冠心病患者中肾动脉狭窄发病率及危险因素的临床研究

目的 探讨冠心病患者中肾动脉狭窄的发生率及危险因素。方法 103例行冠状动脉造影的患者同时行肾动脉造影，并对高血压、糖尿病、吸烟、高胆固醇血症等危险因素进行分析。结果 非冠心病患者中肾动脉狭窄发生率为0％，冠心病中为29％，1支、2支、3支病变肾动脉狭窄发生率分别为0％、10％、69．2％。对危险因素分析发现，冠脉病变支数及吸烟为肾动脉狭窄的最危险因素。结论 对多支冠状动脉病变应常规行肾动脉造影分析，肾动脉狭窄严重者先干预肾动脉再进一步干预冠状动脉。     

冠心病合并肾动脉狭窄危险因素及临床意义

目的：探讨冠心病合并肾动脉狭窄的发病率及危险因素，以及冠状动脉造影同时行肾动脉造影的必要性。方法：对114例接受冠状动脉造影患者同时行肾动脉造影。结果：114例患者，肾动脉狭窄发病率18．4％，经冠状动脉造影证实77例冠心病中肾动脉狭窄发病率为26．0％，冠状动脉造影正常37例中肾动脉狭窄发病率为2．7％。冠心病患者中肾动脉狭窄发病率明显高于非冠心病组（2.7%与26．0％，P＜0．01）。结论：冠心病患者有较高的肾动脉狭窄发生率，为了进一步治疗冠心病，应该在冠状动脉造影明确冠状动脉病变后，常规行肾动脉造影。     

冠状动脉造影同时行选择性肾动脉造影的临床意义

目的评估冠状动脉(冠脉)造影的同时行选择性肾动脉造影的可行性、安全性及其临床意义.方法2001年7月至2002年7月,共纳入792例在冠脉造影后即刻行选择性双侧肾动脉造影的病人,分析肾动脉造影情况、肾动脉狭窄发病率及其相关因素,并随机抽取145例病人测定其手术前后血清肌酐变化.结果冠脉造影同时行双侧肾动脉选择性造影成功率高(99.6%),造影病人术前后血清肌酐无明显变化(78μmol/L±11μmol/L;77μmol/L±3μmol/L,P＞0.05);肾动脉狭窄总体发生率为19.1%(151/792),明显狭窄(＞50%)占7.2%(57/792),双侧肾动脉明显狭窄发生率为4%(32/792);多因素分析显示肾动脉明显狭窄与年龄(＞70岁)、高血压、多支冠脉病变显著相关.结论在冠脉造影病人中行选择性双侧肾动脉造影安全、可行,对准确发现肾动脉狭窄有重要意义.     

粥样硬化性肾动脉病变与冠心病关系的研究

目的了解粥样硬化性肾动脉病变(ARAD)与冠心病(CAD)之间的关系。方法对254例临床疑诊或确诊CAD的患者进行冠状动脉造影的同时行肾动脉造影,并收集相关临床资料。结果肾动脉狭窄≥25%~50%、>50%~75%、>75%~100%的3组患者CAD的发生率分别为86.2%、90.4%、81.8%(P>0.05),而各组冠状动脉3支病变发生率均明显高于单支和双支病变(P<0.05);CAD患者中肾动脉狭窄>50%的两组患者临床表现严重心力衰竭和急性冠状动脉综合征的比例明显高于肾动脉狭窄≤50%的两组患者(P<0.05)。结论粥样硬化性肾动脉病变,而不是狭窄程度可以预测CAD及其严重程度,但明显肾动脉狭窄可能增加CAD患者严重心力衰竭和急性冠状动脉综合征的发生。     

冠心病患者行肾动脉造影的临床意义

[目的]探讨冠心病患者动脉粥样硬化性肾动脉狭窄(RAS)的发生率和危险因素.[方法]对行冠状动脉造影的484例患者同时进行肾动脉造影.[结果]在冠心病患者中,RAS的发生率为12.1%(38/314).RAS的发生率随着冠状动脉病变程度的加重而增加(P<0.01).[结论]对冠心病患者,尤其多支病变,应根据病情需要行肾动脉造影.     

