Tei指数对不同程度冠状动脉病变患者右心功能的评价

目的:探讨Tei指数检测不同程度冠状动脉病变患者右心功能变化的临床应用价值。方法:采用组织多普勒显像技术对30例正常对照组、30例冠状动脉造影阴性组(狭窄<50%)、30例轻度冠状动脉狭窄组(狭窄50%～74%),30例中度冠状动脉病变组(75%～94%)进行三尖瓣环右室室间隔及游离壁Tei指数测定。结果:冠状动脉造影阴性组Tei指数与正常对照组比较不存在显著差异,轻度冠状动脉狭窄组及中度冠状动脉狭窄组Tei指数显著高于正常对照组(P<0.05)。结论:冠状动脉病变患者右心功能亦受损,Tei指数能用于评价右心功能受损情况。     

高血压与冠状动脉狭窄程度的相关性研究

目的 探讨高血压与冠状动脉病变狭窄程度的关系.方法 选择9762例疑诊冠心病患者,其中合并高血压病的5912例患者作为观察组,未合并高血压病的3850例患者作为对照组.采用Gensini积分评价冠状动脉造影病变程度,并计数冠状动脉病变的支数.采用单因素方差分析及多因素回归分析观察高血压病与冠状动脉狭窄程度间的关系.结果...     

应用320排CT评价冠状动脉狭窄的临床研究

目的:通过与冠状动脉造影(CAG)相比较,评价320排动态容积CT冠状动脉成像在诊断冠状动脉狭窄方面的准确性。方法:选择冠心病诊断明确或可疑冠心病患者共60例(男38例,女22例)。所有患者的心律均为窦性心律,心率≥70次/min的患者口服美托洛尔控制心率;均同期行320排动态容积CT(DVCT)与冠状动脉造影,将两种结果进行对照研究。结果:320排动态容积CT显示的780个冠状动脉节段中(每位患者分为13个节段),均符合影像学评价要求;与冠状动脉造影相比较,320排动态容积CT发现冠状动脉狭窄的总体敏感性为92.9%,特异性97.3%,阳性预测值91.9%,阴性预测值97.7%;对于冠状动脉狭窄检出的准确率为96.2%。结论:320排动态容积CT能够较为准确的诊断冠状动脉狭窄程度,可作为一种简便、易行的无创性诊断冠心病的有效方法。     

64层螺旋CT冠状动脉成像诊断冠状动脉狭窄的初步探讨

目的：探讨64层螺旋CT（MSCT）冠状动脉成像对冠状动脉狭窄的诊断价值。方法：53例冠心病患者同期均行64层螺旋CT冠状动脉成像和常规冠状动脉造影（CCA）,以CCA的诊断结果作为金标准,采用美国心脏协会冠状动脉改良分段法,分析745个冠状动脉节段MSCT图像质量及对冠状动脉狭窄的显示情况,得出有意义病变（冠状动脉狭窄率≥500%）MSCT诊断的正确性,并分析钙化对其影响。结果：587个冠状动脉节段图像可以满足诊断要求,158个节段因运动伪影（27个节段）或管壁严重钙化（131个节段）无法进行血管评价。MSCT诊断冠状动脉狭窄的敏感度为93．4％、特异度为97．9％、阳性预测值为93．9％、阴性预测值为97．7％。钙化积分≥1000的患者,MSCT诊断冠状动脉狭窄的特异度、敏感度、阳性预测值、阴性预测值分别为74％、82％、68％、96％。结论：64层螺旋CT冠状动脉成像是一种快速、安全、无创的检查方法,与常规冠状动脉造影检查结果有较好的一致性,可以作为临床怀疑冠心病患者的首选检查方法。     

64层螺旋CT检测不同程度冠状动脉狭窄临床分析

目的：探索64层螺旋CT对冠脉管腔的可评价率和诊断不同程度冠脉狭窄的敏感性、特异性、阳性预测值和阴性预测值并进行比较。方法：将我院2006年1月～2008年7月经选择性冠状动脉造影（selective coronary angiography,SCA）对比的127例64层螺旋CT检测的冠脉狭窄患者的资料进行整理、统计、分析和对比。结果：冠脉管腔可评价率为95.6%。轻、中、重度冠脉狭窄的敏感性为85.9%、90.3%、95.3%（P〈0.05）;特异性为98.3%、99.0%、99.5%（P〈0.05）;阳性预测值为87.8%、91.6%、93.5%（P〉0.05）;阴性预测值为98.0%、99.0%、99.7%（P〈0.001）。结论：64层CT对冠脉管腔的可评价率高,对诊断轻、中、重度冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值均较高,且各百分率有随冠脉狭窄程度的增加而逐渐增高的趋势,并且发现排除性指标优于诊断性指标。     

