脑动脉与冠状动脉粥样硬化狭窄的相关性

目的:探讨脑动脉粥样硬化狭窄与冠状动脉狭窄的相关性。方法:对66例经冠状动脉造影确诊为冠心病的患者同时行脑血管造影。据冠状动脉造影结果分2组,A组(冠状动脉狭窄1支和2支者)30例,B组(冠状动脉狭窄3支者)36例。比较2组脑动脉轻度、中重度狭窄的发生率及颈动脉系统、椎-基底动脉系统狭窄的发生率。结果:B组脑动脉中重度狭窄的发生率、颈动脉系统狭窄发生率明显高于A组,但椎-基底动脉系统狭窄性病变发生率,2组比较差异无统计学意义。结论:脑动脉粥样硬化狭窄程度及发生率与冠状动脉狭窄的程度明显相关。     

冠状动脉粥样硬化性心脏病患者颈总动脉中内膜厚度与冠状动脉病变的关系

目的 探讨冠状动脉粥样硬化性心脏病（冠心病）患者颈总动脉中内膜厚度与冠状动脉狭窄程度与狭窄范围的关系.方法 将211例怀疑冠心病的患者,根据冠状动脉造影结果,依有无狭窄及狭窄程度分为3组：A组（60例）为轻度狭窄组,狭窄程度＜50％;B组（97例）为中重度病变组,狭窄程度＞50％;对照组为54例冠状动脉造影阴性者.157例冠状动脉狭窄患者又依狭窄程度分为单支病变亚组（49例）、双支病变亚组（37例）、三支病变亚组（71例）.采用彩色多普勒声像仪测取颈总动脉中内膜厚度,并比较分析各组颈总动脉中内膜厚度.结果 对照组、A组、B组比较,颈动脉总中内膜厚度依次增高,对照组、A组、B组两两比较差异有统计学意义[（0.812 5±0.118 6）mm vs.（0.893 6±0.133 1）mm vs.（1.038 9±0.141 1）mm,P＜0.05].在以病变范围为基础的分组中,各亚组与对照组比较,颈动脉中内膜明显增厚,且两两比较差异有统计学意义（P＜0.05）;单支病变亚组与双支病变亚组比较,差异有统计学意义[（0.920 4±0.141 5）mm vs.（0.990 6±0.144 3）mm,P＜0.05],但双支病变组与三支病变组比较,差异无统计学意义[（0.990 6±0.144 3）mm vs.（1.031 7±0.149 6）mm,P＞0.05].结论 颈总动脉中内膜厚度能很好地反映冠状动脉狭窄程度,但无法很好地反映病变范围.     

心肌桥与冠状动脉粥样硬化关系的探讨

目的探讨心肌桥与冠状动脉粥样硬化之间的关系。方法回顾性分析接受冠状动脉造影的52例心肌桥患者,其中30例有肌桥近段血管粥样硬化者(A组),22例孤立性心肌桥患者(B组),观察A组患者肌桥近段置入支架后预后情况。结果肌桥的检出率1.41%,均发生在左前降支的中、远段,A组和B组的肌桥长度差异无统计学意义,但A组的肌桥收缩期狭窄程度明显重于B组(68.3±14.0)%和(53.2±15.0)%,P<0.05。随访中A组14例行支架置入者,9例出现心绞痛,复查造影,其中7例出现支架内再狭窄(再狭窄率为50%,7/14);B组预后良好。结论心肌桥有促进其近段冠状动脉发生粥样硬化病变的倾向,且与心肌桥的狭窄程度有关。     

