冠状动脉CT造影的无创血流储备分数(FFR_(CT))在冠心病诊治中的研究进展

<正>目前临床上诊断冠心病最常用和最重要的方法是无创冠状动脉CT造影(coronary computed tomography angiography,CCTA)和有创的冠状动脉造影(invasive coronary angiography,ICA)。但二者仅能提供冠状动脉病变的解剖学信息,不能进行功能学评价。而临床上对冠状动脉病变的功能学评估(冠状动脉狭窄是否导致心肌缺血)决定了病变(特别是临界病     

Predictors of inaccurate coronary arterial stenosis assessment by CT angiography

ABSTRACT Objectives This study sought to investigate the clinical and imaging characteristics associated with diagnostic inaccuracy of computed tomography angiography （CTA） for detecting obstructive coronary artery disease （CAD） defined by quantitative coronary angiography （QCA）.     

The Different Patterns of Coronary Artery Calcification in Acute and Chronic Coronary Syndromes Determined by Electron Beam Computed Tomography

Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intracoronary ultrasound studies revealed sharp differences in the plaque morphology between patients with acute versus chronic coronary syndromes. Whether there are different patterns of coronary artery calcification in patients with stable angina pectoris (SAP) and in those with unstable angina pectoris (UAP) or acute myocardial infarction (AMI), however, remains unclear. Methods Two hundred and sixty - four patients, including 67 with SAP, 94 with UAP and 103 with AMI were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP     

16层螺旋CT冠脉钙化积分在冠心病诊断中的价值

研究表明,冠状动脉钙化几乎仅发生于冠状动脉粥样硬化的部位,因此,冠状动脉钙化能可靠地反映冠状动脉粥样硬化的情况.冠状动脉钙化积分(coronary artery calcification score,CACS)可检测冠状动脉钙化,并对其作定量分析,对于发现冠状动脉粥样硬化的存在并在一定程度上评价冠状动脉硬化及狭窄情况有着重要的临床意义.多层螺旋CT (multislice spiral computed tomography,MSCT)是目前检测冠状动脉钙化的最佳手段.本研究利用16层螺旋CT结合回顾性心电门控技术,将钙化积分方法应用于CAD的诊断,并与选择性冠状动脉造影(selective coronary angiography,SCA)对照,评价多层螺旋CT对冠心病的诊断价值.     

Interaction between APOB gene polymorphism and risk factors in coronary heart disease patients without lipid-lowering treatment

正Objective To investigate the association between APOB gene R532W polymorphism and the risk of coronary heart disease(CHD)in patients without lipid-lowering treatment and to analyze the interactions between the variation of R532W and different risk factors of CHD.Methods CHD and non-CHD were diagnosed according to coronary artery angiography(CAG)and/or coronary computed tomography angiogram(CTA)results,as well     

一种新的、无创的血流储备分数检查

随着多排螺旋CT(multi-slice computed tomography,MSCT)的迅速发展,CT冠状动脉造影(CT coronary angiography,CTCA)已成为临床无创诊断冠心病的重要手段[1-3]。CTCA因其具有较高的时间分辨率与空间分辨率,可以准确地提供冠状动脉解剖学诊断信息,对冠状动脉狭窄病变的诊断有着较高的准确性,特别是超高的阴性预测值使其可作为排除冠心病诊断的重要手段。但CTCA假阳性的比率及易高估病变严重程度的特点,一定程度上限制其在临床的应用。     

Atherosclerotic plaque burdens in type 2 diabetes

In this issue of the Journal of Geriatric Cardiology,Huang et al. have reported the detection of coronary artery disease with electron-beam computed tomography (EBCT),utilizing non-contrast and contrast imaging techniques (EBCTA) in several subgroups including type 2 diabetes mellitus (DM), impaired glucose tolerance (IGT), coronary heart disease, and normal subjects. ……     

