单一影像与融合影像对比评价2型糖尿病冠状动脉病变对心肌血供影响的研究

目的:比较单一影像即核素心肌灌注显像(MPI)与融合影像即MPI/冠状动脉(冠脉)计算机断层摄影术(CT)成像(CCTA)技术,评价2型糖尿病冠脉病变对心肌血供的影响及两种影像技术的诊断效能。方法:确诊2型糖尿病且怀疑或确诊合并冠心病85例,1个月内均行常规二日法腺苷负荷/静息MPI和冠脉造影,其中38例利用单光子发射计算机断层摄影术/CT,完成同机CCTA即MPI、MPI/CCTA。MPI采用心肌17分段5级评分法,及负荷总评分(SSS)对心肌血供做定性及半定量评价;冠脉造影和CCTA按常规将冠脉病变程度分为正常;轻、中、重度;以冠脉造影、冠脉造影联合MPI为参考标准评价MPI、MPI/CCTA融合影像诊断致心肌血供异常的冠脉病变的效能。结果:85例患者,MPI提示正常/异常为22/63例;MPI的诊断效能为:敏感性、特异性、准确性、阳性预测值和阴性预测值分别为80.19%、88.59%、85.10%、83.33%和86.27%;轻度20例(24%),中度12例(14%),严重31例(36%)。38例完成同机CCTA的患者中,以冠脉造影、冠脉造影联合MPI为对照标准,单一的MPI与MPI/CCTA融合影像评价2型糖尿病冠脉病变与心肌血供关系的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为74.55%与96.97%、81.36%与91.67%、78.07%与94.74%、78.85%与94.12%和77.42%与95.65%。MPI/CCTA融合影像示:正常40.35%[46/114(段/支)],中度以上狭窄冠脉59.65%[68/114(段/支)]。结论:MPI/CCTA融合影像评价2型糖尿病冠脉病变对心肌血供影响的效能明显高于单一MPI,对2型糖尿病早期冠心病诊断有重要临床价值。     

冠状动脉成像与核素心肌显像评价功能相关性冠状动脉病变的对比研究

目的 以单光子发射计算机断层(SPECT)心肌灌注显像(MPI)为参考标准,采用双源CT冠状动脉成像(DSCTCA)评价功能相关性冠状动脉病变(FRCAL)的准确性.方法 59例临床疑诊冠心病的患者,行DSCTCA、99Tcm-甲氧异丁基异腈(MIBI)SPECT心肌灌注显像及冠状动脉造影(CCA)检查,将DSCTCA冠状动脉直径狭窄≥50%定义为狭窄,并与MPI表现进行对比分析,DSCTCA评价以CCA为标准.结果 (1)DSCTCA和CCA间的一致性好(按患者计算Kappa=0.93,按血管计算Kappa=0.88).(2)DSCTCA发现34例60支86个节段的冠状动脉有狭窄.(3)MPI检出25例患者的45处心肌灌注缺损区,其中可逆缺损19处、部分可逆缺损21处、恒定缺损5处.(4)以MPI为参考标准,DSCTCA检出65.0%(39/60)的病变冠状动脉为FRCAL;DSCTCA检出心肌灌注缺损的敏感度、特异度、准确度、阳性预测值、阴性预测值,以患者计算分别是92.0%、67.6%、78.0%、67.6%、92.0%,以血管计算分别是86.7%、89.0%、88.6%、65.0%、96.6%.(5)ROC分析发现DSCTCA与CCA在预测FRCAL时有相似的诊断价值,其曲线下面积(AUC)分别是:0.80、0.82.结论 DSCTCA可以间接评价FRCAL,DSCTCA结果为阴性时,有助于排除FRCAL,而异常的DSCTCA结果需结合MPI综合评价.     

核素心肌灌注显像血流定量技术在冠状动脉微血管功能障碍中的应用进展

冠状动脉微血管功能障碍(CMD)广泛存在于包括冠心病在内的多种心血管疾病中。核素心肌灌注显像血流定量技术,包括正电子发射断层成像(PET)和单光子发射计算机断层成像(SPECT),可无创测定心肌血流量和冠状动脉血流储备用于CMD的评估。现就PET和SPECT血流定量分析在CMD中的应用进展进行综述。     

