老年冠心病367例临床分析

目的探讨老年冠心病的临床特点.方法对2001年1月～2004年12月收治的367例老年冠心病住院患者的临床资料进行回顾性分析.结果 367例患者的临床表现为,无明显症状42例、单纯心绞痛92例、单纯心肌梗死56例、单纯心律失常66例、心绞痛或心肌梗死合并心律失常74例、心绞痛或心肌梗死合并心功能不全37例.79例有心肌梗死的病例中,47例表现为Q波心肌梗死;32例表现为非Q波心肌梗死;140例有心律失常的病例中,部分病例有多种心律失常表现,其中房颤51例、室性期前收缩37例、房性期前收缩34例、室内传导阻滞27例、房室传导阻滞12例、病窦综合征8例.结论老年冠心病具有无症状型冠心病多、心绞痛症状不典型者多、心律失常检出率高、易合并心功能不全、多种类型的冠心病合并出现者多、非Q波型心肌梗死发生率高等临床特点.     

急性冠脉综合征中糖原磷酸化酶BB的观察

目的 观察和比较急性冠脉综合征患者发病过程中糖原磷酸化酶BB、肌酸磷酸激酶及其亚型的变化情况方法 对正常对照组、稳定型心绞痛、不稳定型心绞痛及急性心肌梗死患者进行采血,酶联免疫法检测GPBB,生化检测CK、CK-MB。急性心肌梗死组分不同时间段进行比较。结果 稳定型心绞痛组与正常对照组比较,P>0.05。不稳定型心绞痛组与正常对照组比较,GPBB P<0.05,CK、CK-MB P>0.05。急性心肌梗死各组中GPBB与正常对照组相比,均P<0.05.且在12-24 h出现峰值。CK 3 h以内组与正常对照组相比,P>0.05;其余均P<0.05,且呈持续上升趋势。CK-MB 3 h以内组与正常对照组相比,P>0.05;其余均P<0.05,且在24-36 h出现峰值。结论 与CK、CK-MB相比,GPBB对于急性心肌梗死的早期诊断具有明显的特异性和敏感性     

不伴心肌梗死的冠状动脉完全闭塞病变心绞痛的临床分析

目的：探讨不伴心肌梗死的冠状动脉完全闭塞病变心绞痛患者的临床特点。方法：对24例不伴心肌梗死的冠状动脉完全闭塞患者的临床表现、心电图、超声心动图及冠状动脉造影资料进行回顾分析。结果：中、高危险组主要表现为静息心绞痛，低危险组和稳定性心绞痛组主要表现为劳力型心绞痛。冠状动脉造影显示左前降支闭塞10例（37％），右冠状动脉闭塞7例（26％），左回旋支闭塞6例（22％），合并多支血管病变23例（95．8％）。心电图ST段异常14例（58．3％）。62．5％的患者进行经皮冠脉血运重建术。结论：不伴心肌梗死的冠状动脉完全闭塞主要表现为劳力型心绞痛，心电图ST段异常是预测冠脉病变严重程度的主要危险因素。经皮冠状动脉介入治疗正成为慢性冠状动脉闭塞的主要手段之一。     

冠心病患者纤溶系统的异常变化

目的探讨冠状动脉病变中血清纤维蛋白原（Fg）、组织型纤溶酶原激活物（t-PA）、血浆D-二聚体（D-Dimer）与血栓形成关系，并就其作用机理进行研究，为临床治疗提供科学依据。方法急性心肌梗死（AMI）组28例、不稳定心绞痛（UAP）组24例、稳定心绞痛（SAP）组30例和正常对照组20例。分别检测血清Fg、血浆D-Dimer、t-PA及其抑制物（PAI）活性，并对照比较其含量与冠状动脉粥样硬化血栓形成的关系。结果血浆t-PA活性：AMI和UAP明显低于SAP与健康对照组（P〈0．01）；AMI组和UAP组之间，SAP组与健康对照组之间差异无统计学意义（P〉0．05）。血浆PAI活性、D-Dimer和Fg含量：AMI和UAP组明显高于SAP和健康对照组（P〈0．01）；AMI组和UAP组之间，SAP组与健康对照组之间差异无统计学意义（P〉0．05）。结论监测冠状动脉粥样硬化患者血清中血清Fg含量、t-PA、D-Dimer含量，可以及时判断凝血和纤溶功能失衡状况，预防和干扰血栓形成，提高患者良性预后。     

