多层螺旋CT评价血脂康治疗稳定冠状动脉易损斑块的价值

冠状动脉粥样硬化性心脏病(CHD)是目前危害人类健康的最主要疾病之一,研究结果表明,冠状动脉粥样硬化易损斑块破裂,引发血小板聚集、血栓形成及冠状动脉急性闭塞是急性冠状动脉综合征的发病机制.因此,稳定甚至消退易损斑块,成为防止急性冠状动脉事件发生的重要目标.血脂康是中药红曲提取物,包含有以洛伐他汀为主的多种他汀及不饱和脂肪酸、生物碱、甾醇类及少量黄酮类物质[1],已有研究结果表明血脂康能够降低冠心病患者相关事件的危险性[2],提示其可能具有稳定易损斑块的作用.     

多层螺旋CT评价血脂康治疗稳定冠状动脉易损斑块的价值

冠状动脉粥样硬化性心脏病(CHD)是目前危害人类健康的最主要疾病之一,研究结果表明,冠状动脉粥样硬化易损斑块破裂,引发血小板聚集、血栓形成及冠状动脉急性闭塞是急性冠状动脉综合征的发病机制.因此,稳定甚至消退易损斑块,成为防止急性冠状动脉事件发生的重要目标.血脂康是中药红曲提取物,包含有以洛伐他汀为主的多种他汀及不饱和脂肪酸、生物碱、甾醇类及少量黄酮类物质[1],已有研究结果表明血脂康能够降低冠心病患者相关事件的危险性[2],提示其可能具有稳定易损斑块的作用.     

易损斑块的血清炎症标志物的研究进展

急性冠状动脉综合征是严重威胁人类健康的一种常见病和多发病。急性冠状动脉综合征的病理基础是由于易损斑块的存在,且易损斑块的破裂是急性冠状动脉综合征发生的始动环节。现有临床检测方法仅能监测到急性冠脉事件发生的当时及事后血清学变化,而早期发现易损斑块,及时进行干预,对降低急性冠状动脉综合征的发病率和死亡率具有极其重要的临床意义。现主要就检测易损斑块的血清炎症标志物的研究进展作一综述。     

微观结构在易损斑块进展中的作用

急性冠状动脉综合征常常导致严重的心血管事件,而冠状动脉粥样硬化斑块破裂是绝大多数急性冠状动脉综合征发生的原因,因此检测高破裂风险的易损斑块,对筛选和干预急性冠状动脉综合征具有重要意义。随着研究的不断进展,易损斑块内的一些微观结构如斑块内新生血管、微小钙化、胆固醇结晶,在易损斑块的进展中起到重要的作用。因此,本文以易损斑块内最常见的3种微观结构为重点,综述斑块内微观结构在易损斑块进展中的作用。     

动脉易损斑块中新生微血管的分子影像学研究进展

<正>冠状动脉粥样硬化(atherosclerosis,As)性心脏病是现今最常见的心血管系统疾病,也是危害人类健康的常见病。由动脉易损斑块破裂所致的急性心脑血管病事件,近年来越来越受到广泛关注。有相关报道表明:斑块的易损性特征与动脉管腔的狭窄程度不成正相关,却与斑块内的组织成分密切相关[1-2]。斑块内新生血管破裂,将导致急性心脏事件的发生。故本文就动脉粥样斑块中新生微血管的形成机制、病理     

血管内超声对急性冠状动脉综合征的认识

斑块破裂基础上血栓形成是急性冠状动脉(冠脉)综合征发生的主要病理机制。血管内超声在心导管室中应用越来越广泛,它能够在体观察斑块组成以及识别血栓和斑块破裂,有助于加深对急性冠脉综合征的认识。但是,心血管事件发生之前常常没有先兆症状,如果我们能够在急性冠脉事件发生之前检出易损斑块,并进行临床干预使之稳定,不良心血管事件的发生将大大减少。血管内超声下,含有无回声区脂质软斑块、薄纤维帽和正性重构被认为斑块易损的标志。当然,我们不仅要关注于局部病变性质的判断和处理,而且要着眼于整个冠状动脉和相关的系统因素。     

