心脏磁共振技术定量评价老年2型糖尿病患者亚临床期左心室肌T_2~*值的研究

目的采用心脏磁共振(cardiac magnetic resonance,CMR)探讨老年2型糖尿病(type 2diabetes mellitus,T2DM)患者左心室肌T2*值的研究。方法前瞻性收集2014年9月～2017年10月成都市第五人民医院住院确诊的老年T2DM患者17例(老年T2DM组),非老年T2DM患者37例(青年T2DM组),收集同期健康老年体检者12例(老年对照组)。采用T2*映射序列进行左心室短轴位扫描。比较3组左心室各节段T2*值的差异,分析T2DM患者左心室各节段心肌T2*值与糖尿病病程的关系。结果老年T2DM组左心室第6节段心肌T2*值明显低于青年T2DM组和老年对照组[(29.45±3.74)ms vs(34.69±6.45)ms,(38.09±4.27)ms,P0.01]。3组左心室其余各节段心肌T2*值比较,差异无统计学意义(P0.05)。老年T2DM患者左心室第3节段心肌T2*值与T2DM病程呈正相关(γ=0.526,P=0.030),左心室第5节段心肌T2*值与T2DM病程呈负相关(γ=-0.620,P=0.008)。结论 CMR T2*映射技术能够用于定量评价老年T2DM患者心肌改变情况。     

不同冠状动脉病变部位患者的心磁图参数比较

目的 比较不同部位的冠状动脉病变患者心磁图参数。 方法 采用上海MEDI仪器有限公司生产的心磁图仪对99名单支冠状动脉病变患者进行心磁图检查，以91名非冠心病患者为对照组。选择T峰磁场角度、TT角度最大值、TT角度最小值、TT角度变化值、TT距离变化值、T峰最大最小比值、T峰最大电流角度、TT电流角度最大值、TT电流角度最小值、TT电流角度变化值作为参数进行分析，比较左前降支（LAD）组（n = 44），左回旋支（LCX）组(n = 25)，右冠状动脉（RCA）组(n=30)和对照组（n = 91）的心磁图结果。 结果 与对照组比较，LAD组T峰磁场角度显著高于对照组（P<0.01）。LCX组T峰磁场角度、TT电流角度最大值和TT电流角度变化值均显著高于对照组（均P<0.01）。RCA组TT角度最小值和TT距离变化值显著低于对照组（均P<0.01），而TT电流角度最大值和TT电流角度变化值显著高于对照组（均P<0.01）。LCX组T峰磁场角度高于LAD组和RCA组（分别P<0.01；P<0.05）。 RCA组TT距离变化值显著低于LAD组（P<0.01）。 结论 不同部位冠状动脉病变的心磁图部分参数有显著差异。     

肥胖对2型糖尿病患者左室结构和功能的影响

目的 联合应用常规超声心动图和三维斑点追踪成像分析2型糖尿病（T2DM）无肥胖或合并肥胖患者的左室结构和功能,探讨可能影响这些患者左室整体应变的危险因素。 方法 95例T2DM患者,根据是否合并肥胖分为T2DM无肥胖组（n=45,BMI<25 kg/m2）;T2DM合并肥胖组（n=50,BMI≥25 kg/m2）。选取30例年龄与性别相匹配的健康志愿者作为对照组。所有入组者进行常规超声心动图和三维斑点追踪成像检查。 结果 在左室二维几何构型方面,与对照组比较,T2DM组的左室重构更为普遍（P<0.05）,T2DM合并肥胖组的左室肥厚最多见（P<0.05）。在左室舒张功能方面,T2DM无肥胖组e’明显减低（P<0.05）,E/e’明显增大（P<0.05）;T2DM合并肥胖组的e’明显减低（P<0.05）,左房容积指数与E/e’明显增大（P<0.05）。在左室收缩功能方面,与对照组比较,T2DM无肥胖组整体纵向应变（GLS）明显减低（P<0.05）;T2DM合并肥胖组的GLS、整体圆周应变（GCS）、整体面积应变（GAS）、整体径向应变（GRS）均低于其他两组（均P<0.05）。多元回归分析显示,糖化血红蛋白（HbA1c）与体质量指数（BMI）是左室各个方向整体应变的影响因素;相对室壁厚度（RWT）与左室质量指数（LVMI）对部分方向的整体应变有负向影响。 结论 肥胖可能会加重T2DM患者的左室重构和功能障碍,联合应用常规超声心动图和三维斑点追踪成像可以检测出亚临床左室异常。     