冠状动脉妊娠相关血浆蛋白A的表达与急性冠状动脉综合征和冠状动脉狭窄的关系

目的观察妊娠相关血浆蛋白A在粥样硬化冠状动脉局部的表达及其与急性冠状动脉综合征的发生和冠状动脉狭窄程度的关系。方法选取2002年～2006年尸检中符合急性冠状动脉综合征标本15例、无心肌梗死标本18例及有陈旧性心肌梗死标本17例,自主动脉根部左、右冠状动脉窦口起取其左、右冠状动脉,做间隔为1cm的连续横断取材。应用弹力纤维染色及NIHScionImage软件分析系统,测算其狭窄程度,并据此将急性冠状动脉综合征组冠状动脉标本分为四个亚组(<25组、25～50组、50～75组及>75组)。通过标记平滑肌细胞对妊娠相关血浆蛋白A进行定位。用免疫组织化学法检测平滑肌细胞妊娠相关血浆蛋白A在冠状动脉局部的表达。结果妊娠相关血浆蛋白A在发生斑块破裂冠状动脉的残存内皮细胞及邻近冠状动脉内皮细胞中强表达,而其余冠状动脉标本中内皮细胞基本无表达。斑块破裂处妊娠相关血浆蛋白A表达强于周围组织。急性冠状动脉综合征组妊娠相关血浆蛋白A在不同狭窄程度冠状动脉平滑肌表达的阳性率分别为93.3、74.5、78.3及50.0,妊娠相关血浆蛋白A的表达强度有随着冠状动脉狭窄程度增加而减小的趋势。急性冠状动脉综合征组妊娠相关血浆蛋白A在冠状动脉平滑肌表达的阳性率为80.4,无心肌梗死组为66.9,陈旧性心肌梗死组为56.8。急性冠状动脉综合征组冠状动脉妊娠相关血浆蛋白A的表达明显高于无心肌梗死组和陈旧性心肌梗死组,且无心肌梗死组冠状动脉妊娠相关血浆蛋白A的表达强于陈旧性心肌梗死组。结论妊娠相关血浆蛋白A参与急性冠状动脉综合征的发生。妊娠相关血浆蛋白A的表达强度有随着冠状动脉狭窄程度增加而减小的趋势。     

冠状动脉介入治疗中冠状动脉夹层形成的多因素回归分析

目的:探讨影响冠状动脉介入治疗(PCI)中冠状动脉夹层形成的独立危险因素。方法:回顾性分析142例住院期间行经PCI患者的临床和血管造影及处理资料。用单因素和多因素回归方法分析了患者性别、年龄、靶病变形态学、术中球囊扩张等24个变量与冠状动脉夹层发生的关系。结果:在单因素分析中发现:并发糖尿病者,多支病变,B型、C型病变,靶血管病变长度>15mm,夹层组高于对照组;偏心性病变,钙化病变比例夹层组显著高于对照组。球囊扩张次数夹层组明显高于对照组。多元Logistic回归分析发现:病变长度>15mm、偏心性病变、钙化病变、病变直径狭窄率、球囊扩张次数是PCI中冠状动脉夹层形成的独立危险因素。结论:靶血管直径狭窄率、病变长度>15mm、偏心性病变、钙化病变、球囊扩张次数是冠状动脉夹层形成的最重要的独立危险因素。且具有一定的预测价值。     

肥厚型心肌病冠状动脉造影特征

目的　了解肥厚型心肌病患者冠状动脉造影有何特征性改变。方法　对我院自 1987年 8月至 1999年 8月 5 0例肥厚型心肌病患者冠状动脉造影资料进行分析。结果　 5 0例中 6例冠状动脉为左优势型 ,占 12 %。本组冠状动脉近端平均血管内径测量值 :LM :(5 1± 1 0 )mm ,LADp :(4 2±1 0 )mm ,LCXp :(3 8± 0 9)mm ,RAp :(3 8± 0 9)mm ,与正常左冠状动脉近端平均血管内径 (LM :(4 6±0 6 )mm ,LADp :(3 7± 0 6 )mm ,LCXp :(3 4± 0 6 )mm比较 ,明显增粗 ,P≤ 0 0 5 ,而本组病例右冠状动脉与之比较差异无显著性。冠状动脉肌桥 14例 ,发生率为 2 8% (14 5 0 ) ,其中 12例位于前降支 ,且大多位于其中段。 13例冠状动脉有单支或多支≥ 5 0 %的狭窄病变 ,占 2 6 %。结论　本组冠状动脉造影特点 :冠状动脉左优势型的比例明显增高 ;冠状动脉血管粗大 ,以左冠状动脉增粗为主 ;冠状动脉肌桥发生率高 ,大多出现于前降支中段 ;约 1 4的患者合并冠状动脉狭窄 (≥ 5 0 % )。     