冠状动脉内多普勒超声研究冠状动脉血流速度

目的:评价冠状动脉内多普勒超声测量冠脉血流速度的应用价值。材料和方法:利用冠状动脉内多普勒血流钢丝(FloWire) 测量21 例冠状动脉狭窄患者和12 例正常冠状动脉的血流速度。结果:左前降支冠脉狭窄远端的平均最大血流速度(APV) 、舒张期最大血流速度(DPV) 和舒张期与收缩期流速比值(DSVR) 均显著低于正常组测值。结论:应用冠脉内多普勒超声技术可评价正常和冠脉狭窄病变患者的冠脉血流速度,这为定量研究冠脉血流动力学提供了新方法。     

踝肱指数对老年冠状动脉狭窄严重程度的判断价值

目的：探讨踝肱指数对老年冠状动脉狭窄严重程度的判断价值。方法：依据冠状动脉造影118例检查结果分为正常组、单支病变组、2支病变组、3支或左主干病变组,与预先测量的踝肱指数进行对比及统计学处理。结果：3支或左主干病变组踝肱指数明显低于其他组（P〈0．01）,而正常组、单支病变组或2支病变组差异不显著。结论：老年人踝肱指数与冠状动脉狭窄严重程度呈显著负相关,对判断冠状动脉狭窄严重程度有一定价值。     

64层螺旋CT检测冠状动脉粥样硬化斑块的初步研究

目的对比冠状动脉内超声（IVUS）检查的结果，评价64层螺旋CT冠状动脉成像（MSCTCA）在显示和分析冠状动脉粥样硬化病变方面的可行性和准确性。方法对15例可疑冠心病的患者进行64层MSCTCA检查，获取相关的数据，应用后处理技术对冠状动脉粥样斑块进行评估分析，并以3周内实施的IVUS结果为金标准进行对比。同时，对2种方法所获得的计量资料（即：血管段某一点的血管腔内面积、血管截面积）进行对比分析，获得直线回归方程（Y：IVUS值，X：64层MSCT值）。结果所有病例可用于评估的86个无明显狭窄冠状动脉样本中，IVUS显示有斑块病变的血管段为38段，64层MSCTA显示36段，2段诊断为正常血管。64层MSCTA对出现粥样硬化斑块节段诊断的敏感性为94．7％，特异性为100．0％，总符合率为97．7％，误诊率为0，漏诊率为5．3％，阳性预测值100．0％，阴性预测值96．0％。经Kappa检验，Kappa值为0．953，P〈0．05。直线回归方程对于2种方法所获得的管腔内面积：Y=0．817＋0．832X，P〈0．01；血管的截面积：Y=-0．331＋1．019X，P〈0．01。结论64层MSCTCA在显示冠状动脉粥样硬化斑块病变时，能较为清晰地显示管壁斑块病变的构成情况，对于病变的类型及严重程度的评估比较准确和客观。对于临床怀疑冠心病患者的门诊筛查和初步诊断，具有较好的可行性和准确性。     

冠状动脉血管内超声在冠状动脉介入治疗中的应用

目的 探讨冠状动脉冠脉血管内超声显像(IVUS)对冠心病的冠脉病变特点研究及在冠脉支架置入术中的应用价值.方法 选择28例拟行经皮冠脉介入治疗术(PCI)患者,冠脉造影显示单支病变,在支架置入前,应用IVUS观察靶血管的斑块特点(软斑块、纤维斑块、钙化斑块及混合斑块)以及偏心程度,测量血管的最小腔径及腔面积、斑块面积,在支架置入后测量血管的最小腔径及腔面积、斑块面积,观察支架的位置,测量支架的对称指数、支架的贴壁程度及支架展开满意度.结果 28例冠心病患者共置入36枚支架,在支架置人后,最小血管腔径及腔面积均较置入前增大,斑块面积缩小,差异均具有统计学意义(P<0.01),支架置入后IVUS检查所有支架位置满意,能完全覆盖病变,两端无夹层,30例支架扩张满意,3例未充分扩张,3例贴壁欠佳,占支架置入的16.7%,在更换大一号低顺应性球囊高压扩张或用原球囊更高压力扩张(18～22 atm)后复查IVUS达到满意标准.结论 IVUS可清晰显示冠脉内血管的斑块特点、偏心程度、血管腔径、血管腔面积及斑块面积,在支架置入前可指导选择支架的大小,支架置入后可观察支架的位置、贴壁情况,支架扩张是否充分,是评价冠脉支架置入较理想的方法 .     