320排动态容积CT冠状动脉成像与心肌灌注成像的相关性研究

目的探讨320排动态容积CT冠状动脉成像(computed tomography coronary angiography,CTCA)显示的冠状动脉狭窄程度与CT心肌灌注成像(CT myocardial perfusion imaging,CT-MPI)显示的心肌灌注缺损之间的相互关系。方法对60例冠状动脉疾病患者行CTCA及CT-MPI检查,将其结果进行统计学处理,并进行Spearman等级相关分析。结果 CTCA显示冠状动脉左前降支(left anterior descending,LAD)、左回旋支(left circumflex artery,LCX)、右冠状动脉(right coronary artery,RCA)180支,其中正常冠状动脉56支,狭窄冠状动脉124支。按照LAD、LCX、RCA三支冠状动脉供血范围统计,CT-MPI显示86支冠状动脉灌注正常,94支冠状动脉存在灌注缺损。结论冠状动脉狭窄程度与心肌灌注缺损存在正相关的关系。     

Flash双源CT冠状动脉成像的临床应用

冠状动脉CT成像（coronary computed tomography angiographv，CCTA）是近年发展的一种有效地无创冠状动脉成像手段。传统的多层螺旋CT（MSCT）仅有一套X射线发生装置和一套探测器系统，旋转速度太小而无法达到足够大的分辨率，所以在扫描高速运动的冠状动脉时会显得力不从心。     

冠状动脉慢性完全闭塞病变计算机断层扫描血管成像的形态学特征

目的分析冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)在双源计算机断层扫描(computed tomography,CT)血管成像上的形态学特点,并评估具有指导经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗价值的形态学特征。方法回顾性分析经冠状动脉造影(coronary angiography,CAG)证实为CTO病变患者的术前冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)影像资料。评估并记录CCTA上所显示的各形态学指标,包括病变位置、闭塞血管长度、闭塞段血管近端呈钝形、闭塞段血管出现钙化;与CAG结果相比较,分析两者间显示的差异。结果 80例患者(82个CTO病变)CCTA结果显示82支血管闭塞,CCTA诊断CTO病变的敏感度为95.12%,特异度为97.14%;冠状动脉CTO病变45例(54.88%)位于右冠状动脉,CCTA测量闭塞段长度显著小于CAG测量所得,差异具有统计学意义[(28.29±14.15)mm vs.(38.90±23.48)mm,P0.001]。CCTA显示闭塞段血管近端呈钝形19例(23.17%),与CAG对照一致。CCTA显示58个(70.73%)CTO病变闭塞段血管内可见点状、结节状、条片状钙化灶,而CAG显示闭塞段血管存在钙化55个(67.07%),两者间比较差异无统计学意义(P0.05)。结论双源CT诊断冠状动脉CTO病变有较高敏感度及特异度,且可以显示闭塞段长度,近端形态及闭塞段钙化等有利于指导PCI治疗的形态学特征。     

基于无创冠状动脉CT造影的血流储备分数在冠心病诊治中的研究进展

<正>冠心病目前是人们关注度最高的心血管疾病。临床上影像学诊断冠心病最常用的方法有两种:无创冠状动脉CT造影(coronary computed tomography angiography,CCTA)和有创冠状动脉造影(invasive coronary angiography,ICA)。然而,这两种方法仅可以从解剖学角度评价冠状动脉是否狭窄及判断狭窄的程度,并不能从血流灌注情况评价冠状动脉病变     

Relationship between coronary artery calcification and outcomes in maintenance hemodialysis patients

正Objective To evaluate the relationship between coronary artery calcification(CAC)and outcomes in maintenance hemodialysis(MHD)patients.Methods Eighty-six patients who were on MHD between October2014 and May 2015 in the blood purification center of our hospital were enrolled prospectively.CAC was measured and scored by multiple slice computed tomography     

Quantitative analysis of cardiac vein system of normal adults in different phase of cardiac cycle

<正>Objective To quantitatively measure the coronary system parameters at different phase of cardiac cycle in normal adults by 256-slice computed tomography,and to provide normal reference ranges of coronary sinus,mainly branch diameter,sectional area in different phase of cardiac cycle. Methods A total of 70 patients (30 men,     

