血管内超声与定量冠脉造影应用于冠脉临界病变诊治的比较

目的 研究血管内超声（intravascular ultrasound,IVUS）在优化民航飞行员冠脉临界病变诊断和治疗中的应用。 方法 通过定量冠脉造影（quantitative coronary angiography,QCA）和IVUS对120例飞行员患者165处冠脉临界病的最小管腔直径（minimal lumen diameter,MLD）、直径狭窄率（diamter stenosis,DS）与最小管腔面积（minimal lumen area,MLA）、面积狭窄率（area stenosis,AS）等参数进行对比分析;对IVUS提示管腔MLA<4 mm2飞行员患者的冠脉临界病变行支架植入术。 结果 ①同一临界病变处QCA显示的MLD,DS及MLA,AS值均小于IVUS相应的测量值,且差异有统计学意义（P<0.01）,表明IVUS对冠脉病变狭窄定量测量方面准确性更高;②IVUS提高血栓病变（15.0% vs. 2.5%,P<0.05）和心肌桥（42.5% vs. 2.5%,P<0.01）的诊断率;③与QCA相比,IVUS直接显示介入治疗中支架的贴壁情况,指导支架扩张完全。 结论 IVUS较QCA能更准确地检测冠脉临界病变范围,更灵敏地诊断血栓和心肌桥,利于全面优化临界病变的诊疗。     

冠状动脉临界病变血管内超声检查参数与定量血流分数的相关性研究

目的探讨冠状动脉临界病变血管内超声(IVUS)检查参数与定量血流分数(QFR)的相关性。方法前瞻性连续入选2018年9月至2019年9月于同济大学附属东方医院接受QFR和IVUS检查的116例患者(117处冠状动脉临界病变)。根据QFR评估结果,将患者分为QFR≤0.80组(25处病变)和QFR>0.80组(92处病变),比较两组IVUS检查参数的差异。应用Poisson线性相关性分析以及受试者工作特征(ROC)曲线评估IVUS与QFR的相关性,应用logistic多元回归分析QFR≤0.80的预测因素。结果IVUS检查发现,QFR≤0.80组最小管腔面积(MLA)[(3.1±0.8)mm²比(3.6±1.1)mm²,P=0.040]、最小管腔直径(MLD)[(1.8±0.3)mm比(2.0±0.3)mm,P=0.012]显著小于QFR>0.80组,而斑块负荷[(73.5±5.6)%比(68.0±8.4)%,P=0.002]、面积狭窄率[(69.8±8.8)%比(63.8±9.8)%,P=0.007]、斑块偏心指数[(0.83±0.12)比(0.73±0.19),P=0.008]及回声消减斑块比例(52.0%比23.9%,P=0.003)显著高于QFR>0.80组,差异均有统计学意义。Poisson线性相关分析显示,MLA(r=0.259,P=0.005)、MLD(r=0.300,P=0.001)与QFR正相关,而斑块负荷(r=–0.357,P<0.001)以及斑块偏心指数(r=–0.247,P=0.008)与QFR负相关。logistic多因素回归分析表明斑块负荷>70%(OR 4.531,95%CI 1.443~14.222,P=0.010)和斑块偏心指数(OR 1.066,95%CI 1.014~1.121,P=0.012)为QFR≤0.80的独立预测因素。结论冠状动脉临界病变IVUS检查结果中斑块负荷>70%以及斑块偏心指数是QFR≤0.80的独立预测因子。     

Physiological and intravascular ultrasound assessment of an ambiguous left main coronary artery stenosis.

The angiographic assessment of an ambiguous left main coronary artery (LMCA) stenosis is often difficult and not reliable. Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) have improved the diagnostic utility of an ambiguous LMCA stenosis. The combined role of FFR and IVUS in patients with an ambiguous LMCA stenosis is discussed.     

Hemodynamic and intravascular ultrasound assessment of an ambiguous left main coronary artery stenosis.

The assessment of the left main coronary artery (LMCA) stenosis by angiography is not reliable, and noninvasive tests are incapable of discriminating ischemia caused by LMCA versus other stenoses. Among patients with LMCA stenosis, both fractional flow reserve and intravascular ultrasound parameters would determine the severity of stenosis and predict the event rates. This review outlines the evidence in support of their routine use for the assessment of an ambiguous LMCA stenosis.     