血流多普勒与组织多普勒Tei指数评价早产儿及足月儿的右心室功能分析

目的应用组织多普勒成像技术(TDI)评价早产儿及足月儿右心室Tei指数的改变,并与传统血流多普勒的测量方法比较,为临床评估右心室功能及治疗提供依据。方法对100名新生儿中早产儿和足月儿各50名进行两种多普勒超声心动图技术测定右心室等容收缩期(ICT)与等容舒张期时间(IRT)之和(ICT+IRT)及射血时间(ET),并计算Tei指数。结果血流多普勒与组织多普勒两种方法测得的早产儿右心室Tei指数均高于足月儿,差异有统计学意义(P<0.01);且所有受检新生儿的组织多普勒图像较传统血流多普勒图像清晰易辨认,两种方法测量结果差异无统计学意义(P>0.05)。结论早产儿右心室功能低于足月儿,组织多普勒可取代传统方法测量Tei指数,是评估新生儿特别是早产儿右心功能的一种简便而敏感的方法。     

颈动脉粥样硬化与冠心病关系的研究

目的　探讨颈动脉粥样硬化与冠心病之间的关系。方法　采用高频超声对 72例因急性心肌梗死、心绞痛及胸痛待查而入院接受冠状动脉造影的病人进行颈动脉检查 ,根据冠状动脉造影结果分为正常冠状动脉组(A组 )和冠状动脉病变组 (分别为单支病变组B1、双支病变组B2、三支病变组B3) ,采用高频超声探测双侧颈总动脉、颈内动脉及颈外动脉 ,计算颈动脉斑块积分 ,测量血管后壁内中膜厚度 (IMT)及颈动脉内血流频谱Vmax。结果　冠状动脉病变组的IMT值明显高于冠状动脉正常组 (P <0 0 5 ) ,冠状动脉三支病变组的IMT值高于单支和双支病变组 (P<0 0 5 ) ,提示颈动脉的病变与冠状动脉病变之间有良好的相关性 (r=0 4 5 ,P <0 0 5 ) ,且外周动脉粥样硬化的程度与冠状动脉病变的程度密切相关。结论　通过对颈动脉的超声检测 ,可以早期发现冠状动脉的病变 ,并可初步预测冠状动脉病变的程度     

冠状动脉分叉病变的血管内超声虚拟组织学影像特点

目的采用血管内超声(IVUS)和血管内超声虚拟组织学(IVUS-VH)检查方法分析冠状动脉分叉处斑块的影像学特点。方法收集2006年6月-2011年10月行选择性冠脉造影检查患者147例,用IVUS和IVUS-VH分析患者冠状动脉分叉近端、远端以及分叉处的对侧和内侧斑块负荷及其组成成分。结果冠状动脉分叉处血管对侧壁的斑块负荷百分数为47%±14%,大于内侧壁的35%±11%,组间差异有统计学意义(P<0.01)。分叉血管对侧壁的钙化成分为34%±31%,亦大于内侧的22%±21%,组间差异有统计学意义(P<0.01)。结论冠状动脉分叉对侧低剪切力血管处动脉粥样硬化斑块负荷重,且动脉粥样硬化斑块中钙化成分比例较高。     

Assessment of the severity of coronary artery stenosis by the ratio of the regional washout rate determined by adenosine triphosphate stress Tl-201 SPECT

BACKGROUND: Adenosine triphosphate stress thallium-201 single-photon emission computed tomography (ATP SPECT) is useful for diagnosis of coronary artery disease, but its usefulness for evaluating the severity of coronary artery stenosis has not been established. METHODS AND RESULTS: We performed region-of-interest analysis of short-axis images obtained by ATP SPECT in 31 patients with single-vessel disease (>50% stenosis of the luminal diameter). We selected the lowest and highest washout rates (WR) among the anterior, lateral, and inferior WRs and calculated the ratio of the lowest WR to the highest WR (WR ratio = 0.925+/-0.027 in 14 control subjects). ATP SPECT showed positive results in 29 (94%) of 31 patients. The severity of coronary artery stenosis was inversely correlated with the WR ratio (r = -0.703, P < .0001). The sensitivity and specificity of a WR ratio < or = 0.660 for the diagnosis of severe coronary stenosis (> or =80% stenosis) were 83% and 80%, respectively. CONCLUSIONS: Results suggest that ATP SPECT may be useful for assessment of the severity of coronary artery stenosis in patients with single-vessel disease.     