超声对老年急性心肌梗死患者左心室心肌总应变及左心室重构的研究

目的探讨应用超声技术评价老年急性心肌梗死(AMI)患者左心室心肌总应变,及其与左心室重构的相关性。方法选择心肌梗死患者104例,根据冠状动脉造影结果分为左回旋支(LCX)和(或)右冠状动脉(RCA)病变组(LCX/RCA组)31例、单纯左前降支(LAD)病变组(LAD单支组)34例、包含LAD的2支或3支病变组(多支组)39例,另选择性别、年龄相匹配的同期健康体检者40例为对照组。应用二维超声斑点追踪成像测算左心室各节段心肌及整体总应变矢量(ε)及其与左心室短轴平面间的角度(θ),应用实时三维超声心动图测算左心室重构指数(LVRI)。结果与对照组比较,LCX/RCA组左心室前壁ε,LAD单支组下侧壁、下壁ε未见明显减低(P0.05),LCX/RCA组、LAD单支组、LAD多支组其余不同心肌节段ε明显减低(P0.05),且LCX/RCA组下侧壁、下壁θ,LAD单支组前间隔、前壁θ及多支组各部位θ明显升高(P0.05)。与对照组比较,LCX/RCA组、LAD单支组和LAD多支组整体ε、LVRI均显著降低,整体θ显著升高(P0.05)。LCX/RCA组、LAD单支组和多支组整体ε(r=-0.815,P=0.014;r=-0.747,P=0.031;r=-0.768,P=0.024)、θ(r=-0.719,P=0.043;r=-0.763,P=0.021;r=-0.753,P=0.029)均与LVRI呈显著负相关。结论老年AMI患者左心室心肌ε大小及θ能反映局部及整体的心肌应变能力,整体ε、θ与LVRI均呈负相关性。     

代谢指标联合心脏彩超对糖尿病伴高尿酸血症的心脏功能受损评估及预后

目的 探讨代谢指标联合心脏彩超对2型糖尿病（T2DM）伴高尿酸血症（HUA）的心脏功能受损及预后。 方法 选择2019年2月～2021年9月广东省潮州市人民医院诊治的T2DM患者100例和T2DM合并HUA患者100例。分析两组间一般临床资料、代谢指标及心脏指标。采用多因素Logistic回归分析筛选影响糖尿病合并HUA及糖尿病并发症患者的相关危险因素,采用ROC曲线分析代谢指标及心脏指标对T2DM合并HUA的预测价值。 结果 与T2MD组比较,T2DM合并HUA组体质量指数（BMI）(P<0.01)、收缩压（SBP）(P<0.01)、舒张压（DBP）(P<0.05)、三酰甘油（TG）(P<0.01)、低密度脂蛋白胆固醇（LDL-C）(P<0.05)、肌酐（SCr）(P<0.01)、尿酸（UA）(P<0.01)、尿素氮（BUN）(P<0.01)、尿白蛋白/肌酐比（UACR）(P<0.01)水平明显升高,高密度脂蛋白胆固醇（HDL-C）水平明显下降（P<0.01）;与T2MD组比较,T2DM合并HUA组舒张期室间隔厚度（IVST）、左心室心肌重量（LVM）、左心室心肌重量指数（LVMI）、相对室壁厚度（RWT）值明显升高（P<0.01）,左心室射血分数（LVEF）明显下降（P<0.01）;多因素Logistic回归分析提示,BMI、TG、Scr、LVEF、LVM和LVMI是发生T2DM合并HUA患者的独立危险因素（P<0.05）;ROC曲线分析,BMI、Scr、LVEF、LVM和LVMI对T2DM合并HUA具有诊断价值（P<0.05）,其中LVM的诊断价值最大,曲线下面积（AUC）最大;多因素Logistic回归分析提示,BMI、TG、SCr、LVEF、LVM、LVMI是影响糖尿病白蛋白尿患者的独立危险因素（P<0.05）;TG、UA、SCr和LVM是影响糖尿病周围神经病变的独立危险因素（P<0.05）;TG、UA、SCr、LVM和LVMI是影响糖尿病视网膜病变的独立危险因素（P<0.05）。 结论 血脂、肾功能等代谢指标和心室肥厚心脏指标异常与糖尿病合并HUA及糖尿病并发症相关,为该病的诊治提供重要参考依据。     

