多巴酚丁胺负荷及运动试验^99mTc—MIBI心肌断层显像与冠状动脉…

比较６９例冠心病患者多巴酚丁胺负荷＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与８２例运动试验＾９９ｍＴＣ－ＭＩＢＩ心肌断层显像的结果，以探讨它们对冠心病的诊断价值，结果表明；以冠状动脉造影结果为标准，多巴酚丁胺负荷诊断冠心病的敏感性和特异性分别为９１．２％和８０．０％，运动试验分别为８９．４％和８２．９％，多巴酚丁胺负荷检出冠出冠状动脉病变的敏感性和特异性，左前降支为７８．１％和９１．     

多巴酚丁胺负荷试验^99mTc—MIBI心肌断层显像诊断冠心病的应用

为探讨多巴酚丁胺药物负荷试验替代运动试验进行核素心肌断层显像的临床价值，４０例患者通过微量输液泵静脉给予多巴酚丁胺，逐渐加量，至高峰时注射＾９９ｍＴｃ－甲氧基异丁基异腈，之后行心肌图像采集，４８小时再行静息达心肌显像。３１例冠心病患者中３０例多巴酚丁胺负荷试验阳性，９例非冠心病患者中２例阳性，其特异性为７７．８％，灵敏度为９６．８％，无１例因多巴酚丁胺副作用而停止试验，因此，多巴酚丁胺试验核素心肌     

硝酸甘油酯介入~(99m)Tc-MIBI心肌断层显像与多巴酚丁胺负荷超声心动图判定存活心肌的比较

为比较硝酸甘油酯（ＮＴＧ）介入９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与小剂量多巴酚丁胺负荷超声心动图（ＤＳＥ）在判断急性心肌梗塞（ＡＭＩ）后病人存活心肌中的一致性，对３６例ＡＭＩ病人分别进行了ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像和小剂量（＜１０μｇ·ｋｇ－１·ｍｉｎ－１）的ＤＳＥ检查，所有检查均在病人入院后２～３周内完成。结果：在心肌静态显像示梗塞的１０９个节段中，ＮＴＧ显像４３个为存活节段，存活心肌检出率为３９％；在基础状态下超声心动图示梗塞的９４个节段中，ＤＳＥ检查３５个为存活节段，其存活心肌检出率为３７％，两者间差异无显著性（χ２＝０１０５，Ｐ＞００５）。在两法共同检出的９２个梗塞节段中，均存活的节段为２９个，均未存活的节段为４９个，两法的一致性为８４８％（７８／９２，Κ＝０６８）。因此，ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像与ＤＳＥ检查均为判断ＡＭＩ后病人存活心肌的安全、可靠的方法，两法具有良好的一致性。     

99mTc-MIBI延迟心肌断层显像评估存活心肌的初步临床研究

目的评价４小时９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）延迟显像在评估心肌活力方面的价值。方法对３０例冠心病（ＣＡＤ）病人（１８例经冠状动脉造影证实）进行常规静息和４小时延迟９９ｍＴｃＭＩＢＩ心肌断层显像。对其中１０例经冠状动脉血运重建术治疗的病人术后３５６±１９２天进行心肌断层显像随访。将左室心肌划分为９个节段。采用四点计分法对各节段核素分布进行半定量评价（摄取正常＝３，重度降低或缺损＝０）。结果３０例ＣＡＤ病人常规静息显像示１２６个（４６７％）节段核素分布异常，延迟显像示１０５个（３８９％）节段核素分布异常。常规静息显像心肌计分≤１（“无活力”）的节段有９３个；延迟显像时３６４％的０分节段和５３１％的１分节段计分改善≥１。延迟显像与冠状动脉血运重建术后显像对比，判断存活心肌的阳性预测值为８４２％，阴性预测值为９００％，预测准确率为８７２％，两者有良好的一致性（χ２＝２１５９，Ｐ＜００１）。结论９９ｍＴｃＭＩＢＩ延迟心肌显像，通过一次给药可较有效地克服静息心肌显像低估心肌活力的不足，对判定缺血心肌活力状态方面具有临床实用价值     

^99mTc—MIBI心肌灌注显像与电子束CT诊断冠心病的比较

目的比较９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌ＳＰＥＣＴ显像与电子束ＣＴ（ＥＢＣＴ）冠状动脉钙化（ＣＡＣ）定量积分对冠心病诊断的价值。方法２１例经冠状动脉造影确诊的病人同时进行９９ｍＴｃＭＩＢＩ心肌ＳＰＥＣＴ显像（潘生丁介入试验）及ＥＢＣＴ检查，以冠状动脉造影为金标准，以决策矩阵法评价心肌ＳＰＥＣＴ及ＥＢＣＴ的临床应用价值。结果心肌ＳＰＥＣＴ显像灵敏度为９１％，特异性为８０％，准确性为８６％；ＥＢＣＴ以钙化积分≥１００为阳性标准，则其灵敏度、特异性和准确性分别为５５％、１００％及７６％。结论心肌ＳＰＥＣＴ显像和ＥＢＣＴ冠状动脉ＣＡＣ定量积分法均为非创伤性检查法，对冠心病的诊断各具优势及局限性，有互补作用     

潘生丁负荷99mTc-MIBI心肌断层显像诊断川崎病心肌缺血的价值

潘生丁负荷９９ｍＴｃＭＩＢＩ心肌断层显像诊断川崎病心肌缺血的价值于宪一朴英爱韩玉昆魏克伦李志杰裴著果张彩霞川崎病可累及冠状动脉，导致心肌梗塞。本研究采用潘生丁负荷９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像，探讨无创性诊断川崎病心肌缺血的价...     