西罗莫司洗脱支架和Pixel支架治疗冠状动脉小血管病变的比较

目的对比研究西罗莫司洗脱支架(CypherTM支架)和Pixel支架治疗冠状动脉小血管病变的安全性及疗效。方法将2003年3月至2005年1月在我院住院的67例小血管病变患者随机分成A、B两组,A组34例接受CypherTM支架治疗,B组33例接受Pixel支架治疗。比较分析两组的手术成功率、并发症发生率、心脏不良事件发生率、再狭窄率及晚期管腔丢失等指标。结果两组支架置入术的成功率均为100%,无残余狭窄或残余狭窄<10%,无任何并发症。A组有30例、B组有29例患者在术后约9个月复查了定量冠状动脉造影。随访期间,A组中有2例出现支架内再狭窄导致临床心绞痛复发;B组有7例复发心绞痛,其中6例经冠状动脉造影证实为支架内再狭窄所致;两组均无一例死亡。A组的造影再狭窄率为6.7%,B组为20.7%(P<0.05);A组的晚期管腔丢失为0.19±0.58mm,B组为0.63±0.61mm(P<0.01);A组的靶血管再次血运重建率为6.7%,B组为20.7%(P<0.05)。结论CypherTM支架和Pixel支架治疗小血管病变均安全、有效,但CypherTM支架的远期疗效明显优于Pixel支架。     

新型氮氧化钛生物有效支架与国产雷帕霉素药物洗脱支架在老年冠状动脉血运重建临床应用的对比研究

目的对比研究氮氧化钛生物有效性支架（Titan2-BAS）与国产雷帕霉素药物洗脱支架（SES）在老年冠状动脉血运重建临床应用中的疗效。方法共入选125例老年冠心病患者,男75例,女50例。根据植入的支架不同分为A组（Titan2-BAS）79例,B组（SES）46例,均采用经桡动脉或尺动脉途径冠脉血运重建。A组阿司匹林与氯吡格雷治疗1～3个月,B组至少12个月。计算A、B两组支架病变的通过率、早期支架内血栓发生率及随访主要不良心脏事件（MACE,指死亡、急性心肌梗死、靶血管重建等）发生率。结果（1）A组病变内径（3.1±0.3）mm,长度为（25±3.6）mm,B组病变内径（3.1±0.4）mm,长度为（24±4.2）mm,两组无显著差异。（2）A组129处〉75%狭窄病变共植入Titan2-BAS146枚,1枚支架未能通过病变（右冠状动脉）,通过率99.3%;B组72处病变共植入SES82枚,通过率100%,两组无显著差异。（3）随访1～17个月,平均5.3个月。两组均无死亡病例;A组无急、晚期血栓。B组1例术后2d出现支架内血栓;A组1例术后3个月行靶血管重建,B组无靶血管重建;综合以上,两组MACE发生率无显著差异（1.3%对2.2%）。结论Titan2-BAS与SES在老年冠状动脉血运重建方面的近期及远期疗效相近,Titan2-BAS不增加MACE发生率。     

冠状动脉狭窄合并颅内-外动脉粥样硬化的超声检查

目的分析冠状动脉狭窄性病变与颅内-外动脉粥样硬化性狭窄的关系.方法将213例经血管造影证实的冠状动脉狭窄（≥70%）欲行冠状动脉搭桥术的患者分为A组（狭窄动脉≤2支）42例,B组（狭窄动脉≥3支）171例.采用彩色多普勒血流显像（CDFI）和经颅多普勒超声（TCD）分别检查患者颈动脉和颅内动脉,比较两组患者颅内-外动脉狭窄性病变的发生情况.结果①B组患者颅内动脉狭窄性病变检出率高于A组,分别为59.6%（102/171）和42.8%（18/42）,P=0.008.②B组患者颈动脉狭窄≥50%的发生率高于A组,分别为55.6%（95/171）和33.3%（14/42）,P=0.01.③颈动脉狭窄≥50%,同时合并颅内多发血管狭窄的发生率B组为49.7%（85/171）,明显高于A组的16.7%（7/42）,P=0.000.结论随着冠状动脉粥样硬化程度的加重,颅内-外动脉狭窄性病变亦相应加重.对于确诊冠状动脉粥样硬化性病变的患者,CDFI和TCD联合检测可以及时发现颅内-外动脉狭窄性病变.     

经桡动脉冠状动脉腔内支架术治疗冠状动脉复杂病变

目的:比较经桡动脉与股动脉途径经皮冠状动脉介入治疗冠状动脉复杂病变时间、治疗成功率和并发症。方法:回顾性对照分析近8个月来100例冠状动脉复杂病变介入治疗经桡动脉（A组50例）,股动脉（B组50例）成功率及并发症。结果:两组患者手术成功率相似（94%vs90%,P>0.05）;经皮冠状动脉介入治疗总时间两组间差异无显著性（62±14与62±10min,P>0.05）。但A组术后并发症显著低于B组。结论:经桡动脉途径与股动脉途径介入治疗冠状动脉复杂病变成功率相似,但前者术后并发症少。     