老年冠心病合并2型糖尿病病人血脂水平与冠状动脉病变分析

目的探讨老年冠心病（CHD）合并2型糖尿病（T2DM）病人血脂关系。方法观察组78例经冠状动脉造影和WHO糖尿病水平变化，并结合冠状动脉造影结果分析血脂异常和冠状动脉病变情况的诊断标准诊断的CHD合并T2DM病人。对照组为经冠状动脉造影明确诊断为CHD但不伴有糖尿病的病人。比较两组的血脂水平，进行两组间冠状动脉造影资料的比较。结果CHD合并T2DM病人的三酰甘油（TG）、低密度脂蛋白胆回醇（LDL—C）、脂蛋白-α（LPa）水平明显高于无糖尿病的CHD病人（P〈0．05），高密度脂蛋白胆固醇（HDL—C）明显低于无糖尿病的CHD病人（P〈0．05）。结论老年CFID合并T2DM病人的血脂异常更明显；血脂异常在冠状动脉病变的发生发展中起着重要作用。     

原发性高血压合并2型糖尿病患者的心律失常

背景 原发性高血压（EH）和2型糖尿病（T2DM）常易并发。已有研究证实了EH可致心律失常，但对于二者合并存在时心律失常发生状况及心脏结构和功能的变化特征，还未见报道。目的 研究EH合并T2DM患者心律失常的发生状况及其可能机制。方法住院患者168例，分为EH组、T2DM组、EH合并T2DM组及正常组，对4组患者的相关临床资料、24h动态心电图及超声心动图检查结果进行分析比较。结果1）EH合并T2DM组与EH组和T2DM组相比易发生心律失常（P〈0．05）。2）EH合并T2DM组左心房内径（LAD）、升主动脉内径（AO）、左心室内径（LVD）、室间隔厚度（IVS）、左心室质量（LVM）值、E／A比值异常例数和二尖瓣返流程度（MR）均高于EH组和DM组（P均〈0．05），EF值低于EH组和DM组（P〈0．05）。3）多元线性回归分析显示EH合并T2DM时，房性心律失常次数与LAD、IVS、MR正相关，与LVD负相关；室性心律失常次数与LVD、IVS、LVM正相关。4）Logistic回归分析显示年龄、疾病种类、高血压病程和LVM的升高是患者发生心律失常的风险因素。结论 EH合并T2DM时更易发生心律失常，且能明显加重患者左心室结构和功能损害。     