彩色室壁动力技术对节段室壁运动的定量研究

目的：应用彩色室壁动力技术（ＣｏｌｏｒＫｉｎｅｓｉｓ,ＣＫ）研究局部心室壁运动。方法：我们以自行研制的计算机软件,通过由乳头肌水平的左室短轴切面和心尖四腔切面ＣＫ图像,获取各节段各时相的区域心内膜位移面积百分比（ＲｅｇｉｏｎａｌＦｒａｃｔｉｏｎＡｒｅａＣｈａｎｇｅ,ＲＦＡＣ）,对４５名正常人和１５名患陈旧性心肌梗死的冠心病患者的ＣＫ图像进行了定量分析研究。结果：正常人相同切面的ＣＫ图像具有比较一致的形态特点,其不同心肌节段在收缩期的ＲＦＡＣ均值有较恒定的范围。心肌梗死患者的ＲＦＡＣ面积堆积图与正常人比较有显著的不同,运动异常的节段其ＲＦＡＣ值明显低于正常人。结论：ＣＫ技术能够实时、客观地展示收缩期各时相心内膜的运动状态,ＲＦＡＣ是ＣＫ技术定量评价室壁运动的较好指标,值得进一步研究并应用于临床。     

冠状动脉心肌桥的诊断及临床意义

目的探讨冠状动脉心肌桥的诊断以及临床意义.方法对486例行冠状动脉造影(CAG)检查资料进行了回顾性分析.结果共检出13例心肌桥,检出率为2.67%;其中位于左前降支(LAD)12例,左回旋支(LCX)1例;合并冠状动脉粥样硬化症2例;临床表现急性心肌梗死1例,心绞痛4例.结论冠脉造影是冠状动脉心肌桥的特异性诊断方式;局部冠状动脉收缩期狭窄是心肌桥的主要征象;心肌桥患者多数无临床症状,严重者可致心绞痛甚至心肌梗死.     

冠状动脉完全闭塞无心肌梗死患者临床特点

目的探讨冠状动脉完全闭塞无心肌梗死患者的临床特点。方法选取冠状动脉造影显示冠状动脉完全闭塞而无心肌梗死发生的23例患者（无心肌梗死组）和冠状动脉造影显示冠状动脉完全闭塞有明显临床心肌梗死证据的27例患者（心肌梗死组），比较两组患者的临床特点。结果两组在高血压、年龄、性别等方面比较差异无显著性。无心肌梗死组在糖尿病、血脂异常、吸烟、心绞痛史等方面与心肌梗死组比较，差异均有显著性（均为P〈0．05）。无心肌梗死组冠状动脉病变血管支数较心肌梗死组多，侧支循环建立较好。但经皮冠状动脉介入治疗的成功率要低于心肌梗死组。结论冠状动脉造影显示有冠状动脉完全闭塞患者中，部分患者可无心肌梗死表现。除年龄、性别等不可控制因素外，糖尿病、血脂异常、吸烟等危险因素可能促进冠状动脉粥样硬化的发展。部分冠状动脉完全闭塞而无心肌梗死的患者常有较长的心绞痛史，冠状动脉病变弥散，侧支循环建立较好，所以在某支冠状动脉病变发展到完全闭塞时可不表现心肌梗死。     

Acute myopericarditis with focal ECG findings mimicking acute myocardial infarction

Background: Although history, physical examination, laboratory data points, and electrocardiogram (ECG) are helpful, distinguishing among pericarditis, myopericarditis, and myocardial infarction can be difficult. Objectives: This case, which presents as pericarditis with concomitant myocarditis (myopericarditis), illustrates the four evolving ECG stages of pericarditis and highlights some of the potential difficulties in differentiating between myopericarditis and acute myocardial infarction. Case Report: We present the case of a previously healthy 15-year-old boy who presented to the Emergency Department (ED) from his family physician's office for chest pain and presumed pericarditis. The patient's initial ECG showed infero-lateral ST-segment elevation, and his troponin T was elevated at 1.54 ng/mL (ref. < 0.03). Several hours after presentation to the ED, the patient experienced “10/10” chest pain, and a repeat ECG showed ST elevation increased from the prior ECG. After an emergent echocardiogram revealed no regional wall abnormalities, he was transferred to a pediatric cardiac intensive care unit, where a heart catheterization revealed no coronary irregularities. He was discharged 4 days later with the diagnosis of myopericarditis. Conclusion: This case report illustrates some of the difficulties in differentiating among myopericarditis and myocardial infarction in a 15-year-old patient presenting with chest pain.     

