生冠状动脉狭窄的关系

目的:研究右冠状动脉的长度和其发生冠状动脉狭窄的关系。方法:将100例右优势型冠状动脉病例分为2组:A组50例,右冠状动脉无明显狭窄;B组50例,右冠状动脉至少1处明显狭窄。测量2组右冠状动脉的长度。结果:A组右冠状动脉的平均长度为100~213mm,明显长于B组的67~177mm(P<0·01)。即使考虑年龄、性别和其他一些危险因素,2组间仍差异有统计学意义。结论:较短的右冠状动脉和发生粥样硬化病变有高度的关联。     

A case report of reversible collateral vessels between right and left coronary artery

We report a case of reversible collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). A 55 year-old woman was admitted to our hospital because of chest oppression. Cardiac catheterization revealed 99% stenosis to seg. 1. We found good collateral vessels from LCA to RCA. We performed PTCA (Percutaneous Transluminal Coronary Angioplasty) on this lesion. PTCA was successful and this lesion improved (99%----40%). After PTCA, collateral vessels had disappeared. After one year, the patient had chest oppression on effort again. We performed cardiac catheterization and found 90% stenosis to seg. 6. So we performed PTCA on the new lesion. During balloon inflation, we found good collateral vessels from RCA to LCA (reversible collateral flow). We considered that reversible collateral flow was important for myocardial protection.     

Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management.

To clarify the natural history and management of patients with aberrant origin of a coronary artery from the aorta, we reviewed 18 patients whose right (RCA) or left (LCA) coronary artery arose aberrantly and passed between the aorta and right ventricular infundibulum. Nine patients had aberrant LCA. Three young males died suddenly after exertion, each with proximal focal LCA stenosis. None of the six adults with angina (ages 36-70 years) studied angiographically had proximal LCA stenosis. Unlike the young, "sudden death-prone" patients in whom coronary bypass of proximal stenosis may have prophylactic value, our older patients with aberrant LCA did not have proximal stenosis or sudden death, and therefore LCA bypass for sudden death prophylaxis is not warranted. Nine patients (ages 18-60 years) had aberrant origin and course of the RCA. Seven patients studied angiographically because of angina had no focal proximal RCA stenosis, but two patients had hypoplastic RCA ostia. Although a potential concern in these latter patients, sudden death has not been reported with aberrant RCA, therefore in the absence of syncope, RCA bypass for sudden death prophylaxis is not indicated.