CCTA评价冠状动脉狭窄程度与SPECT心肌灌注显像关系的研究

目的：探讨冠心病患者CCTA不同狭窄程度与SPECT MPI间的关系。方法68例患者进行了CCTA和MPI检查,所有患者均行冠状动脉造影。CCTA按管腔狭窄程度分为5个级别,即0,1%~24%,25%~49%,50%~74%,75%~100%。MPI分为正常和灌注缺损(包括可逆缺损和不可逆缺损)。结果68例患者共204根血管纳入分析。以患者为单位进行分析,40例CCTA显示管腔重度狭窄的患者中,29例(72.5%)MPI显示灌注缺损。另外11例(27.5%)CCTA异常的患者心肌灌注 MPI显示正常。在28例CCTA显示未见明显狭窄的患者中,17例(60.1%)显示心肌灌注正常,而另外11例(39.9%)显示灌注缺损。根据CCTA冠状动脉狭窄程度分组,心肌灌注缺损(包括不可逆性灌注缺损和可逆性灌注缺损)出现的比率：0,1%~24%,25%~49%,50%~74%,75%~100%分别为5(27.7%)/18,1(33.3%)/3,5(71.5%)/7,4(50%)/8,25(78.1%)/32。结论冠状动脉狭窄和灌注缺损的不匹配多发生在冠状动脉中度狭窄的患者。在轻度狭窄和重度狭窄的患者中,二者多匹配。冠状动脉中度狭窄的患者应进行CCTA和 MPI联合检查评价冠心病。     

High-resolution selective three-dimensional magnetic resonance coronary angiography with navigator-echo technique: segment-by-segment evaluation of coronary artery stenosis

PURPOSE: To investigate the feasibility of high-resolution selective three-dimensional (3D) magnetic resonance coronary angiography (MRCA) in the evaluation of coronary artery stenoses. MATERIALS AND METHODS: In 12 patients with coronary artery stenoses, MRCA of the coronary artery groups, including the coronary segments with stenoses of 50% or greater based on conventional x-ray coronary angiography (CAG), was performed with double-oblique imaging planes by orienting the 3D slab along the major axis of each right coronary artery-left circumflex artery (RCA-LCX) group and each left main trunk-left anterior descending artery (LMT-LAD) group. Ten RCA-LCX and five LMT-LAD MR angiograms were obtained, and the results were compared with those of conventional x-ray angiography. RESULTS: Among 70 coronary artery segments expected to be covered, a total of 49 (70%) segments were fully demonstrated in diagnostic quality. The identification of segmental location of stenoses showed as high an accuracy as 96%. The retrospective analysis for stenosis of 50% or greater yielded the sensitivity, specificity, and accuracy of 80%, 85%, and 84%, respectively. CONCLUSION: Selective 3D MRCA has the potential for segment-by-segment evaluation of major portions of the right and left coronary arteries with high accuracy.     

Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

Objective

To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis.

Patients and methods

The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography.

Results

The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively.

Conclusion

In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.     

Quantitative assessment of myocardial perfusion with a spin-labeling technique: preliminary results in patients with coronary artery disease

PURPOSE: To determine perfusion and coronary reserve in human myocardium without contrast agent using a spin labeling technique. MATERIALS AND METHODS: Assessment of myocardial perfusion is based on T1 measurements after global and slice-selective spin preparation. This magnetic resonance imaging (MRI) technique was applied to 12 healthy volunteers and 16 patients with suspected coronary artery disease under resting conditions and adenosine-induced vasodilatation. RESULTS: In volunteers, quantitative perfusion was calculated as 2.4 +/- 1.2 mL/g/minute (rest) and 3.9 +/- 1.3 mL/g/minute (adenosine), respectively. Perfusion reserve was 2.1 +/- 0.6. In patients, when comparing perfusion reserve in the anterior and posterior myocardium, reduced values according to a stenotic supplying vessel could be seen in seven of 11 patients who underwent stress testing. In these patients, the relative difference of coronary reserve was 44% +/- 18%. Two patients without stenosis of coronary arteries showed no differences in coronary reserve (with a relative change of 2 +/- 2%). CONCLUSION: In patients with single-vessel coronary artery disease, differences in coronary reserve were clearly detectable when comparing anterior and posterior myocardium. The spin labeling method is noninvasive and easily repeatable, and it could therefore become an important tool to study changes in myocardial perfusion.     