超声评价冠心病患者血管内皮舒张功能

目的 通过超声检测肱动脉内径评价冠心病患者肱动脉血管内皮舒张功能变化.方法 采用高分辨率超声检测稳定型心绞痛、不稳定型心绞痛、急性心肌梗死患者及正常对照组血流介导的肱动脉血管舒张功能和硝酸甘油介导的肱动脉血管舒张功能.结果 冠心病各组血流介导的血管舒张反应均较正常对照组降低（P〈0.05）.稳定型心绞痛组与正常对照组,硝酸甘油介导的血管舒张反应无显著性差异（P〉0.05）,而不稳定型心绞痛组和急性心肌梗死组硝酸甘油介导的血管舒张反应均低于正常对照组与稳定型心绞痛组（P〈0.05）.结论 冠心病患者存在内皮舒张功能损害,这种损害呈渐进性发展.     

Thallium-199: a new radiopharmaceutical for myocardial perfusion imaging

The efficacy of a new radionuclide, thallium-199 for myocardial scintigraphy was compared with conventional thallium-201 imaging. Owing to the short half-life of thallium-199 (7.4 hours), when the injected dose of thallium-199 was increased to 200 MBq, the total dose reaching the critical organs was 3.6–15.5 times lower than with conventional nuclide, thallium-201. Studies were performed in a total of 177 patients. The patients were divided into two groups (a) 17 patients with acute myocardial infarction and (b) 160 patients undergoing coronary angiography: 55 patients with no significant coronary artery disease and 105 patients with coronary disease. The sensitivity of the test was 92% with a specificity of 82% and overall predictive accuracy of 84%. Myocardial images obtained with low and high energy collimators have similar predictive accuracy. Perfusion defects were detected more frequently with increasing severity of angina. Myocardial infarction was characterized by persistent defects and myocardial ischaemia by redistribution of thallium. Thallium-199 myocardial scintigraphy performed at rest can be used for the diagnosis of acute myocardial infarction and for the determination of infarct site and extent. Thallium-199 is a new myocardial imaging agent, with a predictive accuracy for the diagnosis of coronary artery disease similar to thallium-201, but a significantly reduced total body dose permits repeat studies with a reduced radiation dose for the patient.     

地尔硫(艹卓)治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的 探讨地尔硫[艹卓]治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法 对106例围手术期心绞痛患者静脉应用地尔硫[艹卓]，观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化，判断疗效。结果 82例（77．4％）用药期间未再发作，另有24例（22．6％）仍有心绞痛发作，但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降（均P〈0．05）。无一例因严重不良反应而停药。结论 静脉应用地尔硫[艹卓]治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。     

急诊介入治疗高危不稳定性心绞痛的临床研究

目的研究急诊介入治疗高危不稳定性心绞痛（UAP）的效果及安全性。方法71例UAP患者入院后随机分为两组：急诊介入治疗组43例,非急诊介入治疗组28例。均行冠脉造影和介入治疗。观察30d内心脏事件（包括心绞痛、急性心肌梗死、猝死、再次介入治疗及冠脉搭桥手术）的发生率,症状缓解率,症状缓解时间,住院时间及住院费用。结果急诊介入治疗与非急诊介入治疗组比较,急诊介入治疗UAP降低了30d内心脏事件（心绞痛、急性心肌梗死、猝死）的发生,差异具有显著性（P〈0.05）;缩短了症状缓解及住院时间,差异具有显著性（P〈0.05）;降低住院费用,具有显著性差异（P〈0.05）;而手术的成功率及疗效相似,差异无显著性（P〉0.05）。结论急诊介入治疗高危的UAP患者效果好,安全,并可缩短住院时间,降低住院费用。     