血管内超声在冠状动脉临界病变中的应用研究

目的:研究传统冠状动脉定量分析方法(QCA)与血管内超声(IVUS)在冠状动脉临界病变中的应用。方法:共入选经过冠状动脉造影(至少4体位造影)证实病变狭窄处于临界病变的患者150例。将入选者分为:常规冠状动脉造影组90例(QCA),血管内超声组60例(IVUS)。通过QCA和血管内超声定量分析方法分析2组最小管腔直径、参考血管直径、直径狭窄率及最小管腔面积等参数指标;将相关数据建立直线回归分析方程,分析二者之间是否具有线性关系;采用Cox回归模型分析2组免于心血管事件方面差异,观察2组术后住院期间、30d、3个月、6个月、9个月和12个月主要心血管事件。结果:血管内超声组分别采用QCA和IVUS分析,参考血管直径2者具有正相关性分别为(3.28±0.19)mmvs.(3.17±0.21)mm,R=0.627。最小管腔直径分别为(2.04±0.18)mmvs.(2.0±0.17)mm,R=0.782。比较2组之间的参数:QCA组通过计算得出直径狭窄率,与IVUS管腔面积狭窄率之间无相关性(R20.05,P=0.222),IVUS最小管腔面积(4.7±0.67)mm2。通过COX回归模型显示2组在免于心血管事件方面的差异,可见QCA组发生心血管事件率具有较高的趋势。结论:对于临界病变的患者,采用IVUS的方法能够检测出更严重狭窄的发生率,传统冠状动脉造影判定结果往往低估真正的病变情况。对于临界病变的患者,采用IVUS进行测量分析,具有减低心血管事件风险的趋势。     

The role of intravascular ultrasound and quantitative angiography in the functional assessment of intermediate coronary lesions: Correlation with fractional flow reserve

BackgroundThe correlation between fractional flow reserve (FFR) and intravascular ultrasound (IVUS) metrics including minimal lumen area (MLA), plaque burden and morphology remain a matter of debate.MethodsBetween June 2008 and May 2013, 132 intermediate stenoses in 109 patients were assessed by FFR, IVUS and quantitative angiography. Receiver-operating characteristic (ROC) curve analyses were used to identify MLA/lesion length/plaque burden cut-off values predictive of FFR < 0.80.ResultsFFR < 0.80 was observed in 39 lesions. In the entire cohort, MLA value < 2.70 mm² had 79.5% sensitivity, 76.3% specificity, 0.822 area under curve (AUC), 58.5% positive predictive value, 89.9% negative predictive value and 77.3% accuracy in predicting a positive FFR. In lesions with reference diameter vessel (RVD) ≥ 3.0 mm, the MLA cut-off value was 2.84 mm² (sensitivity 72.2%, specificity 83.0%, AUC 0.842) whereas in lesions with RVD < 3.0 mm, 2.59 mm² (sensitivity 90.5%, specificity 69.6%, AUC 0.823). A moderate correlation was observed between MLA and FFR (r = 0.429, p < 0.001). The cut-off lesion length predictive of FFR < 0.80 was 11.0 mm with a weak correlation between the two (r = − 0.348, p < 0.001). Plaque morphology did not significantly affect FFR (p = 0.485). On multivariable analysis, MLA (OR: 0.15; 95% CI: 0.05–0.40; p < 0.001) and plaque burden (OR: 1.11; 95% CI: 1.04–1.20; p < 0.003) were independent predictors of FFR < 0.80.ConclusionA modest, yet significant correlation was observed between MLA and FFR. The high negative predictive value of large MLAs (using afore-mentioned cut-off values) may provide some degree of confidence that the lesion in question is not functionally significant.     

Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound

This case report describes the devastating consequences of spontaneous coronary dissection in a 36 year old female patient who otherwise had a normal coronary arteriogram. Intravascular ultrasound showed coronary artery dissection and intramural haematoma at the left main stem coronary artery. Acute coronary syndrome developed and subsequently surgical revascularisation was performed successfully.     

Noncritical disease of the left main coronary artery: limitations of angiography and the role of intravascular ultrasound

OBJECTIVE: To review the diagnosis and management of noncritical left main stem disease. DATA SOURCES: MEDLINE was searched using the key phrases 'intravascular ultrasound' and 'left main coronary artery'. DATA EXTRACTION: Articles addressing the angiographic or ultrasound assessment of left main stem disease were systematically reviewed. Reference is also made to articles dealing with outcomes for patients with left main stem disease. DATA SYNTHESIS: The assessment of left main stem disease by coronary angiography is often suboptimal. Intravascular ultrasound has demonstrated significant left main stem disease in angiographically normal arteries. It has also demonstrated that mild to moderate left main stem disease frequently accompanies disease in the other coronary arteries. The natural history of mild to moderate left main stem disease has not been well characterized; thus, the optimum management of this condition is not known. CONCLUSIONS: To establish the natural history of noncritical left main stem stenosis, it is proposed that centres performing frequent intravascular ultrasound examinations systematically and quantitatively interrogate the left main stem during all left coronary examinations. Angiographic and ultrasonic measures of left main stem disease can then be correlated with clinical outcome during long term follow-up. This will clearly require the collaboration of several centres to generate a sufficiently large database to address these clinical questions.     