100例~（99m）Tc—MIBI次极量运动心肌断层显像与冠状动脉造影对比研究

本文报道了１００例９９ｍＴｃ—ＭＩＢＩ次极量运动心肌断层显像与冠状动脉造影的对比研究，结果表明，９９ｍＴｃ一ＭＩＢＩ次极量运动心肌断层显像对陈旧性心肌梗塞病变的检出率和对病变范围的估价优于心电图。本组心绞痛患者９９ｍＴｃ—ＭＩＢＩ心肌断层显像诊断敏感性为９３％，特异性７９％，运动心电图对心绞痛诊断的敏感性为５９％，特异性７９％。９９ｍＴｃ—ＭＩＢＩ次极量运动心肌断层显像是判断心肌缺血敏感可靠的方法。     

多巴酚丁胺~(99m)Tc-MIBI心肌断层显像对检测心肌梗塞后残余心肌缺血的价值

目的：评价多巴酚丁胺９９ｍＴｃ－甲氧基异丁基异晴心肌断层显像（Ｄｏｂｕ－ＥＣＴ）检测心肌梗塞后残余心肌缺血的价值。材料与方法：６２例心肌梗塞患者在行冠状动脉造影时进行多巴酚丁胺心肌断层显像检查。结果：Ｄｏｂｕ－ＥＣＴ对心肌梗塞后残余心肌缺血检出率为７７％，高于多巴酚丁胺心电图负荷试验（Ｄｏｂｕ－ＥＣＧ）。无论是１支，还是２支或３支血管病变，Ｄｏｂｕ－ＥＣＴ对心肌梗塞后残余心肌缺血的检出率均高于Ｄｏｂｕ－ＥＣＧ（５６％，４％；８６％，２７％；１００％，４７％；Ｐ＜０．０１）。２１例急性心肌梗塞行溶栓治疗患者残余心肌缺血率为６７％，低于未行溶栓治疗患者（７２％）或陈旧性心肌梗塞患者（９４％），但差异无显著性。Ｄｏｂｕ－ＥＣＴ对非梗塞区心肌缺血的检出率为５６％。结论：多巴酚丁胺９９ｍＴｃ－甲氧基异丁基异晴心肌显像能够识别心肌梗塞后有无残余心肌缺血及其部位和范围。     

多巴酚丁胺^99mTc—MIBI心肌断层显像对检测心肌梗塞后残…

目的：评价多巴酚丁胺＾９９ｍＴｃ－甲氧基异丁基异晴心肌断层显像检测心肌梗塞后残余心肌缺血的价值。材料与方法：６２例心甩梗塞患者在行冠状动脉造影时进行我巴酚胺心肌以显像检查。结果：Ｄｏｂｕ－ＥＣＴ对心肌梗塞后残余心肌缺血检出率为７７％，高于多巴酚丁胺心电图负荷试验。无论是１支，还是２支或３支血管病变，Ｄｏｂｕ－ＥＣＴｃｆ ｎｙ ｅｍｎ ｓｇｊｑｐｆｊｆｒｇ ｇｑｇｔｗｔｕ ｎｙ ｅｍｎ ｒｍｎｗｔｌ     

急诊~(99m)Tc-MIBI心肌显像在不典型急性心肌梗塞诊断及溶栓治疗中的应用(附5例报告)

为探讨急诊９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像在不典型急性心肌梗塞（ＡＭＩ）诊断及溶栓治疗中的价值，对５例不典型ＡＭＩ患者静脉注射９９ｍＴｃＭＩＢＩ后２小时进行心肌断层显像。结果，５例患者均明确了诊断，其中２例在６小时内进行了溶栓治疗，通过第二次心肌显像，支持临床冠状动脉再通判断。因此，急诊９９ｍＴｃＭＩＢＩ心肌显像对不典型ＡＭＩ的诊断具有特殊的价值；同时，对判断溶栓疗效，估价预后也具有一定的意义。     