肾动脉狭窄患者的尿蛋白及血脂分析

目的研究经冠状动脉造影确诊为冠状动脉粥样硬化性心脏病(冠心病),同时行肾动脉造影确诊为肾动脉狭窄患者的24小时尿蛋白定量及血脂水平.方法对比分析12例肾动脉狭窄患者及16例肾动脉无狭窄患者的24小时尿蛋白定量及血清总胆固醇、甘油三酯水平.结果肾动脉狭窄患者24小时尿蛋白定量较肾动脉无狭窄患者高,血清总胆固醇及甘油三酯水平则无明显差异.结论对动脉粥样硬化患者,如果24小时尿蛋白定量升高,排除了肾小球疾病引起尿蛋白升高的疾病后,需高度怀疑肾动脉狭窄.在动脉粥样硬化的患者中,血脂水平并非引起肾动脉狭窄的决定因素.     

冠状动脉造影患者中肾动脉狭窄的相关研究

动脉硬化性肾动脉疾病（renal artery disease RAD）和其他动脉硬化性血管疾病包括冠状动脉疾病，常常是共存的。作者通过前瞻性设计，对200例怀疑冠心病而行冠状动脉造影的患者常规给予肾动脉造影，旨在了解肾动脉狭窄发生率以及与之相关的危险因素。     

冠状动脉粥样硬化与肾动脉狭窄关系研究

目的 探讨肾动脉狡窄与冠状动脉粥样硬化之间的关系。方法 对305例一临床拟诊的冠心病患者,进行冠状动脉造影和腹主动脉造影检查。对两组患者的动脉粥样硬化的易患因素进行独立t检验、趋势X^2检验、线性关联分析、多元logistic回归分析。结果 接受冠状动脉造影和腹主动脉数字减影检查的305倒患者中,肾动脉狭窄发生率为12．8％,经冠状动脉造影证实的172例冠心病患者中,肾动脉狡窄的发生率为22．3％;冠状动脉造影完全正常的103例患者中,无1例有肾动脉狭窄及病变存在。多元Logistic回归分析表明,年龄〉60岁,有冠心痛者,血肌酐≥100μmol／L是肾动脉狡窄的独立预测因素。结论 对冠心病患者,尤其是年龄〉60岁、血肌酐≥100μmol／L的患者,在冠状动脉造影时应进行常规腹主动脉造影检查,而对冠状动脉造影正常者,可不作为常规检查。     

冠心病与肾动脉狭窄相关性研究

目的：评价冠心病与动脉硬化性肾动脉狭窄的相关性，以及引起肾动脉狭窄的危险因素。方法：１９９７年６月￣１９９９年１２月，对临床诊断或怀疑冠心病需要行冠状动脉造影的患者，在冠状动脉造影同时常规进行肾动脉造影，同时调查动脉粥样硬化的常见易患因素及血肌酐水平与肾动脉狭窄的关系。结果：２６０例进行造影的患者中，３０％（７９／２６０）患者有肾动脉狭窄，其中肾动脉明显狭窄４１例（１６％），轻度狭窄３８例（１５％     

冠心病患者颅外颈动脉狭窄的发生率及危险因素

目的 观察可疑冠心病者颅外颈动脉狭窄（ECCAS）的发生率,评价致ECCAS的危险因素.方法 对106例患者行冠状动脉造影（CAG）后作颈动脉数字减影血管造影（DSA）;据CAG结果分正常及冠心病组,后者分为1、2、3支病变组;据DSA结果分为无ECCAS及有ECCAS组,后者分为轻、中、重度狭窄;危险因素与ECCAS的关系用单变量及多变量Logistic回归分析.结果 冠心病组ECCAS发生率（36.5%）明显高于对照组（6.3%）（P〈0.01）;冠状动脉病变程度与ECCAS程度显著正相关（rs=0.431,P〈0.01）;老龄（OR=1.183,P〈0.01）、高血压（OR=5.456,P〈0.01）、冠状动脉病变程度（OR=1.799,P〈0.05）是ECCAS的独立危险因素.结论 同时行CAG和颈动脉DSA显示,ECCAS多见于有高血压的老年严重冠心病患者.     