无创平板运动试验评分与冠状动脉造影预后指标的相关性

目的 探讨冠心病患者无创平板运动试验Duke评分（DTS）与冠状动脉造影评价预后的指标校正的TIMI帧数（CTFC）之间的相关性,为利用无创的平板运动试验评价冠心病患者的预后提供依据。 方法 对冠状动脉造影确诊为冠心病,并在造影前2周内完成平板运动试验的患者61例进行回顾性分析。根据DTS进行分组(≥5分为低危组、<5分为中高危组),分析DTS与CTFC的相关性,比较不同危险组间CTFC的差异。结果 DTS与冠心病患者冠状动脉前降支（LAD）、回旋支（LCX）、右冠状动脉（RCA）的CTFC均呈负相关（r=-0.834、-0.769、-0.698,均P<0.01)。DTS低危组3支冠状动脉的CTFC值明显小于中高危组,组间CTFC值有明显差异\[LAD:(21.3±1.7)帧 vs (24.1±2.2)帧;LCX:(26.9±2.6)帧 vs (30.6±3.4)帧;RCA:(21.1±4.0)帧 vs (25.1±4.3)帧,均P<0.01\]。结论 冠心病患者平板运动试验Duke评分与LAD、LCX、RCA的CTFC值呈负相关。根据DTS得出的危险分层与CTFC有良好的相关性。     

脂蛋白（a）与2型糖尿病微血管并发症关系探讨

对122例T2DM患者依微血管并发症分为有糖尿病肾病（DN）、有糖尿病视网膜病变（DR）、有DN及DR、无DN和DR4组,并进行Lp（a）、HbA1c、TC、TG、HDL—ch、LDL—ch测定。结果T2DM有DN组Lp（a）、TC、TG、HbA1c、LDL—ch值均显著高于无DN和DR组,T2DM有DR组Lp（a）、TC、TG、HbA1c、LDL—ch值均显著高于无微血管并发症组,2型糖尿病有糖尿病肾病及视网膜病变组Lp（a）、TC、TG、HbA1c、LDL—ch值均显著高于无微血管并发症组,高浓度的Lp（a）与糖尿病微血管并发症有密切关系。结论T2DM患者血清Lp（a）升高可能是微血管病变的重要的危险因素。     

甘油三酯葡萄糖乘积指数与BMI对2型糖尿病合并非酒精性脂肪性肝病的预测价值

目的 探讨甘油三酯葡萄糖乘积指数（TyG）与BMI对2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）的预测价值。方法 回顾性分析2020年5月—2021年7月中国医科大学附属盛京医院诊治349例T2DM患者的临床资料,按照有无NAFLD分为T2DM合并NAFLD组（n=213）和单纯T2DM组（n=136）。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ²检验。采用logistic回归分析TyG及BMI与T2DM合并NAFLD的关系,受试者工作特征曲线（ROC曲线）评价TyG、BMI及TyG联合BMI对T2DM合并NAFLD的预测效能。采用Kappa系数分析预测结果的一致性。结果 T2DM合并NAFLD组的BMI、舒张压、空腹血糖、糖化血红蛋白、ALT、AST、GGT、TG、TC、LDL-C、TyG均高于单纯T2DM组（P值均<0.05）,T2DM合并NAFLD组的HDL-C低于单纯T2DM组（P<0.05）,两组在收缩压、总胆红素、直接胆红素、间接胆红素间的差异均无统计学意义（P值均>0.05...     

Potential risk of provisional stenting in left main coronary artery bifurcation in multivessel‐related acute coronary syndrome

We present a case of an elderly man suffering from an acute coronary syndrome (ACS) with preshock vital signs and remarkable ST–T wave depression in leads V4–V6, and ST elevation in lead aVR. Coronary angiography showed total occlusion of the right coronary artery (RCA) and impending occlusion in the distal left main coronary artery (LMCA) with a tandem lesion in the proximal left anterior descending artery (LAD). After insertion of an intra‐aortic balloon pump both the LAD and left circumflex artery (LCX) were dilated alternatively; and cross‐over stenting in the LMCA bifurcation was subsequently performed. However, total occlusion of the LCX occurred and it caused acute hemodynamic collapse and ventricular fibrillation storm. Immediate installation of percutaneous cardio‐pulmonary support system allowed stent deployment to be performed in the RCA and subsequent reopening of the LCX that led to a return to sinus rhythm. The patient recovered almost normal left ventricular wall motion and previous activity without any neurological deficit within 2 weeks. Provisional stenting in ACS in the LMCA bifurcation with multivessel disease has a potential risk of acute hemodynamic collapse; a planned two‐stent deployment strategy may assure a higher rate of safety in such cases. © 2011 Wiley‐Liss, Inc.     