多巴酚丁胺负荷201Tl心肌断层显像对冠状动脉病变的诊断

目的 :探讨多巴酚丁胺 (DOB)负荷 2 0 1Tl心肌单光子发射计算机断层显像对冠状动脉病变的诊断价值。方法 :对 70例临床确诊或疑诊冠心病的患者在冠状动脉造影前后 2周内进行 DOB负荷 2 0 1Tl心肌断层显像。结果 :DOB2 0 1Tl心肌断层显像诊断冠心病的敏感性为 93.3% ,特异性为80 .0 % ;单、双、三支冠状动脉受累时的敏感性为 90 .9%、93.7%、10 0 % ;心肌显像对左前降支、回旋支和右冠状动脉病变诊断的敏感性和特异性分别为 6 8.5%、75.0 % ,4 2 .9%、97.6 %和 81.6 % ,87.5%。负荷试验终点时双支、三支血管病变 DOB用量明显低于单支病变用量 (P <0 .0 1)。试验中未见严重不良反应。结论 :DOB2 0 1Tl心肌断层显像对冠状动脉病变有一定的诊断价值     

99mTc-MIBI心肌灌注断层显像在冠心病冠状动脉内支架置入术的应用

目的 :应用硝酸甘油 (NTG)介入 ,单光子发射计算机断层显像 (SPECT)检查估测冠状动脉 (冠脉 )介入治疗前后存活心肌的大小、范围。方法 :对 42例冠心病患者行静息及NTG介入SPECT心肌显像检查 ,应用阅片计分法、极坐标靶心图定量分析法估测心肌活力。以 19例接受经皮腔内冠脉成形术 (PTCA)加冠脉内支架置入 (Stent)术后静息显像结果为“金标准” ,评价NTG介入显像对心肌活力检测效果。结果 :静息显像及NTG介入SPECT显像其不规则感兴趣区内放射性稀疏缺损面积、放射性计数、放射性异常计分差异有显著性意义 (t分别为 7.5 43、4.6 0 8、6 .76 2 ,均 P <0 .0 0 1)。静息显像检测出存活心肌为 5 6 .3% ,NTG介入显像为 6 9.6 %。NTG介入显像估测存活心肌准确率为阅片计分法 80 .9% ,定量分析法 90 .5 %。结论 :NTG介入SPECT检查可提高存活心肌检出率 ,为冠脉内支架置入术治疗提供客观依据     

影像融合技术在冠状动脉慢性闭塞病变介入治疗中的应用研究

目的：探讨影像融合技术在冠状动脉慢性闭塞病变介入治疗中的应用。方法：选取2019年8月至2020年1月,我院50例冠状动脉慢性闭塞病变患者,随机平均分为对照组和观察组,各25例。对照组单纯冠状动脉造影指导开通,观察组通过融合技术指导开通,分别对比分析两组患者手术并发症发生率,造影剂使用量及射线暴露时间等。结果：观察组总辐射时间、放射剂量、总手术时间、导丝数量、导丝通过时间与对照组比较,差异有统计学意义（P <0.001）。观察组支架置入数量及平均住院日与对照组比较,差异无统计学意义（P> 0.05）。观察组住院总费用与对照组比较,差异有统计学意义（P <0.05）。术后随访中观察组与对照组比较,肌酐值、NTpro-BNP两组差异有统计学意义（P <0.05）。结论：影像融合技术在冠状动脉慢性闭塞病变介入治疗中的应用,减少造影剂使用量及射线暴露时间。     

无创心脏影像学检查在冠心病诊断中的临床应用价值

正以往对冠心病的诊断和治疗取决于冠状动脉解剖狭窄的程度,因此,有创的冠状动脉造影(coronary angiography,CAG)成为诊断冠心病的金标准。但是,近年研究结果显示,冠状动脉解剖学狭窄对心肌灌注和心肌灌注储备的影响更重要,心肌灌注异常是冠心病心肌缺血的第一个临床表现[1]。如何更早发现和确定患者是否存在心肌灌注和心肌灌注储备异常则成为近年学者们共同关注的一个焦点。随     

计算机断层摄影术冠状动脉造影诊断冠心病和评价冠状动脉病变的价值

目的:研究计算机断层摄影术冠状动脉(冠脉)造影(CTCA)在急性胸痛患者中诊断冠心病和评价冠脉病变程度的价值.方法:回顾性入选133例临床诊断为不稳定性心绞痛的急性胸痛患者,分别接受64排CTCA和冠脉造影检查.以定量冠脉造影(QCA)为诊断标准,评价CTCA诊断冠心病和冠脉病变程度的准确性.结果:CTCA诊断冠心病的敏感性93.4%,阳性预测值94.2%.Pearson相关分析示:CTCA和冠脉造影评价的冠脉直径狭窄程度显著相关(P<0.001).Logistic回归分析示,钙化程度是CTCA诊断冠心病敏感性的独立影响因素(RR=2.37,95%CI:1.35-4.18,P=0.003).ROC曲线分析显示,钙化积分对预测冠脉三支血管存在≥50%或≥75%狭窄有预测作用,P均<0.05.结论:CTCA在急性胸痛患者中对冠心病的筛查和冠脉病变程度的评价有较高价值.     