冠状动脉易损斑块评价方法研究进展

冠状动脉粥样硬化是冠心病最主要的病因,易损斑块是冠状动脉粥样硬化的主要表现形式。早期识别冠状动脉易损斑块对于预防急性心血管事件的发生具有重要意义。现就冠状动脉易损斑块评价方法如血管内超声(IVUS)、光学相干断层成像(OCT)、冠状动脉多层CT(MSCT)、MRI、炎症指标等研究进展做一综述。     

虚拟组织学对急性冠状动脉综合征患者斑块评价研究进展

人们一直不断探索冠心病发生发展的病理机制,积极探索易损斑块、易损病变、易损患者的识别方法,减少心血管事件。血管内超声虚拟组织学是研究冠状动脉病变特征的简单有效的手段之一。近期对于急性冠状动脉综合征的血管内超声虚拟组织学研究显示薄帽纤维粥样硬化斑块与长期的不良心血管事件相关。冠状动脉不同部位发生易损斑块的概率不同。吸烟、高胆固醇血症与斑块不稳定性相关。他汀类药物可减少斑块容积,但是对斑块成分的影响仍不明确。目前仍无可靠的血清学标志物显示冠状动脉斑块的易损性。     

冠状动脉计算机断层扫描血管造影易损斑块形态特点及其影像学研究进展

急性心肌梗死和心源性猝死是大多数患者冠状动脉疾病的首发表现,识别发生急性冠脉综合征的高风险患者是当代心血管成像的主要挑战。早期识别和准确评价易损斑块,可有效地预防和降低不良事件的发生。由计算机断层扫描血管造影开发的易损斑块特点包括:斑块体积大、低衰减斑块、正性重构、点状钙化及餐巾环征。现介绍易损斑块详细形态特点及其临床价值,同时描述非侵入性检查成像技术——计算机断层扫描血管造影对易损斑块检测的最新进展及优缺点。     

光相干层析成像系统在冠状动脉易损斑块检测中的应用

粥样斑块的自发破裂及继发的血栓形成是急性冠状动脉事件和猝死的主要原因。目前将那些濒临破裂 ,进而发生血栓和 (或 )迅速进展的斑块称为易损斑块 (vulnerableplaque) [1 ] 。如何正确识别易损斑块已成为当前急性冠状动脉综合征诊治中面临的重要挑战。目前 ,多种成像技术已被     

冠状动脉CT成像与易损斑块

冠状动脉内斑块破裂或侵蚀所致的急性腔内血栓是急性冠状动脉综合征的主要原因。防止急性血栓形成成为了降低冠状动脉粥样硬化性心脏病病死率的唯一有效策略。斑块易破裂的冠状动脉病变与稳定斑块相比,存在不同的形态学改变。因此可以利用特殊的成像方法来识别这些易损斑块。亚毫米空间分辨率和图像质量优良的现代计算机断层扫描方法可以对冠状动脉斑块进行检测、分析和量化。斑块体积较大、低CT衰减、餐巾环征、正性重构以及点状钙化等与斑块容易破裂有密切关系。将冠状动脉斑块的形态学与功能特征等相结合,在未来有可能成为检测易损斑块的新方法。现将就多层螺旋CT与冠状动脉易损斑块的检测做一综述。     

Pathophysiology of coronary thrombosis: role of plaque rupture and plaque erosion

Coronary artery disease is the leading cause of death in much of the western world. Atherosclerotic plaques in the coronary arteries contribute to luminal obstruction leading to myocardial ischemia; however, abrupt coronary artery occlusion most frequently results from superimposition of a thrombus on a disrupted plaque, leading to the most serious clinical manifestations of coronary artery disease, ie, unstable angina, acute myocardial infarction, and sudden death. Plaque that have undergone disruption and, by inference, plaques at risk for disruption (vulnerable plaques), tend to demonstrate outward vessel remodeling, contain a large lipid core, thinned out fibrous cap, reduced collagen content, and increased inflammatory cell infiltration. Plaque stabilization through change in plaque composition may be responsible for reduced frequency of acute vaso-occlusive events observed with lipid and other risk-factor modifying interventions.     