Non-invasive assessment of coronary artery geometry using coronary CTA

AimTo assess the association of coronary artery geometry with the severity of coronary artery disease (CAD).Methods73 asymptomatic individuals at increased risk of CAD due to peripheral vascular disease (18 women, mean age 63.5 ± 8.2 years) underwent coronary computed tomography angiography (coronary CTA) using first generation dual-source CT. Curvature and tortuosity of the coronary arteries were quantified using semi-automatically generated centerlines. Measurements were performed for individual segments and for the entire artery. Coronary segments were labeled according to the presence of significant stenosis, defined as >70% luminal narrowing, and the presence of plaque. Comparisons were made by segment and by artery, using linear mixed models.ResultsOverall, median curvature and tortuosity were, respectively, 0.094 [0.071; 0.120] and 1.080 [1.040; 1.120] on a per-segment level, and 0.096 [0.078; 0.118] and 1.175 [1.090; 1.420] on a per-artery level. Curvature was associated with significant stenosis at a per-segment (p < 0.001) and per-artery level (p = 0.002). Curvature was 16.7% higher for segments with stenosis, and 13.8% higher for arteries with stenosis. Tortuosity was associated with significant stenosis only at the per-segment level (p = 0.002). Curvature was related to the presence of plaque at the per-segment (p < 0.001) and per-artery level (p < 0.001), tortuosity was only related to plaque at the per-segment level (p < 0.001).ConclusionCoronary artery geometry as derived from coronary CTA is related to the presence of plaque and significant stenosis.     

Influence of coronary dominance on coronary artery calcification burden

ObjectiveTo evaluate the influence of coronary artery dominance on observed coronary artery calcification burden in outpatients presenting for coronary computed tomography angiography (CCTA).MethodsA 12-month retrospective review was performed of all CCTAs at a single institution. Coronary arterial dominance, Agatston score and presence or absence of cardiovascular risk factors including hypertension (HTN), hyperlipidemia (HLD), diabetes and smoking were recorded. Dominance groups were compared in terms of calcium score adjusted for covariates using analysis of covariance based on ranks. Only covariates observed to be significant independent predictors of the relevant outcome were included in each analysis. All statistical tests were conducted at the two-sided 5% significance level.Results1223 individuals, 618 women and 605 men were included, mean age 60 years (24–93 years). Right coronary dominance was observed in 91.7% (n = 1109), left dominance in 8% (n = 98), and codominance in 1.3% (n = 16). The distribution of patients among Agatston score severity categories significantly differed between codominant and left (p = 0.008), and codominant and right (p = 0.022) groups, with higher prevalence of either zero or severe CAC in the codominant patients. There was no significant difference in Agatston score between dominance groups. In the subset of individuals with coronary artery calcification, Agatston score was significantly higher in codominant versus left dominant patients (mean Agatston score 595 ± 520 vs. mean 289 ± 607, respectively; p = 0.049), with a trend towards higher scores in comparison to the right-dominant group (p = 0.093). Significance was not maintained upon adjustment for covariates.ConclusionsWhile the distribution of Agatston score severity categories differed in codominant versus right- or left-dominant patients, there was no significant difference in Agatston score based on coronary dominance pattern in our cohort. Reporting and inclusion of codominant subsets in larger investigations may elucidate whether codominant anatomy is associated with differing risk.     

冠心病患者冠状动脉侧支循环形成的形态学特点分析

目的:分析国人冠状动脉侧支循环的形态学特点。方法:将265例冠心病病人的冠状动脉造影结果进行分析,按Levin的方法进行分类,并与之比较。结果:不同狭窄程度两组间侧支循环开放率差别有高度统计学意义(X2=14.43,P<0.001)。三支血管间侧支循环开放率差别均有统计学意义(X2=3.96,X2=4.28,P<0.05)。东、西方组冠状动脉各支病变的侧支分布的比较差别有高度统计学意义(右冠状动脉X2=9.68,P<0.01;左冠状动脉X2=41.73,P<0.001;左冠状动脉旋支X2=8.54,P<0.01。结论:冠状动脉侧支循环的形成与冠状动脉狭窄程度及病变血管有关。中国人的冠状动脉侧支循环具有独特性。     

CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

双源CT冠脉成像在冠脉狭窄诊断中的价值

价节段达到94.98%(625/658),图像优良率95.52%(597/625).DSCT诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值分别为91.8%、98.3%、94.4%、97.5%,其中对左主干、左前降支及右冠状动脉的敏感性及特异性达到95%,对角支、左回旋支分支及有冠状动脉远端的诊断敏感性有所下降,分别为86.0%、71.4%、76.9%.结论 在不控制心率的情况下,DSCT诊断冠脉狭窄安全可靠,可广泛用于冠心病患者的筛查、冠状动脉手术/支架术前评估及术后随访.     

Relationship of epicardial fat volume to coronary plaque,severe coronary stenosis,and high-risk coronary plaque features assessed by coronary CT angiography

BackgroundAssociations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.ObjectivesThis study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).MethodsWe retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling.ResultsThere were 402 patients with a median age of 66 years (range, 23–92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm³ vs 89 ± 39 cm³), PCP (110 ± 57 cm³ vs 98 ± 45 cm³), and NCP (115 ± 44 cm³ vs EFV 100 ± 52 cm³). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3–6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9–3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1–5.1; P = 0.02) but not of positive remodeling.ConclusionsEFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.