Aortoiliac Angiography During Coronary Artery Angiography Detects Significant Occult Aortoiliac and Renal Artery Atherosclerosis in Patients with Coronary Atherosclerosis

PURPOSE: Peripheral atherosclerosis (renal and aortoiliac localizations) are frequently detected in aged patients with concomitant coronary artery disease (CAD): the risk of finding peripheral disease is increased in patients with CAD. Angiography of the aortoiliac vessels performed at the time of coronary angiography may detect any occult renal artery stenosis and atherosclerotic involvement of the aortoiliac segment. We sought to determine utility of performing angiography of aortoiliac and renal arteries during coronary arteriography in patients with known or suspect coronary atherosclerosis. METHODS: Medical records of all patients undergoing combined coronary and aortoiliac angiography between May 1998 and December 2002 was retrospectively reviewed. Moderate to severe arterial stenosis (>50% stenosis), vessel occlusion, aneurismal vessels were noted as significant angiographic findings. Contrast-induced nephropathy was defined as a rise in serum creatinine of > or =25% form baseline. RESULTS: In the study period 112 patients (81 males, mean age 68.4+/-7.8 years) with known or suspected CAD underwent combined cardiac catheterization and aortoiliac angiography. Pretreatment with 0.45% saline at a rate of 1 ml/kg/h for 12 h was administered to all patients. Significant findings were reported in 37 (33%) patients including 14 renal artery stenoses, 8 aortic aneurismal disease, and 15 aortoiliac lesions. Most patients with significant findings had 2 and 3-vessel CAD. A strong correlation was found between the number of risk factors and the frequency of angiographic findings (r = 0.92). Complications include six contrast-induced nephropathy: no case required renal replacement therapy. CONCLUSIONS: Aortoiliac and renal atherosclerosis is frequently associated to multivessel CAD. In selected patients undergoing cardiac catheterization aortoiliac angiography may be practical in detecting occult renal or aortoiliac artery lesions. Further clinical outcome studies are strongly required to support this strategy.     

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

Background: Identification of peripheral vascular disease by angiography in patients undergoing coronary angiography may be considered as malpractice but sometimes seems to be justified under clear entry criteria. The present mata-analysis is aimed to analyze the appropriateness and results of screening angiography of subclavian or abdominal aorta performed at the time of coronary angiography. Methods: A search of published literature for peripheral angiography in patients undergoing coronary angiography over the last 10 years was performed using the MEDLINE database. No language restriction was employed. Only studies enrolling more than 100 patients for abdominal aortography and 50 patients for subclavian/internal mammary artery angiography were considered. Reference lists from identified studies were also reviewed to identify other potentially relevant references. Results: Twenty-nine studies were retrieved: 8 articles about subclavian artery (SA) and internal mammary (IMA) angiography and 21 about renal (RA) and aortoiliac (AOI) angiography. The total number of patients enrolled was 27,936. Nine studies out of 29 were prospective. Defined entry criteria were reported in 24 out of 29 studies. Significant SA and IMA stenosis were reported in 5.5 and 9% of patients, respectively. RA stenosis >50% was present in 12.7% of patients with CAD. Finally, undetected AOI disease was reported in 35.5% of patients undergoing coronary angiography. Mean complication rate was 0.8 ± 0.6%. Predictors of SA and IMA stenosis were unclear. Age, multi-risk profile, multi-vessel CAD, history of PVD or carotid disease, severe hypertension, unexplained renal dysfunction or decreased creatinine clearance have been reported most frequently as predictors of RA and AOI disease in patients undergoing coronary angiography. Conclusions: Consistent evidence of appropriateness of renal angiography in selected patients undergoing coronary angiography have been produced in literature. IMA and AOI angiography seem to be not justified unless they are part of SA in patients scheduled for arterial conduit with brachial differential pressure, thoracic irradiation or surgery, or of abdominal angiography to detect RA stenosis in laboratories with radiological digital peripheral equipment.     

Mid‐term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND. Longer‐term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events.

AIM. To assess the longer‐term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting.

METHOD. In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long‐term follow‐up.

RESULTS. Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all‐cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all‐cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups.

CONCLUSIONS<1/emph>. In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all‐cause mortality depending on a significant coronary artery stenosis.     

