Rubidium-82 Positron Emission Tomography With Intravenous Ergonovine to Diagnose Vasospastic Angina

The gold standard to diagnose vasospastic angina is intracoronary reactivity testing, which is performed selectively at dedicated centres. Noninvasive imaging with single-photon emission computerized tomography (SPECT) or echocardiography does not enable accurate localization of spasm or quantification of change in myocardial perfusion in response to an abnormal vasoreactivity. Rubidium-82 positron emission tomography myocardial perfusion imaging (⁸²Rb PET-MPI) with intravenous ergonovine was used to diagnose refractory vasospastic angina in a patient with a complex ischemic syndrome, recent coronary stenting, and persistent atypical angina despite maximal tolerable doses of guideline-directed medical therapy.     

双源CT心周脂肪定量与冠状动脉粥样硬化病变程度的相关性

目的 分析心周脂肪体积与心血管危险因素、冠心病的发生和冠状动脉狭窄程度之间的关系.方法 221例同期行64排双源CT和经皮冠状动脉造影检查的患者入选,进行腰围、体质指数和空腹血生物化学指标测定.使用64排双源CT测定心周脂肪体积,通过经皮冠状动脉造影检查明确患者的冠心病诊断和冠状动脉病变支数,并采用Gensini积分量化冠状动脉狭窄的严重程度.结果 入选患者男性占71.04%.男性心周脂肪体积明显大于女性(241.44±78.08 cm~3比216.46±64.36 cm~3,P=0.025).年龄≥70岁的患者心周脂肪体积明显大于年龄<70岁的同性别患者(P<0.05).冠心病患者的心周脂肪体积明显大于非冠心病患者(242.10±75.80 cm~3比189.23±52.26 cm~3,P<0.001).Logistic回归分析显示心周脂肪体积(OR=1.11,P<0.001)和体质指数(OR=1.01,P=0.001)是影响冠心病发生的独立危险因子.心周脂肪体积随着冠状动脉病变支数的增加而增加,并且与Gensini积分呈正相关.结论 64排双源CT可对心周脂肪组织进行准确定量,心周脂肪体积与心血管危险因素和冠心痛的发生以及冠状动脉病变程度存在较强的相关性,可作为一个新的评估冠心病风险和病变程度的指标.     

Myocardial Infarction Associates With a Distinct Pericoronary Adipose Tissue Radiomic Phenotype: A Prospective Case-Control Study

ObjectivesThis study sought to determine whether coronary computed tomography angiography (CCTA)-based radiomic analysis of pericoronary adipose tissue (PCAT) could distinguish patients with acute myocardial infarction (MI) from patients with stable or no coronary artery disease (CAD).BackgroundImaging of PCAT with CCTA enables detection of coronary inflammation. Radiomics involves extracting quantitative features from medical images to create big data and identify novel imaging biomarkers.MethodsIn a prospective case-control study, 60 patients with acute MI underwent CCTA within 48 h of admission, before invasive angiography. These subjects were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, sex, risk factors, medications, and CT tube voltage. PCAT was segmented around the proximal right coronary artery (RCA) in all patients and around culprit and nonculprit lesions in patients with MI. PCAT segmentations were analyzed using Radiomics Image Analysis software.ResultsOf 1,103 calculated radiomic parameters, 20.3% differed significantly between MI patients and controls, and 16.5% differed between patients with MI and stable CAD (critical p < 0.0006); whereas none differed between patients with stable CAD and controls. On cluster analysis, the most significant radiomic parameters were texture or geometry based. At 6 months post-MI, there was no significant change in the PCAT radiomic profile around the proximal RCA or nonculprit lesions. Using machine learning (XGBoost), a model integrating clinical features (risk factors, serum lipids, high-sensitivity C-reactive protein), PCAT attenuation, and radiomic parameters provided superior discrimination of acute MI (area under the receiver operator characteristic curve [AUC]: 0.87) compared with a model with clinical features and PCAT attenuation (AUC: 0.77; p = 0.001) or clinical features alone (AUC: 0.76; p < 0.001).ConclusionsPatients with acute MI have a distinct PCAT radiomic phenotype compared with patients with stable or no CAD. Using machine learning, a radiomics-based model outperforms a PCAT attenuation-based model in accurately identifying patients with MI.     

成人瓣膜病患者电子束CT检出冠状动脉钙化

评价成年瓣膜病患者电子束CT检查冠状动脉钙化的临床意义。208例42－75岁瓣膜病患者换瓣术前行电子束CT及选择性冠状动脉造影检查，同时进一步分析患者的冠心病危险因素。结果发现，208例瓣膜病患者中无冠状动脉钙化者114例，造影证实无冠心病者109例，占95．6％（P＜0．005），另5例合并冠心病，其中4例至少有一项冠心病危险因素。全组瓣膜病患者电子束CT检查既无冠状动脉钙化，临床又无冠心病危险因素共58例，造影证实仅1例有冠心病，占1．72％。结果表明，瓣膜病患者以电子束CT检查冠状动脉钙化阴性，并且无传统冠心病危险因素者排除冠心病的准确性高于95．6％。从而认为电子束CT检出冠状动脉钙化阴性对排除瓣膜病患者合并冠心病有重要的临床意义，术前行电子束CT检查，可以大大减少有创的冠状动脉造影检查的应用。     

心房颤动者冠状静脉窦形态学的多层螺旋计算机断层摄影术研究

目的:应用多层螺旋计算机断层摄影术(MSCT)探讨心房颤动(房颤)者冠状静脉窦及左心房形态学的变化.方法:因房颤行MSCT肺静脉成像和行冠状动脉血管成像检查的患者,共收取冠状静脉窦图像质量最佳者100例,分为房颤组[50例:女20例,平均年龄(50.5±13.0)岁]及对照组[50例:女23例,平均年龄(53.6±13.0)岁].测量冠状静脉窦口的直径(上下径和前后径)、距冠状静脉窦口1 cm、2 cm处冠状静脉窦的直径(上下径和前后径)及各处面积;左心房的直径.结果:房颤组与对照组比较:冠状静脉窦口直径[上下径:(19±7)mm vs(16±8)mm,P:0.05;前后径:(13±2)mmvs(11±3)mm,P=0.01]、距冠状静脉窭口1 cm处冠状静脉窦直径[上下径:(15±1)mm vs(13±2)mm,P＜0.01;前后径:(11±5)mm vs(11±1)mm,P=0.03]和左心房直径[上下径(45±4)mm vs(31±7)mm,P=0.04;前后径:(53±4)mm vs(44±5)mm,P＜0.01]房颤组明显高于对照组.结论:房颤者冠状静脉窦及左心房发生形态解剖重构;其形状与正常人群无差异,其中管状冠状静脉窦占82%.