Ischemic heart disease detected by the standard deviation of the spatial QRS-T angle and by treadmill exercise test]

Beat-to-beat fluctuations of the spatial QRS-T angle, which are reported to be greater in patients with ischemic heart disease than in healthy subjects, are thought to be a helpful factor in diagnosing ischemic heart disease. In this study, we assessed the usefulness of the standard deviation of the spatial QRS-T angle per beat as an index of magnitude of the fluctuations. The subjects consisted of 27 patients with effort angina, 14 with vasospastic angina, 18 with the "chest pain syndrome" and 36 normal controls. The standard deviations of the spatial QRS-T angle were obtained for 10 consecutive stable beats at rest using Frank's orthogonal X, Y, Z scalar electrocardiogram. The results were compared with those of coronary angiography and exercise tolerance tests. Treadmill exercise tests were performed in all patients using Bruce's protocol to observe decreased ST levels and delta ST/HR indices. QRS-T angle deviation values were 8.10 +/- 8.64 degrees (mean +/- SD) in the effort angina group, 3.63 +/- 1.26 degrees in the vasospastic angina group, 4.13 +/- 1.70 degrees in the "chest pain syndrome" group, and 2.35 +/- 0.85 degrees in the normal control group; the groups of patients with heart disease showed significantly higher values (all p < 0.01) than did the control group. The effort angina group showed a significantly higher value than did the vasospastic angina group and the "chest pain syndrome" group (all p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser Doppler anemometry distinguishes primary Raynaud phenomenon from VWF syndrome

OBJECTIVES: We evaluated two microcirculatory function-tests, the Laser Doppler (LD)-Anemometry and the Laser Doppler Imager (LDI)-Flowmetry in their value to further elucidate functional behavior of the "Vibration-induced white finger syndrome" (VWF) and to distinguish between Raynaud's phenomenon (RP) of idiopathic or vibration origin. PARTICIPANTS AND METHODS: Ninety-four patients, suffering from RP were studied (78 patients with primary RP and 16 patients with VWF). Measurement of blood cell velocity (BCV) before and after provocation was obtained by nailfold capillary microscopy and an included Laser detector ("Anemometry"). Digital blood flux was recorded by LDI-Flowmetry during a standardized cooling and rewarming thermal challenge. RESULTS: "Time to peak" of BCV, a measure of maximal reactive hyperemia was longer in VWF in comparison to primary RP (30.37 versus 19.29 sec P < 0.02), respectively. CONCLUSION: Based on the fact, that prolongation of reactive hyperemia, an indicator of impaired endothelium-dependent vasodilation is also frequently found in peripheral arterial occlusive disease, it is hypothesized that VWF is not only a microcirculatory vasospastic disorder, but may also be related to atherosclerosis. Anemometry, in association with an appropriate provocation-test, could represent a useful non-invasive method for objectifying diagnosis of VWF in patients with RP.     

Doppler Surrogate Endoscopy for Screening Esophageal Varices in Patients With Cirrhosis

Background:

Portal hypertension is a common consequence of hepatic cirrhosis, which causes esophageal varices. Bleeding from varices has a high mortality rate. The present gold standard for diagnosing varices is endoscopy. Considering endoscopy side effects and patients'' low acceptance, there have been always efforts for finding alternative diagnostic methods including Doppler ultrasonography (US).

Objectives:

The aim of the present study was to evaluate changes of Doppler indices in cirrhotic patients with and without esophageal varices.

Patients and Methods:

Sixty six patients with known cirrhosis entered this cross-sectional study. Gastroscopy was performed for patients, and the first questionnaire was filled based on the Japanese Portal Hypertension Society guidelines. Then patients were referred for Doppler US of splenoportal system, and information was documented in the second questionnaire.

Results:

Forty-four patients were male and 22 female. Forty six patients had esophageal varices, and 20 did not. There were no significant associations between splenoportal indices found by Doppler US, and presence of esophageal varices in patients. However, we found a negative association between platelet ratio to spleen diameter, and to splenic vein diameter.

Conclusions:

Neither of studied variables was perfect to differentiate cirrhotic patients with and without EVs. Endoscopy is still the gold standard diagnostic method for diagnosing esophageal varices in patients with cirrhosis. It seems that some of the splenoportal Doppler indices are promising, but more research and evaluation is necessary.     

Lack of association between the insertion/deletion polymorphism of the angiotensin-converting enzyme gene and vasospastic angina

Background and hypothesis: It has been suggested that the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is an independent risk factor for coronary atherosclerosis and myocardial infarction, but its relation to vasospastic angina has not been fully proven. In the present study, we investigated the possible relationship between the ACE I/D genotype and vasospastic angina. Methods: We explored the distribution of the ACE genotype in 20 patients with vasospastic angina without fixed coronary artery stenosis, 55 angina patients with fixed coronary artery stenosis, and 30 control subjects without coronary artery disease. Results: The frequency of the DD genotype in patients with vasospastic angina (DD: 30.0%, ID: 20.0%, II: 50.0%) did not differ from that in the control subjects (DD: 23.3%, ID: 26.7%, II: 50.0%), while the frequency in patients with coronary artery stenosis (DD: 43.7%, ID: 21.8%, II: 34.5%) was significantly higher than that in the control subjects. The frequency of the D allele also did not differ between patients with vasospastic angina (0.40) and control subjects (0.37), while the frequency was significantly higher in patients with coronary artery stenosis (0.55). Conclusions: These findings suggest that the ACE DD genotype is a potent genetic risk factor for organic coronary artery disease, while it confers no appreciable increase in risk of vasospastic angina. These results also suggest the diversity of the pathogenesis of vascular lesions in these two types of coronary artery disease.     