Intracoronary Imaging in the Detection of Vulnerable Plaques

Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.     

冠心病患者的心率变异性分析

目的探讨冠心病患者心率变异性的变化。方法选择冠心病患者70例,作为冠心病组,选择无冠心病的健康人50例,作为对照组,进行动态心电图检查,分别测定时域指标（SDNN、SDANN、RMSSD、PNN50）和频域指标（TP、LF、HF）,进行心率变异性变化的参数分析。结果冠心病组的指标SDNN、RMSSD、PNN50、TP、LF、HF均显著低于健康组,P〈0．01,有统计学意义。结论冠心病患者的心率变异性时域和频域指标均明显减低,反映自主神经调节心脏平衡的功能减低,易发生严重的心血管事件。     

Coronary artery calcium score, risk factors, and incident coronary heart disease events

BACKGROUND: Whether the absence of coronary artery calcium, or conversely the presence of high volumes of coronary artery calcium, may alter assessment of coronary heart disease risk based on traditional risk factors is uncertain. We sought to identify a potential threshold of coronary artery calcium for clinical use and examine the predictive power of coronary artery calcium in individuals categorized using conventional coronary heart disease risk assessment. METHODS: The study included 10,746 men and women (36.3%) with a mean age of 53.8+/-9.9 years who were either physician- or self-referred for electron beam tomography scanning to a preventive medical clinic. Coronary heart disease risk factors were elicited by use of a questionnaire. RESULTS: During a mean follow-up of 3.5 years, 81 primary events (coronary heart disease death or nonfatal myocardial infarction) occurred. Among individuals with a coronary artery calcium score of zero, the primary event rate was very low (0.4 events per 1000 person-years of observation). When participants were stratified by self-reported coronary heart disease risk factors (0-2, or 3-4), a coronary artery calcium score >or=100 was associated with substantially increased risk of coronary heart disease events within each level of stratification. In a subgroup of participants with available clinical data, similar results were found when participants were categorized by Framingham risk scores. CONCLUSIONS: Coronary artery calcium score can identify individuals at increased risk for coronary heart disease events who otherwise would be considered low-risk based on clinical assessment. A coronary artery calcium score of zero is associated with very low risk for coronary heart disease in the short to intermediate term ( approximately 3.5 years) regardless of the number of risk factors present.     

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three‐dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image‐guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography.     

炎症因子与冠心病合并糖尿病关系的研究进展

冠心病和糖尿病存在胰岛素抵抗、慢性炎症反应的共同土壤,均是一种炎症性疾病,炎症因子C反应蛋白(CRP)和纤溶酶原激活物抑制物-1(PAI-1)在动脉粥样硬化性疾病及2型糖尿病的发生、发展过程中起着重要的作用,冠心病合并糖尿病患者体内的炎症因子CRP、PAI-1水平较单纯冠心病、糖尿病均高,增高的CRP、PAI-1具有潜在的预测不稳定斑块破裂血栓形成发生急性心血管事件的作用,同时增高的CRP、PAI-1对2型糖尿病发病情况也起重要预测作用。并且为早期干预、指导治疗提供一定理论依据。     

易损斑块的诊断进展

急性冠状动脉综合征患者具有较高的发病率,预后较差,而冠状动脉内易损斑块破裂伴随血栓形成是其主要原因.因此早期正确诊断易损斑块,对于急性冠脉综合征的防治具有重大意义.现就易损斑块的诊断进展作一综述.     

Coronary embolus complicating peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare disorder in which heart failure occurs during the last month of pregnancy or within 5 months of delivery, in the absence of any other etiology or prior heart disease. We present the case of a 42-year-old woman with peripartum cardiomyopathy. She was admitted with an acute myocardial infarction. Multiple mobile ventricular thrombi were seen in the echocardiogram. Coronary angiogram showed consequential coronary embolus occluding the left anterior descending artery. A successful embolectomy was performed followed by coronary stenting. There have been only two reports in the medical literature of coronary embolic events in the setting of peripartum cardiomyopathy; however, to our knowledge, we believe our case is the first to describe coronary intervention as treatment for the event.