电子束计算机断层摄影术检出冠状动脉钙化诊断冠心病的再评价

目的：评价电子束计算机断层摄影术（ＥＢＣＴ）平扫诊断冠心病的价值。方法：５６８例进行冠状动脉造影的患者，于冠状动脉造影前进行冠状动脉ＥＢＣＴ检查。采用心电触发单层序列平扫。以冠状动脉造影存在１支以上的管径狭窄≥５０％为诊断冠心病标准。结果：５６８例患者中，冠心病患者３７６例，无冠心病患者１９２例。冠心病患者的冠状动脉钙化计分（２８３．８５±５６３．６３）明显高于非冠心病患者（３３．４６±９２．１１，Ｐ＜０．００１）。以ＥＢＣＴ有无冠状动脉钙化判断冠心病的敏感性、特异性及准确性分别为８２．９８％、６６．６７％及７７．４６％。在５０岁以下（不含５０岁，５０岁以下组）的患者，冠状动脉钙化判断冠心病的特异性和阳性预测值较５０岁以上（５０岁以上组）患者高，但敏感性较低；５０岁以下组的患者，左回旋支及右冠状动脉钙化预测冠心病的价值高于前降支钙化。结论：ＥＢＣＴ发现的冠状动脉钙化对冠心病诊断有重要意义，尤其对５０岁以下组的患者，冠状动脉钙化其价值更大     

单光子发射型计算机断层心肌灌注显像对经皮冠状动脉腔内成形术的近期疗效评估

目的：探讨单光子发射型计算机断层摄影术（ＳＰＥＣＴ）心肌灌注显像在评估经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗冠心病效果中的作用。方法：通过运动—静息心肌灌注显像，观察ＰＴＣＡ前后患者运动试验结果、心肌各心室壁节段放射性异常积分及靶心图缺损范围的变化。结果：ＰＴＣＡ后患者运动耐量增加；放射性异常积分及靶心图缺损范围明显缩小，说明近期缺血明显改善。８例多支病变患者中，有６例仅进行部分血运重建，心肌灌注显像示缺血严重、范围广的心肌节段，其相关血管多为“罪犯”（ｃｕｌｐｒｉｔ）血管。结论：ＳＰＥＣＴ心肌灌注显像对ＰＴＣＡ近期疗效评估具有较高的实用价值，并可为ＰＴＣＡ前判断需要扩张的关键性病变血管提供帮助。     

冠状动脉病变:影像学与生理学评价

近年来,冠心病仍然是世界范围内威胁人类健康的主要死因,冠状动脉造影长久以来一直被认为是评价冠状动脉病变的影像学"金标准"。然而对于一些复杂病变如分叉病变、易损斑块及临界病变等,应用冠状动脉造影评价冠状动脉病变略显局限。因此,为了满足临床需要,新的影像学及生理学评价技术应运而生,目前用于评价冠状动脉病变的有创性或无创性技术有:血管内超声、光学相干断层成像、血流储备分数等。他们各有千秋,并在心血管领域发挥重要的作用。     

Cockcroft_Gault方程估算GFR对冠状动脉病变的评估

目的探讨Cockcroft_Gault方程估算肾小球滤过率与冠状动脉狭窄程度的研究。方法冠状动脉造影确定为冠心病者253例为冠心病组,以Gensini积分对冠状动脉病变程度进行评分并分级,168例冠状动脉粥样硬化狭窄程度50%患者为对照组,通过Cockcroft_Gault方程估算两组患者的肾小球滤过率,分析冠状动脉病变与估算肾小球滤过率之间的关系。结果冠心病组与对照组的估算肾小球滤过率分别为:(61.13±11.10)[m L/(min×1.73m2)]和(77.92±11.80)[m L/(min×1.73m2)](P0.05),差异有统计学意义。冠状动脉轻度、中度和重度病变组,估算肾小球滤过率分别为(66.73±14.56)[m L/(min×1.73m2)],(63.83±15.45)[m L/(min×1.73m2)]和(57.23±14.37)[m L/(min×1.73m2)],差异有统计学意义(P0.05)。结论 Cockcroft_Gault方程估算的肾小球滤过率可作为评估冠状动脉病变的临床参考指标。     