单纯右冠状动脉狭窄对左心室功能的影响

目的:探讨单纯右冠状动脉（RCA）狭窄不同狭窄程度和狭窄节段对左心室功能的影响。方法:将冠状动脉造影证实为单纯RCA狭窄的患者99例,按不同狭窄程度、不同狭窄节段和不同冠脉优势型进行分组,并与494例无冠状动脉狭窄的对照组比较,经左心室造影测定的左室射血分数（LVEF）和左室舒张末压（LVEDP）。结果:与对照组患者相比,轻度、中度和重度单纯右RCA狭窄患者的LVEF变化不显著,完全闭塞患者的LVEF显著下降（P<0.05）;右冠中段、右冠远段、后降支和侧后支病变患者的LVEF均无有意义变化,右冠近段病变患者LVEF下降有统计学意义（P<0.05）。单纯RCA狭窄患者中,右冠优势组LVEF略低于均衡优势组和左冠优势组,但差异未达显著水平。单纯RCA狭窄对LVEDP的影响并不明显。结论:单纯RCA主干近段狭窄和单纯RCA完全闭塞对左室收缩功能可产生一定程度的损害。     

Anomalous origin of the right coronary artery from the left coronary sinus is associated with early development of coronary artery disease

BACKGROUND: Anomalous origin of the right coronary artery (RCA) from the left coronary sinus can cause sudden cardiac death. Whether this unique anatomical defect also predisposes to early development of coronary artery disease (CAD) remains uncertain. METHODS: Demography, cardiovascular risk factor profiles and coronary angiograms were reviewed in 1,532 consecutive patients over the past 3 years. RESULTS: Thirteen patients (0.8%) had anomalous RCA from the left coronary sinus, while the rest had normal origin from the right coronary sinus. CAD was found in 9/13 anomalous RCA patients (group A) and in 795/1,519 patients with normal RCA origin (group B). There were no differences in the distributions of age, sex or cardiovascular risk factors between the two groups. The distribution of critical lesions among the 3 major coronary arteries showed no significant differences either. However, among the patients with RCA involvement, the anomalous RCA group was significantly younger (54.8 +/- 4.8 years versus 64.9 +/- 10.1 years; p = 0.022). CONCLUSION: The anomalous RCA from left coronary sinus is associated with early development of CAD. The affected patients are 10 years younger.     

Noninvasive coronary flow velocity reserve measurement in the posterior descending coronary artery for detecting coronary stenosis in the right coronary artery using contrast-enhanced transthoracic Doppler echocardiography

BACKGROUND: Coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) has been found to be useful for assessing left anterior descending coronary artery (LAD) stenosis. However, this method has been restricted only for the LAD. The purpose of this study was to detect severe right coronary artery (RCA) stenosis by CFVR measurement using contrast-enhanced TTDE. METHODS: In 60 consecutive patients with angina pectoris (mean (SD) age: 60 (11), 18 women), coronary flow velocities in the RCA were recorded in the postero-descending coronary artery by contrast-enhanced TTDE at rest and during hyperemia induced by intravenous infusion of adenosine triphosphate (140 mcg/ml/kg). CFVR was calculated as the ratio of hyperemic to basal peak and mean diastolic flow velocity. CFVR measurements by TTDE were compared with the results of coronary angiography performed within 1 week. RESULTS: Coronary flow velocity was successfully recorded in 49 (82%) of the 60 patients with contrast agent. CFVR (mean (SD)) was 1.4 (0.4) in patients with, and 2.6 (0.6) in patients without significant stenosis in the RCA (%diameter stenosis > 75%, P < 0.001). Using the cutoff value 2.0 for CFVR in the RCA, its sensitivity and specificity in detecting significant stenosis in the RCA were 88% and 91%, respectively. CONCLUSION: CFVR measurement in the postero-descending coronary artery by contrast enhanced TTDE is a new, noninvasive method to detect significant stenosis in the RCA.     

冠心病右冠状动脉病变的临床分析

目的:分析我科冠心病患者临床症状和冠脉造影资料,总结右冠脉狭窄的临床特点。方法:统计我科2002至2006所有行冠脉造影并确诊冠心病患者的冠脉狭窄资料,将其分为单支血管病变组和多支病变组,就右冠和左冠脉病变的特点作对比分析。结果:多支病变组右冠脉和左冠脉狭窄发病率相差不明显(P>0.05),而单支病变组右冠脉狭窄发病率明显低于左冠脉(P<0.001)。结论:右冠脉狭窄病变发病率比较低。     

Intraoperative evaluation of the functional significance of coronary collateral vessels in patients with coronary artery disease.