右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响

目的　探讨右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响及其机制。方法　对比分析左冠状动脉狭窄患者在合并与不合并右冠状动脉病变时的左心室射血分数。结果　与相应部位单纯左冠状动脉狭窄患者相比 ,合并右冠状动脉病变患者左心室射血分数均呈不同程度地下降 ,其中在左前降支、左前降支 +左回旋支狭窄基础上合并右冠状动脉病变时左心室射血分数下降有统计学意义 (P <0 .0 5或 0 .0 1) ,左主干合并右冠状动脉狭窄患者下降幅度最大 ,但无统计学意义。结论　右冠状动脉病变可在单纯左冠状动脉狭窄的基础上使左心室收缩功能进一步恶化 ;当左冠状动脉狭窄部位为左前降支、左主干或左前降支 +左回旋支时 ,对左心室收缩功能影响更为严重     

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。     

Incidence of sudden cardiac death in patients with 2-vessel coronary disease in relation to anatomy and rhythm profile

102 patients with angiographically documented double vessel coronary artery disease were followed for 1-83 months (mean: 42 months). Incidence of sudden death was studied in relation to location and severity of coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during long-term ECG monitoring. The incidence of sudden death was 30.5% (18/59 cases) in patients with lesions of the left anterior descending branch (LAD) and the right coronary artery (RCA) (Group GI), 26.1% (6/23 cases) in patients with lesions of the LAD and the left circumflex coronary artery (LCX) (Group G II) and 10.0% (2/20 cases) in patients with lesions of the RCA and the LCX (Group G III) (p less than 0.05). The incidence of isolated ventricular beats and complex arrhythmias was significantly higher in patients who died suddenly in both Group I and Group II compared to Group III (p less than 0.05). Our data show that in patients with double vessel coronary artery disease there is an increased risk of sudden death if the LAD is involved, particularly in the presence of complex arrhythmias.     

A rare coronary anatomy comprising dual (Type IV) left anterior descending arteries and an anomalous left circumflex artery from the right coronary artery

We present the case of a rare coronary anomaly in a 64-year-old male who presented with exertional angina. The right coronary artery (RCA) was dominant, giving origin proximally to an anomalous left circumflex (LCX) artery and a left anterior descending (LAD) artery which supplied the conventional mid and distal LAD territory. The left main artery (LM) arose from the left coronary sinus and branched into a large first septal and an intermediate artery. There was associated non-critical atherosclerotic disease. We report this because of the rare division of the LAD area of supply by arteries from both coronary sinuses (dual LAD) with an anomalous LCX also arising from the proximal RCA. The clinical implications are discussed.     

Electrocardiographic discrimination of infarct-related artery between left circumflex and right coronary artery: comparison of ST elevation between leads II and III

OBJECTIVES: Admission electrocardiography was evaluated to discriminate left circumflex artery (LCX) versus right coronary artery (RCA) as the cause of acute myocardial infarction. METHODS: Electrocardiographic findings were assessed in patients with RCA (n = 60) and LCX (n = 60) occlusion. RESULTS: ST segment elevation in the inferior leads or right precordial leads was more common in the RCA group. ST segment depression or negative T wave was more common in leads I, aVL in the RCA group. ST segment elevation was more common in leads V5, V6 in the LCX group. ST segment was elevated in inferior leads in 55 patients in the RCA group and 27 patients in the LCX group. Mean ST level was higher in lead III than in lead II in the RCA group, but not in the LCX group. The ST level was higher in lead III than in lead II in 78% of the RCA group, but only 44% of the LCX group (p < 0.01). CONCLUSIONS: Comparison of ST levels between leads II and III, and a three-dimensional analysis in 12-lead electrocardiography is useful for discriminating the left circumflex artery from the right coronary artery as the cause of acute myocardial infarction.     