心肌缺血预适应对急性心肌梗死后临床及预后的影响

目的　探讨心肌缺血预适应 (IP)对急性心肌梗死 (AMI)临床及预后的近期影响。方法　根据心肌梗死前有无心肌缺血证据或 (和 )心绞痛病史将 198例患者分为A、B两组。对其临床资料进行回顾分析。结果　A组小面积心肌梗死发生率高于B组 ,而肌酸磷酸激酶 (CK)和同工酶 (CK MB)峰值、严重心脏并发症和梗死后心绞痛发生率、近期住院病死率均明显低于B组。结论　既往心绞痛促进冠状动脉侧支循环的建立 ,发病前心绞痛可能促进IP产生 ,二者协同对AMI后的心肌细胞起保护作用。     

Tl-201 myocardial SPECT in silent myocardial ischemia and angiographically proven coronary heart disease

Silent myocardial ischemia is defined as true myocardial ischemia without angina pectoris in patients with angiographically detected coronary artery disease. In this study 52 patients (46 male, 8 female: mean age 53 years) with a pathological exercise test but no symptoms were investigated. They showed stenosis of 75% or more of the diameter in at least one coronary segment on angiography. Prior to or after catheterization (within 14 days) Tl-201 SPECT was done and evaluated independently of angiography. A clear correlation between angiographically confirmed stenosis and reversible perfusion defects with Tl-201 SPECT was established (62 out of 76 lesions). Furthermore, there was a significant relation between angiographically detected subtotal or total occlusions of coronary vessels and irreversible perfusion defects using Tl-201 SPECT (35 in 44 lesions) (p less than 0.001). In patients with ST depression but without angina pectoris during the exercise test, the Tl-201 SPECT is highly suited to determine the hemodynamic effect of coronary stenoses.     

Increased plasminogen activator inhibitor activity and diabetes predict subsequent coronary events in patients with angina pectoris

BACKGROUND: Plasminogen activator inhibitor (PAI) is a marker of recurrence of myocardial infarction. Diabetes mellitus is also an important risk factor of coronary artery disease, including myocardial infarction and angina pectoris. AIM: We examined baseline plasma PAI activity levels, clinical variables, and angiographic findings and assessed them as prospective values for subsequent coronary events, such as sudden death, nonfatal myocardial infarction and coronary revascularization by percutaneous transluminal coronary angioplasty or coronary artery bypass surgery during the follow-up period. METHODS: We conducted a prospective study for 4 years of 249 consecutive patients admitted with angina pectoris. Blood samples for PAI were drawn at discharge. RESULTS: In the multivariate Cox proportional hazard model, PAI activity and diabetes mellitus were significant and independent risk factors (the risk increased by 10% in those with a higher PAI concentration and by 70% in diabetic patients). Event-free survival was reduced by higher PAI activity (> or = 8.4 IU/mL) and the presence of diabetes. The patients with higher PAI activity and diabetes had a 4.2-fold risk in comparison with the patients with lower PAI activity and no diabetes. However, patients with lower PAI activity were less likely to have coronary events even when they had diabetes. CONCLUSIONS: Higher PAI activity and diabetes predict subsequent coronary events in patients with angina pectoris. Diabetes has less prognostic value for subsequent coronary events in patients with lower PAI activity.     

地尔硫治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的探讨地尔硫治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法对106例围手术期心绞痛患者静脉应用地尔硫,观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化,判断疗效。结果82例(77.4%)用药期间未再发作,另有24例(22.6%)仍有心绞痛发作,但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降(均P<0.05)。无一例因严重不良反应而停药。结论静脉应用地尔硫卓治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。     

影响急性心肌梗死静脉溶栓治疗的多因素分析

目的 探讨急性心肌梗死（AMI）静脉溶栓的疗效及影响静脉溶栓再通的因素。方法 回顾性分析相关因素对冠状动脉再通的影响。结果 比较分析再通组与未再通组资料，年龄，性别，吸烟，高血压，糖尿病，血脂异常，心绞痛，既往心肌梗死史，梗死部位，心功能不全及心房纤颤是影响AMI后静脉溶栓再灌注的因素。结论 年龄，糖尿病，心绞病史，既往心肌梗死史，梗死部位，心功能，心房纤颤为影响再灌注的独立相关因素。     