Coronary hemodynamics were studied intraoperatively in 65 patients undergoing aortocoronary bypass grafting. Poststenotic coronary pressure and graft flow hyperemia were measured. Patients without coronary collateral vessels on arteriography (class A) were compared with patients with collateral vessels (class B). Patients in class A were grouped according to the angiographically determined degree of coronary stenosis. Eight of these patients with moderate coronary stenosis underwent intraoperative studies with transient complete coronary occlusion and were classified in the "acute" occlusion group. In class B all patients had complete coronary occlusion with good retrograde filling of the distal segment. In class A patients there was good correlation between the degree of stenosis and poststenotic pressure or hyperemic response. Stenosis had to be at least 80 percent before it produced a significant pressure gradient or graft flow hyperemia. In class B patients (those with complete "chronic" coronary occlusion), poststenotic pressure was significantly greater than in the class A patients with "acute" occlusion, significantly less than in the class A groups with 71 to 80 percent and 81 to 90% stenosis but not significantly different from values in the class A group with 91 to 99 percent stenosis. The hyperemic response was significantly less than in the "acute" occlusion group of class A, significantly greater than in the class A groups with 71 to 80 percent and 81 to 90 percent stenosis, but not significantly different from values in the class A group with 91 to 99 percent stenosis. It is concluded that (1) under basal conditions a coronary stenosis must be at least 80 percent to be hemodynamically significant, and (2) well developed collateral vessels produce in a completely occluded coronary artery hemodynamic changes that simulate those of a 90 percent coronary stenosis without collateral vessels.     

Non-invasive evaluation of coronary reserve. Assessment of coronary reserve in patients with coronary artery disease by transesophageal-Doppler echocardiography

We assessed coronary flow reserve using transesophageal Doppler echocardiography in patients with coronary artery disease. The study included 33 coronary artery disease patients who were undergoing coronary arteriography. The blood flow velocities of the left anterior descending artery before and after intravenous infusion (0.56 mg/min for 4 min) of dipyridamole were recorded using transesophageal Doppler echocardiography. Fourteen normal healthy individuals, matched for age, served as a control group. The index of coronary flow reserve, i.e. the ratio of dipyridamole to baseline maximum diastolic velocity, was calculated. Maximal coronary flow reserve in coronary artery disease patients was significantly lower than in the control group (1.4+/-0.2 vs. 2.8+/-0.3, P<0.001). The coronary artery disease patients were classified into three groups: Group A included 10 patients with <50% left anterior descending artery stenosis; Group B included seven patients with 50-69% left anterior descending artery stenosis; 16 patients with >70% left anterior descending artery stenosis constituted Group C. The maximum coronary flow reserve was significantly different for A vs. B and A vs. C. (A, 1.77+/-0.18; B, 1.51+/-0.1; C, 1.28+/-0.24). A strong and significant correlation was found between the maximum coronary flow reserve and the degree of proximal left anterior descending artery stenosis (r=0.78, P<0.001). Coronary artery disease patients without left anterior descending artery stenosis on the arteriogram exhibited lower maximum coronary flow reserve compared to the control subjects (1.78+/-0.19 vs. 2.8+/-0.3, P=0.000).     

冠心病病变程度与窦性心率震荡关系的研究

目的观察冠心病患者病变程度和窦性心率震荡的关系。方法根据冠状动脉造影结果将65例拟诊冠心病并行HOTER检查的患者分为4组：A组为冠状动脉狭窄〈50％;B组为冠状动脉狭窄在50％-99％,但无闭塞;C组为大于1支血管存在闭塞;D组为冠状动脉造影结果正常。根据公式TO=（RR1＋RR2）-（RR-1＋RR-2）／（RR-1＋RR-2）计算TO值,RR1＋RR2代表VPC代偿间歇后的前2个窦性心率的RR间期均值,RR-1＋RR-2代表VPC前的2个窦性心率的RR间期均值。TO值≥0时表示VPC后初始阶段窦性心率减速,TO值〈0时表示VPC后初始阶段窦性心率加速。测量VPC后20个窦性心率的RR间期值,并以RR间期值为纵坐标,以RR间期序号为横坐标,绘制RR间期值的分布图,再用任意连续5个序号窦性心率的RR值计算并做出回归线,其中正向最大斜率为TS。TS〉2．5ms／RR时,窦性心率存在减速现象,TS≤2．5ms／RR时,窦性心率不存在减速现象。结果B组TO值为0．027±0．015,高于A组-0．044±0．016、D组-0．039±0．021（P〈0．05）;B组TS值1．61±0．21,低于A组、D组（P〈0．05）;C组TO值为0．052±0．008,高于A组、B组、D组（P〈0．05）,C组佟值为1．04±0．23,低于A组、B组、D组（P〈0．05）;A组与D组各值之间差异无统计学意义（P〉0．05）。结论冠心病病变程度越重,窦性心率震荡现象越不明显。     