Coronary to pulmonary artery fistulas: an incidental finding with challenging therapeutic options

We report the incidental finding of 2 coronary to pulmonary artery fistulas observed at coronary angiography performed in a 48-year-old man presenting with acute inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an acute thrombotic occlusion of the mid segment of the right coronary artery (RCA), which was treated with thromboaspiration and bare-metal stenting. Significant stenoses of the left anterior descending (LAD) and left circumflex (LCX) arteries were also observed during angiography, as well as the presence of 2 large coronary to pulmonary artery fistulas, one originating from the proximal LAD and the other from the ostial RCA. The clinical evolution was uneventful and the patient underwent successful coronary bypass grafting of the LAD and LCX lesions associated with ligation of the coronary artery fistulas 6 weeks later. The fact that 2 large coronary to pulmonary artery fistulas were observed during an acute coronary syndrome in a previously asymptomatic patient with extensive coronary artery disease is of particular interest, because it allowed early surgical correction of this rare inborn coronary anomaly before the development of late and irreversible left ventricular dysfunction.     

Correspondence between left ventricular 17 myocardial segments and coronary arteries.

AIMS: The last guidelines recommend a standardized 17-segment model for tomographic imaging of the left ventricle. The aim of this study is to analyse the correspondence of the 17 left ventricular segments with each coronary artery by myocardial perfusion SPECT studies. METHODS AND RESULTS: Fifty patients selected for percutaneous revascularization of one coronary artery [24 left anterior descending (LAD), 15 right coronary artery (RCA), and 11 left circumflex (LCX)] were included. The (99m)Tc-labelled compound was injected immediately after the inflation of the balloon during percutaneous coronary angioplasty. At least 90 s of complete occlusion time was required. Maximal contour of regions of hypoperfusion corresponding to each coronary artery occlusion were delineated over the polar map of 17 segments. Nine segments corresponded to only one coronary artery: eight to LAD (basal anterior, basal anteroseptal, mid-anterior, mid-anteroseptal, apical anterior, apical septal, apical lateral, and apex) and one to LCX (basal anterolateral). Basal inferoseptal, mid-inferoseptal, and apical inferior segments could correspond to LAD or RCA. Basal inferior, basal inferolateral, mid-inferior, and mid-inferolateral segments could correspond to RCA or LCX, whereas the mid-anterolateral segment could correspond to LAD or LCX. CONCLUSION: The most specific segments (anterior, anteroseptal, and all apical segments except the infero-apical) correspond to LAD but no segment can be exclusively attributed to the RCA. Inferoseptal segments can be attributed to LAD or RCA, inferior and inferolateral segments to RCA or LCX, and mid-anterolateral segment to LAD or LCX.     

心电图对老年急性下壁心肌梗死冠状动脉病变部位的预测价值

目的　探讨急性下壁心肌梗死心电图与冠状动脉病变的关系 ,以揭示体表心电图对梗死相关动脉及病变节段的预测价值。方法　对 15 6例老年急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行对比分析。结果　梗死相关动脉为右冠状动脉占 79.5 % ,左回旋支占 2 0 .5 %。单纯急性下壁心肌梗死病变节段多发生在第一右心室支开口以远 (77.6 % ) ,合并右心室心肌梗死病变节段多发生在第一右心室支开口前 (87% )。STⅢ 抬高 /STⅡ 抬高 >1,STⅠ、aVL下移≥ 1mm ,提示右冠状动脉为梗死相关动脉的敏感性分别为 87.9%、89.5 % ,特异性分别为 84 .4 %、81.2 % ,阳性预告值分别为 95 .6 %、94 .8% ,两者差异无显著性意义 (P >0 .0 5 )。ST段V1、V2 下移≥ 1mm ,提示左回旋支为梗死相关动脉的敏感性 ,特异性和阳性预告值分别为 84 .4 %、91.9%、73.0 %。结论　急性下壁心肌梗死时心电图对判断梗死相关动脉及病变节段有重要的预测价值