Recurrent coronary artery stenosis: assessment with three-dimensional MR imaging

PURPOSE: To assess the diagnostic value of three-dimensional coronary magnetic resonance (MR) angiography with fat saturation and navigator echo in the setting of restenosis after percutaneous transluminal coronary angioplasty (PTCA). MATERIALS AND METHODS: Thirty consecutive patients who had PTCA and were referred for elective coronary reangiography underwent MR imaging and coronary angiography. The pulse sequence was a cardiac triggered, single-slab, three-dimensional, gradient-echo sequence, employing a spin-echo navigator echo measurement to track the variation of the diaphragm during the scan. The following segments of the coronary arteries were included in this prospective study: left main coronary artery, proximal and middle left anterior descending, proximal and middle left circumflex, proximal and middle right coronary artery, and intermediate branch, if present. The quality of the MR images was graded from 0 to 5. RESULTS: In total, 221 coronary artery segments could be identified. Mean image quality was 3.3. Overall accuracy for segments with an image quality of grade 2 or more was 90%. To achieve a positive predictive value >70% for a significant stenosis/restenosis, only segments with quality >/=3 could be assessed, whereas an acceptable negative predictive value could be achieved for nearly all segments. CONCLUSION: Our preliminary data suggest that MR coronary angiography may be most helpful as a screening test in selected patients to exclude clinically relevant stenoses or to assess restenoses after PTCA or in patients in whose coronary angiography is relatively contraindicated.     

Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: Comparison with the results of intracoronary Doppler technique

BACKGROUND: This study compared coronary flow reserve (CFR) estimated by technetium 99m sestamibi imaging with the results obtained with intracoronary Doppler in patients with coronary artery disease. Intraobserver and interobserver reproducibility of the radionuclide-estimated CFR was also assessed. METHODS AND RESULTS: Fourteen consecutive patients (mean age, 54 +/- 7 years) with documented coronary artery disease in whom percutaneous coronary intervention was planned underwent dipyridamole (0.74 mg/kg) sestamibi imaging and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the pulmonary artery and myocardial counts from single photon emission computed tomography images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. In the study vessels, CFR was 1.36 +/- 0.43 as estimated by sestamibi and 1.39 +/- 0.42 by intracoronary Doppler ( P = .69). A significant relationship between CFR estimated by sestamibi and CFR obtained by intracoronary Doppler was observed ( r = 0.85, P < .001). On Bland-Altman analysis, the mean difference between CFR by sestamibi and by Doppler was 0.03 and the intraclass correlation coefficients for intraobserver and interobserver reproducibility were high (all P < .001) for both global and regional CFR. CONCLUSIONS: This study demonstrates a good agreement between CFR estimated by sestamibi imaging and by intracoronary Doppler results and a lack of intraobserver and interobserver variability of this noninvasive approach.     

TCD和CDFI联合检测对椎-基底动脉狭窄的诊断价值

目的将通过经颅多普勒超声（TCD）和彩色多普勒血流显像（CDFI）联合检测诊断的椎-基底动脉狭窄患者的检测资料进行分析,并与数字减影血管造影（DSA）做对比研究,客观评价二者对椎-基底动脉狭窄的诊断价值。方法经TCD、CDFI诊断的椎-基底动脉狭窄患者38例,均进一步行磁共振血管造影（MRA）、DSA检测,对比分析其检测结果。结果与DSA比较,TCD、CDFI对椎动脉的检测敏感性为83%,特异性为91%;TCD对基底动脉狭窄检测的敏感性为75%,特异性为93%。以DSA为标准,TCD对基底动脉近段、中段、远段的检出率分别为100%、50%和33%。以DSA为标准,TCD＋CDFI对椎-基底动脉狭窄的检出率为79%,MRA的检出率为96%,TCD、CDFI、MRA三者联合检出率为98%。结论①TCD、CDFI对椎-基底动脉狭窄的特异性较高,且无创、经济、方便,故可作为首选筛查手段。但因其敏感性不是很高,故当临床出现后循环神经缺失症状,而检测结果阴性时,可结合MRA检查;②TCD、CDFI、MRA三者联合对VBA狭窄有较好的准确性。