SPECT Imaging for Detecting Coronary Artery Disease and Determining Prognosis by Noninvasive Assessment of Myocardial Perfusion and Myocardial Viability

Basic knowledge of active and passive transport mechanisms for concentrating monovalent cations in myocardial cells led to the investigation of the application of radioisotopes of potassium, thallium, rubidium, and ammonia to the in vivo noninvasive assessment of regional myocardial perfusion and viability utilizing gamma camera or positron emission tomographic (PET) imaging technology. Subsequently, technetium-99m (Tc-99m)-labeled isonitriles (sestamibi and tetrofosmin), which bind to mitochondrial membranes, emerged as superior imaging agents with single photon emission tomography (SPECT) imaging. When any of these imaging agents are injected intravenously during either exercise or pharmacologic stress, myocardial defects in tracer uptake represent either abnormal regional flow reserve or myocardial scar reflecting of coronary artery disease (CAD). The major clinical indications for stress SPECT or PET myocardial perfusion imaging are for detection of CAD as the cause of chest pain and risk stratification for prognostication. Patients with normal stress myocardial perfusion scans have an excellent prognosis with <1.0% annual rate future annual death or nonfatal infarction. The greater the extent and severity of ischemic perfusion defects (defects seen on stress images but improve on resting images), the greater the subsequent death or infarction rate during follow-up. Rest imaging alone is performed for determination of myocardial viability in patients with CAD and severe left ventricular dysfunction. Myocardial segments showing >50% uptake compared to normal uptake have a better long-term outcome with revascularization than with medical therapy with enhanced left ventricular function and improved survival. Other applications of SPECT imaging include the evaluation of cardiac sympathetic function, assessment of myocardial metabolism in health and disease, and molecular imaging of coronary atherosclerosis and myocardial stem cell therapy.     

A Novel Technique in the Use of Fractional Flow Reserve in Coronary Artery Bifurcation Lesions

The side branch (SB) in bifurcation lesions is a frequently encountered challenge that interventional cardiologists must face. There is great interest in determining fractional flow reserve (FFR) in the SB to help guide treatment decisions; however, difficulty with the pressure guidewire limits its widespread use. We propose a novel technique that will ease the incorporation of FFR in routine evaluation of bifurcation lesions, and allow better assessment of provisional stenting and need for SB intervention. Conventionally, to measure SB FFR, the jailed SB is re-crossed through the stent strut using a pressure wire. Our technique involves the use of a microcatheter and wire exchange within the SB, thereby alleviating some of the technical difficulties associated with the FFR wire. In light of the difficulties and clinical concerns associated with bifurcation lesions, we propose an innovative method to ease the incorporation of FFR to allow better assessment of provisional stenting and need for SB intervention.     

Effect of Presence of Ramus Intermedius Artery on Location of Culprit Lesions in Acute Left Circumflex Coronary Artery Occlusion

Background and aimCoronary artery anatomy frequently affects location of atherosclerotic plaques and subsequent culprit lesions. We sought to clarify whether presence or absence of Ramus Intermedius coronary artery (RI) would affect location of culprit lesions in acute left circumflex (LCX) coronary artery occlusion.MethodsThe study included 180 patients, 100 with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) and 80 with ST elevation myocardial infarction (STEMI). All culprit lesions were located in the LCX coronary artery. RI group included 45 patients and the No RI group included 135 patients.ResultsCulprit LCX lesions were similarly located at a comparable distance from LCX ostium in both groups and the presence of RI was not associated with significantly more proximally located culprit LCX lesions (34.7 ± 15.2 mm compared to 30.8 ± 17.9 mm respectively, p > 0.05). The frequency distribution of culprit lesions’ distance from LCX ostium showed no significant difference between both groups in any of the segments studied (10 mm each). There was no significant difference between both groups regarding markers of myocardial necrosis size as cardiac biomarkers (peak cardiac troponin-T 1077.4 ± 361.2 pg/dl vs 926 ± 462.2 pg/dl respectively, p = 0.13), (peak creatine kinase-MB 232.2 ± 81 ng/dl vs 194.7 ± 99.2 ng/dl respectively, p = 0.07) or left ventricular ejection fraction (EF 46.3 ± 6.3% vs 48.3 ± 8.3% respectively, p = 0.76).ConclusionPresence of RI coronary artery, as an additional flow divider, may not be associated with more proximal culprit lesions, compared to its absence, in cases of acute LCX coronary artery occlusion. Possible underlying pathophysiologic mechanisms remain to be clarified.