Different therapeutic proportion of patients undergone coronary angiography in the era of development in MSCT

Objective To study the different therapeutic proportion of the patient populations undergone coronary angiography (CAG) in the era of development in multislice spiral computed tomography(MSCT).Methods Two hundred and fifty four consecutive patients(mean age 59.24±10.65),who underwent CAG at Daxing Hospital from February 2007 through October 2007,were enrolled,160 patients were male and 94 were female.By evaluating from the coronary angiogram,the patients were not diagnosed to have coronary heart disease(CHD) with less than 50% diameter stenosis of coronary artery;the patients to have CHD with more than or equal to 50% stenosis of coronary artery;the patients were performed the procedure of percutaneous coronary intervention(PCI) with more than or equal to 70% stenosis;the patients were proposed to have coronary aortic bypass graft(CABG) surgery with left main coronary artery lesions or diffuse triple coronary artery lesions.Results In the 254 consecutive patients,59 patients(23.2%) had not been diagnosed to have CHD;195(76.8%)to have CHD,of these patients with CHD,49 patients(19.3%)were not indicated for PCI (including the patients receiving follow-up coronary angiography after stenting),81(31.9%)had been performed the procedure of stent implantation,57(22.4%)proposed to have CABG,8(3.1%)the procedure of PCI had not been successful,or had not been performed because of patients opposing to this therapy.Conclusion Multislice spiral computed tomography can be applied as a non-invasive screening tool to exclude the presence of CHD,to increase the positive proportion of the populations with CHD in all patients receiving coronary angiograhpy,to avoid the use of CAG in a subset of patients.     

冠状动脉CT血管成像在冠心病介入诊疗中的研究进展

<正>随着经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的不断发展,影像学技术在冠心病临床诊疗中的价值日益凸显。其中,冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)作为无创性心脏影像学技术的代表,在此领域的应用已不仅仅局限于估测冠状动脉病变的解剖学狭窄程度,而且有助于制定更加合理的介入治疗方案。本文根据最新研究,对CCTA在评估     

Quantitative analysis of coronary sinus venous system of normal adults by multi-slice computed tomography

正Objective To quantitatively measure the coronary sinus,mainly branch diameter,sectional area in normal adults by multi-slice computed tomography (MSCT) and analyze the relationship between the above imaging indexes and the gender and age. Methods A total of 95 subjects (40 men,55 women; mean age 53. 93±14. 08     

Molecular imaging of plaques in coronary arteries with PET and SPECT

Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lu-men stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increas-ingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography （PET） and single photon emission computed tomography （SPECT） has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging tech-niques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coro-nary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.     

从自发性冠状动脉夹层到动脉壁内血肿1例

自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)常见于无冠状动脉粥样硬化危险因素的年轻女性,多表现为急性冠脉综合征(acute coronary syndrome,ACS),需要紧急行冠状动脉造影(coronary angiography,CAG)并结合血管内超声(intravascular ultrasound,IVUS)或光学相干断层扫描(optical coherence tomography,OCT)影像检查明确,给予药物治疗、经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)或外科治疗.本文以1例SCAD患者2次诊治经过为背景,讨论了SCAD的病因、发病机制、临床表现、诊断及治疗策略.     

Percutaneous coronary Intervention for ostial occlusion lesion of an anomalous right coronary artery

Ostial lesions present many challenges for percutaneous coronary intervention （PCI）. Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wtre technique and focused-force angloplasty（J Genatr Cardio12009, 6：189-192）.     

Effect of muscle mass reduction on the progression of coronary artery calcification in maintenance hemodialysis patients

<正>Objective To evaluate the extent and progression of coronary artery calcification in maintenance hemodialysis(MHD) patients,and to explore the risk factors of rapid progression of coronary artery calcification in MHD patients.Methods The patients who underwent MHD in the Huashan Hospital affiliated to Fudan University from January 1,2013 to December 31,2017 were enrolled.This study included cross-sectional study and prospective cohort study.Multi-slice spiral computed tomography was use...