8层螺旋CT冠状动脉成像的价值

目的探讨8层螺旋CT对冠状动脉疾病的诊断价值。方法32例患者进行冠状动脉8层螺旋CT成像(CT an-giography,CTA)检查(PTCA术后8例,疑似冠心病者24例),同时对这些患者进行冠状动脉造影(coronary angiography,CAG)检查。以冠状动脉主要节段管腔直径减少>50%作为诊断冠心病的标准。结果8层螺旋CT对冠状动脉的总体显示率为88.2%,评价冠状动脉狭窄的敏感性64.7%,特异性为86.2%,显示钙化以及非钙化斑块混合存在导致血管狭窄19处,其中高估3处,可以显示冠状动脉内支架位置、形态以及远段血流,但难以准确显示支架内再狭窄和闭塞。结论8层螺旋CT对诊断冠状动脉疾病的意义有限。     

Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results

An aging population makes multiple vascular distributions more likely in patients arriving at the cath lab for coronary artery angiography or complete cardiac catheterization. Whether or not screening angiography of supraaortic vessels can be performed at the time of cardiac catheterization by the invasive cardiologist is still debatable. We sought to determine safety and utility of performing angiography of supraaortic vessels during cardiac catheterization. Medical records of all patients undergoing combined coronary and noncoronary angiography between May 1998 and December 2002 was retrospectively reviewed. One hundred and forty patients (80 males, mean age 67.8 ± 5.4 years) underwent combined cardiac catheterization and angiography of supraaortic vessels. Carotid artery angiography was performed at the same time of cardiac catheterization in 62 patients and subclavian artery angiography in the other 78 patients. Significant findings were reported in 32 (22.8%) patients. Complications included 1 transient ischemic attack and 2 carotid spasm resolved with nitrates infusion. In most cases the same standard catheters used during coronary angiography were used also for noncoronary angiography (119 patients, 85%). The incidence of significant angiographic findings and the relatively frequent association of CAD with supraaortic vessel atherosclerosis supports combined cardiac catheterization and angiography of supraaortic arteries but only in patients with multivessel coronary artery disease.     

3.0T磁共振全心冠状动脉成像在诊断冠状动脉狭窄中的临床价值

目的 探讨3.0T磁共振全心冠状动脉成像在冠状动脉狭窄诊断中的临床应用价值.方法 应用3.0T MR自由呼吸三维导航快速梯度回波序列,对30例临床怀疑为冠心病患者进行MR全心冠状动脉成像检查,完成MR检查的27例中有19例进行了行冠状动脉造影检查,以血管造影为"金标准",初步估价3.0T磁共振全心冠脉成像诊断冠状动脉狭窄(>50%)的敏感性、特异性、准确度、阳性预测值及阴性预测值.结果 30例进行MR全心冠状动脉成像的患者中,27例获得了满意的检查结果(84.5%),MR全心冠状动脉成像检查在进行了冠状动脉造影检查的患者中共发现24支冠状动脉显著狭窄.与冠状动脉造影结果对照,MR全心冠状动脉成像诊断冠状动脉显著性狭窄敏感性为73.91%,特异性为82.29%,准确度为77.19%,阳性预测值为70.83%,阴性预测值为87.88%.结论 3.0T磁共振全心冠脉成像能够无创性地进行冠状动脉成像,初步评价冠状动脉主干及近、中段狭窄.冠状动脉MRA表现了较高的阴性预测值,对排除冠状动脉狭窄具有较高的临床应用价值.     

Assessing the appropriateness and increasing the yield of renal angiography in patients undergoing coronary angiography: a scoring system