Serial volumetric intravascular ultrasound assessment of arterial remodeling in left main coronary artery disease.

Serial volumetric intravascular ultrasound (IVUS) was used to study de novo, nontreated left main coronary arteries (LMCAs) in 31 patients. Using an automated contour detection algorithm, analysis of 7.2 +/- 2.5 mm long segments included arterial, lumen, and plaque volumes and plaque burden (plaque/arterial volumes). During follow-up (7.7 +/- 2.4 months), the percent change in lumen volume correlated with the percent change in arterial volume (r = 0.897, p <0.0001), but not with the percent change in plaque volume (r = 0.066, p = 0.7263). Percent changes in arterial volume correlated with percent changes in plaque + media volume (r = 0.448, p = 0.0115), indicating arterial remodeling. However, there was a spectrum of responses ranging from inadequate remodeling (decrease in lumen volume despite no increase or a decrease in plaque volume: i.e., arterial shrinkage) to overcompensation (an increase in lumen volume despite an increase in plaque volume). Serial volumetric IVUS (1) confirms the existence of both positive and negative remodeling in LMCA, and (2) shows that in moderate LMCA disease, luminal changes resulted primarily from positive versus negative remodeling, not plaque progression and/or regression.     

Comparison of lumens of intermediate coronary stenosis using 16-slice computed tomography versus intravascular ultrasound

We aimed to quantify ambiguous coronary stenosis using the minimal lumen area with 16-slice computed tomography compared with intravascular ultrasound. The sensitivity, specificity, and accuracy for significant lesion classification was 68%, 86%, and 78%, respectively. The correlation between intravascular ultrasound and CT minimal lumen area was r = 0.73 (p <0.001), and the 95% confidence interval for CT measurement was -72% to +56%.     

Serial intravascular ultrasound and quantitative coronary angiography after self-expandable wallstent coronary artery implantation

Serial intracoronary ultrasound studies revealed significant postprocedural stent expansion accompanied by significant stent shortening during long-term follow-up. The disadvantageous lumen loss by neointimal formation could be balanced by late stent expansion.     

First human experience with angiopeptin-eluting stent: a quantitative coronary angiography and three-dimensional intravascular ultrasound study.

Angiopeptin has been shown to reduce in-stent restenosis in various animal models. Meanwhile, BiodivYsio DD phosphorylcholine (PC)-coated stent provides a platform for local delivery of antiproliferative agents to the coronary artery. We studied the feasibility, safety, and impact on tissue growth of angiopeptin-eluting BiodivYsio DD PC-coated stents in human native de novo coronary lesions. We enrolled 14 patients (16 lesions) who underwent intravascular ultrasound (IVUS)-guided angiopeptin-eluting stent implantation in native coronary arteries between 3.0 and 4.0 mm in diameter with lesion length相似文献   

定量多层螺旋CT冠状动脉成像与定量冠状动脉造影的对比研究

目的通过与同期定量冠状动脉造影(QCA)作对照,评价定量冠状动脉多层螺旋CT(QCT)成像对冠状动脉疾病的诊断价值。方法选择冠心病患者78例,利用QCA和QCT测量同一病变的最小管腔直径、最小管腔面积、参考直径、参考面积、靶病变长度、直径狭窄率、面积狭窄率等指标,比较2种方法结果的相关性及一致性。结果 78例患者中,存在明显冠状动脉病变62例(79.49%),QCT和QCA一致认为重度狭窄(>75%)的节段共为47段,其中右冠状动脉1 5段,前降支27段,回旋支5段。QCT和QCA测量的最小管腔面积、面积狭窄率比较,差异有统计学意义(P<0.05),2种测量最小管腔直径、参考直径、参考面积、靶病变长度和直径狭窄率的比较,差并均无统计学意义(P>0.05)。QCT和QCA测量最小管腔直径,靶病变长度,参考直径,参考面积,直径狭窄率一致性较好(0.5≤r_c≤0.85),最小管腔面积、面积狭窄率则一致性不佳(r_c<0.5)。结论 QCT检查能良好评价冠状动脉病变.可用于术前即可指导对经皮冠状动脉介入治疗中球囊和支架的选择。