Noninvasive assessment of significant right coronary artery stenosis based on coronary flow velocity reserve in the right coronary artery by transthoracic Doppler echocardiography

BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE) has been reported to be useful for the noninvasive assessment of coronary stenosis in the left anterior descending artery. However, the measurement of CFVR in the right coronary artery by TTDE has not yet been validated in a clinical study. OBJECTIVE: The aim of this study was to evaluate whether CFVR by TTDE can detect significant stenosis in the right coronary artery. METHODS: We studied 50 patients who underwent coronary angiography. Coronary flow velocity in the posterior descending branch of the right coronary artery (PD) was measured by TTDE both at baseline and during hyperemia induced by the intravenous infusion of adenosine triphosphate. CFVR was calculated as the hyperemia/baseline (average diastolic peak velocity). RESULTS: Adequate spectral Doppler recordings in the PD were obtained in 36 patients including 26 patients who were given an echocardiographic contrast agent to improve Doppler spectral signals. The study population was divided into 2 groups with (Group A;n = 11) and without (Group B;n = 25) significant stenosis in the right coronary artery. CFVR in Group A was significantly smaller than that in Group B (1.6+/-0.3versus2.5+/-0.4; P < 0.0001). The sensitivity of a CFVR of <2.0 for predicting the presence of significant stenosis in the right coronary artery was 91%, and the specificity was 88%. CONCLUSIONS: The measurement of CFVR in the PD by TTDE is useful for the noninvasive assessment of significant stenosis in the right coronary artery.     

右冠状动脉狭窄程度对左冠状动脉狭窄患者左室射血分数的影响

目的研究右冠状动脉不同程度狭窄对左冠状动脉狭窄患者左室射血分数（LVEF）的影响。方法根据左冠状动脉病变部位不同,将1 000例左冠状动脉狭窄患者分为左前降支（LAD）狭窄,左回旋支（LCX）狭窄,左主干（LM）狭窄,左前降支+左回旋支（LAD+LCX）狭窄4个系列。每个系列再根据右冠状动脉（RCA）病变程度不同分为RCA正常组（直径狭窄<50%）、RCA非闭塞组（99%>直径狭窄≥50%）和RCA闭塞组（直径狭窄≥99%）,比较分析3组间LVEF的差异。结果在LAD,LCX,LM,LAD+LCX狭窄时,与RCA正常组LVEF相比,RCA非闭塞组LVEF分别下降0.9%,0.3%,3.4%和2.8%;RCA闭塞组LVEF分别下降10.9%,3.7%,6.5%和5.2%。LAD狭窄时,RCA非闭塞组和RCA闭塞组之间LVEF有统计学差异（P<0.01）。结论右冠状动脉病变可在左冠状动脉狭窄的基础上使左室射血分数进一步下降;当左冠状动脉狭窄为闭塞性病变时,影响更为明显。     

Differential diagnosis of lesions of the left coronary artery trunk and multiple hemodynamically-significant stenoses of the coronary arteries

Clinical manifestations were compared in coronary patients with different sites and spread of coronary atherosclerosis, in order to assess the feasibility of differential diagnosis of left coronary arterial (LCA) trunk lesions versus multiple coronary arterial stenoses. Four groups of patients were examined: isolated third- or fourth-degree LCA trunk stenosis (15 patients, group 1); third- or fourth-degree stenosis of the anterior interventricular branch (AIVB) and the circumflex branch (CB) (44 patients, group 2); third- or fourth-degree stenosis of AIVB, CB or the right coronary artery (RCA) (77 patients, group 3); and third- or fourth-degree stenosis of AIVB, CB, the diagonal branch or RCA (33 patients, group 4). The clinical condition of patients with isolated LCA branch lesions was much worse than that of patients with multiple coronary arterial stenosis. Differential diagnosis is based on the severity of the pain syndrome, the spread of ischemic zone on resting ECG, the scope of past myocardial infarction, stress tolerance and the magnitude of ST depression in response to exercise.