The real appropriateness and yield of a coincident renal angiography in patients undergoing coronary angiography is still a matter of debate. We have attempted to defined a scoring system to assess the need for renal angiography in patients undergoing diagnostic coronary angiography. We retrospectively reviewed our invasive cardiology database searching for patients underwent coincident screening abdominal aorta angiography to detect occult renal artery stenosis were analyzed and entry in a development set. Univariate and multivariate logistic regression analyses were employed to determine independent predictors of extra-cardiac atherosclerotic involvement. Based on the odds ratio, identified variables were assigned to a weighted integer; the sum of integers was a total score. Thus, the scoring model was tested on a validation set based on a prospective series of consecutive patients enrolled on the basis of an identified cut-off score. In the development set (635 patients, mean age 68±11.2 years) an angiographically significant RAS was observed in 20% of cases (128 patients). The rate of significant angiographic findings increased proportionally with increasing risk score (Pearson coefficient 0.98). A score of ≥5 was identified to be the cut-off beyond which renal angiography seems to have a sufficiently good efficacy in detecting clinically significant renal artery diseases (‰>‰30% of patients). In the validation set the patients were enrolled on the basis of the identified cut-off score (317 patients, mean age 69±14.1 years): angiographic occult RAS was diagnosed in 156/317 (49.2%) patients of the validation set versus 128/635 (20%) patients of the development set, p<0.01. This scoring system, once applicated in standard medium–high volume cath labs, may be effective in increasing the yield of renal artery angiography in patients undergoing coronary angiography.     

64层螺旋CT诊断冠状动脉病变的临床价值

目的：通过对64排螺旋CT（MSCT）冠状动脉造影与选择性冠状动脉造影检测冠状动脉病变（冠状动脉狭窄≥50%）的对比分析,探讨64层螺旋CT评估冠状动脉病变诊断的准确性。方法：回顾性收集2007年12月～2008年10月于我院同期接受64层螺旋CT冠状动脉成像和常规经皮冠脉造影的112位冠心病患者的影像资料,以常规冠脉造影为参考标准,对2种检查方法的结果进行对比分析,评估64层螺旋CT冠脉造影对冠状动脉病变诊断的准确性。结果：按常规冠脉造影计算,112例患者共发现374处病变用于评价,MSCT造影检测冠脉病变总的准确性为90.6%,假阳性率和假阴性率分别为4.3%和5.1%;其中MSCT检测为假阴性均发生在左回旋支和右冠远段,假阳性均为冠状动脉伴有钙化。结论：64排螺CT冠状动脉造影检测冠状动脉病变诊断的准确性较高,但血管解剖和冠状动脉钙化可能会影响其对冠状动脉病变的评价和检测。     

高血压病合并肾动脉狭窄患者的凝血及纤溶功能

目的：探讨高血压病合并肾动脉狭窄（renal artery stenosis,RAS）患者的凝血及纤溶功能。方法：对高血压病合并胸痛患者,在进行冠状动脉造影检查同时进行肾动脉造影检查,测定凝血系统中内皮素（ET-1）、血管血友病因子（vWF）和纤溶系统中血浆组织型纤溶酶原激活剂（tPA）、纤溶酶原激活剂抑制物（PAI-1）。比较高血压病合并RAS组和非RAS组血中凝血和纤溶系统指标水平有无差异,同时比较冠心病组和非冠心病组,冠状动脉单支、双支和三支血管病变组与正常组之间这些凝血与纤溶指标有无差异。结果：（1）157例患者,其中126例（80.2%）患者肾动脉造影正常,另31例患者（19.6%）存在RAS（腔径狭窄≥30%）,其中17例患者（10.8%）存在轻度狭窄（30%≤腔径狭窄〈50%）,14例患者（8.9%）存在显著的RAS（腔径狭窄≥50%）,包括5例患者（3.2%）存在显著单侧RAS（腔径狭窄≥70%）,2例患者（1.2%）存在显著双侧RAS（腔径狭窄≥70%）;（2）RAS组与非RAS组比较,凝血系统中ET-1和vWF明显升高,而纤溶系统中t-PA显著降低、PAI-1明显升高,组间比较差异有统计学意义（P〈0.05）;（3）冠心病组与非冠心病组比较,ET-1、vWF和PAI-1水平升高,tPA水平降低,根据冠状动脉造影结果,多支病变组与正常组比较ET-1、vWF、tPA和PAI-1水平差异有统计学意义（P〈0.05）,但单支病变组与正常组比较ET-1、tPA和PAI-1水平差异无统计学意义（P〉0.05）;（4）RAS同时合并冠心病组与冠心病组、RAS组的ET-1、vWF和PAI-1水平均高于对照组,而tPA水平低于对照组,在RAS合并冠心病组差异有统计学意义（P〈0.01）。结论：接受冠状动脉造影检查患者,高血压病合并RAS的发生率高。高血压病合并RAS患者,尤其是合并有冠心病时,凝血功能亢进而纤溶功能降低。