Cardiovascular magnetic resonance of the myocardium at risk in acute reperfused myocardial infarction: comparison of T2-weighted imaging versus the circumferential endocardial extent of late gadolinium enhancement with transmural projection

Background

In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. Recently, T2-weighted cardiovascular magnetic resonance (CMR) has been introduced as a new method for assessing MaR several days after the acute event. Furthermore, it has been suggested that the endocardial extent of infarction as assessed by late gadolinium enhanced (LGE) CMR can also be used to quantify the MaR. Hence, we sought to assess the ability of endocardial extent of infarction by LGE CMR to predict MaR as compared to T2-weighted imaging.

Methods

Thirty-seven patients with early reperfused first-time ST-segment elevation myocardial infarction underwent CMR imaging within the first week after percutaneous coronary intervention. The ability of endocardial extent of infarction by LGE CMR to assess MaR was evaluated using T2-weighted imaging as the reference method.

Results

MaR determined with T2-weighted imaging (34 ± 10%) was significantly higher (p < 0.001) compared to the MaR determined with endocardial extent of infarction (23 ± 12%). There was a weak correlation between the two methods (r² = 0.17, p = 0.002) with a bias of -11 ± 12%. Myocardial salvage determined with T2-weighted imaging (58 ± 22%) was significantly higher (p < 0.001) compared to myocardial salvage determined with endocardial extent of infarction (45 ± 23%). No MaR could be determined by endocardial extent of infarction in two patients with aborted myocardial infarction.

Conclusions

This study demonstrated that the endocardial extent of infarction as assessed by LGE CMR underestimates MaR in comparison to T2-weighted imaging, especially in patients with early reperfusion and aborted myocardial infarction.     

超敏C反应蛋白检测在冠心病诊断中的临床价值探讨

目的 探讨超敏c反应蛋白（HS—CRP）检测在冠心病（CHD）诊断中的应用价值。方法结合临床检查及冠脉造影情况,将150例冠心病患者分为稳定性心绞痛（SAP）、不稳定性心绞痛（UAP）、急性心肌梗死（AMI）3个组。分别测定150例冠心病患者血清超敏c反应蛋白（Hs—CRP）、肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）,并与50例健康人做对比。结果与正常对照组比较,CHD组血清Hs—cRP均明显升高差异具有统计学意义（P〈0．05）,且AMI组患者血清的Hs—CRP浓度明显高于UAP组（P〈0．01）;UAP组患者血清的hs—cRP浓度明显高于SAP组（P〈0．01）,且AMI组治疗后Hs—CRP浓度显著下降;冠心痛阳性检出率HS—CRP（90．7）〉CK（41．3％j〉CK—MB（34．6％）。结论血清HS—CRP水平高低与CHD病情密切相关,可作为冠心病患者病情严重程度的敏感性指标。     

Exercise and redistribution thallium-201 myocardial scintigraphy: changes in distribution qualitatively unaffected by previous infarction

Summary. Eighteen patients with stable exertional angina pectoris were investigated by thallium-201 (²⁰¹T1) exercise and redistribution single photon emission computed tomography (SPECT) after coronary angiography. Eight of the patients had a previous myocardial infarct. Six patients had single-, eight double- and four triple-vessel disease. An exercise SPECT was acquired 10 min after the administration of isotope, injected 1–2 min before the termination of a symptom-limited exercise test. A redistribution SPECT was recorded 3 h later. ²⁰¹T1 activity per pixel was compared between the exercise and redistribution SPECT in relative and absolute terms. For each patient there was a good correlation between activity per pixel in the redistribution SPECT and the corresponding pixels in the exercise SPECT (mean correlation coefficient 0–86 ± 0–08), irrespective of the extent of coronary artery disease or presence of a previous infarction in the pixel region. Relative wash-out correlated to the degree of coronary artery stenosis (r= 0–48), but did not differ between infarcted and non-inf arcted myocardial regions. A similar relationship was documented for pixels with visual ‘refill’ in the redistribution SPECT. This implies that most of the information in the redistribution SPECT was present already in the exercise SPECT. Thus, qualitative information of a similar kind is obtained from images acquired immediately after exercise and after 3–4 h of redistribution.