Effect of dipyridamole on QT dispersion in vasospastic angina pectoris.

Life-threatening ventricular arrhythmias have frequently been documented in patients with vasospastic angina. Moreover, the incidence of ventricular arrhythmias has been closely associated with increased QT dispersion. However, the underlying mechanism responsible for this arrhythmogenesis has not been clarified. The effects of dipyridamole and subsequent aminophylline administration on QT dispersion were examined in 35 patients with vasospastic angina and 30 patients with atypical chest pain. None of the patients enrolled in this study revealed any significant stenosis in coronary angiography. QT dispersion during dipyridamole followed by aminophylline administration was compared between the 2 groups. The baseline QT dispersion was similar in both groups (vasospastic angina: 27 +/- 8 ms; atypical chest pain: 28 +/- 7 ms). No significant changes in QT dispersion were observed in patients with atypical chest pain by dipyridamole (23 +/- 9 ms) and subsequent aminophylline administration (23 +/- 5 ms). However, the QT dispersion in patients with vasospastic angina increased significantly by dipyridamole administration (53 +/- 14 ms, p <0.0001) and returned to baseline by subsequent aminophylline administration (26 +/- 10 ms). Our data suggest that the disparity of ventricular repolarization in vasospastic angina may be mediated by increased endogenous adenosine.     

Validity of N-terminal propeptide of the brain natriuretic peptide in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease

BACKGROUND AND AIMS: Left ventricular diastolic dysfunction has been reported in patients with liver cirrhosis. Although conventional Doppler echocardiography has been used to assess diastolic filling dynamics, this technique is limited in diagnosing left ventricular diastolic dysfunction. The aim of the study was to validate the N-terminal propeptide of the brain natriuretic peptide (NT-proBNP) in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease. METHODS: In 64 patients, left ventricular diastolic dysfunction was classified using tissue Doppler imaging and serum levels of NT-proBNP were measured. RESULTS: Left ventricular diastolic dysfunction was found in 25 of 31 (80.6%) patients with severe liver fibrosis/cirrhosis versus 2 of 8 (25.0%) patients with moderate and 6 of 25 (24.0%) patients with mild liver fibrosis (P<0.001). Mean NT-proBNP levels were 407.1+/-553.4 pg/ml in patients with severe fibrosis/cirrhosis as compared with 60.8+/-54.9 pg/ml and 55.4+/-41.4 pg/ml in patients with mild and moderate fibrosis (P=0.001). NT-proBNP was most accurate in predicting advanced left ventricular diastolic dysfunction with an area under the receiver-operating characteristic curve of 0.90 (95% confidence interval, 0.77-1.0; P<0.001). A cutoff value of greater than 290 pg/ml was highly predictive of advanced left ventricular diastolic dysfunction. CONCLUSION: NT-proBNP is a useful marker in detecting advanced left ventricular diastolic dysfunction in patients with chronic liver disease. Patients with severe liver fibrosis/cirrhosis and NT-proBNP levels exceeding 290 pg/ml should undergo further cardiac evaluation.     

Local intense mosaic pattern at site of flail mitral leaflet: report of a new color Doppler sign

Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR. In 3 other patients, the sign was absent; two of those had flail mitral leaflet with severe MR. No local mosaic pattern was seen on color Doppler in 20 other patients with MR but no flail mitral leaflet. We speculate that the focal intense mosaic color Doppler morphology may have been caused by intrusion of the flail leaflet into the MR stream, or to a Coanda-like effect of the MR jet "adhering" to the flail leaflet.     

Differentiation of pancreatic tumours by conventional ultrasound,unenhanced and echo-enhanced power Doppler sonography

BACKGROUND: Echo-enhanced power Doppler sonography (power Doppler sonography after injection of a contrast agent) is a non-invasive and increasingly used procedure for differentiating between pancreatic tumours. However, the diagnostic accuracy of this method compared to conventional ultrasound or unenhanced power Doppler sonography has never been investigated in a large prospective controlled study. METHODS: 137 patients were included in the study, selected from 190 consecutive patients with a mean age of 60 years (range 16-85) who presented at our department in the period January 1998 through June 2001 with clinical suspicion of a pancreatic tumour. Sonography was performed by an experienced examiner blind to the patients' clinical diagnoses. The exact diagnosis was based on histological evidence from biopsy examination (surgical and fine needle biopsy) or on a follow-up of at least 18 months. RESULTS: Of the 137 patients, 47 had pancreatic cancer; 41 had masses associated with pancreatitis; 17 had neuroendocrine tumours; 12 had cystic lesions of the pancreas; and 10 had other pancreatic diseases. A normal pancreas was found in 10 patients. The sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing pancreatic carcinoma was 87% and its specificity 94%. The corresponding values for chronic pancreatitis were 85% and 99%, respectively. CONCLUSIONS: Echo-enhanced power Doppler sonography has a high sensitivity and specificity in the differential diagnosis of pancreatic tumours. However, histology is the standard of reference.     

Treatment of severe peripheral arterial and vasospastic disease of the upper extremity by spinal cord stimulation

Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upper extremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients with severe PAD and in six patients with VD of the upper limbs. Transcutaneous oxygen tension index (chest TcpO₂/hand TcpO₂), Doppler wrist pressure index (WPI), capillary microscopy (CM), and a patients pain score (PS) graded from 1 to 10 (1=no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients and remained significant throughout the follow-up period. TcpO₂ index decreased significantly (2.01±0.79 prae-OP vs 1.57±0.62 at 18 months). Capillary microscopy improved regarding red blood cell velocity and capillary density. Doppler WPI remained unchanged throughout the course. The results demonstrate that treatment of severe PAD and VD by use of thoracic SCS reduces pain significantly in these patients and increases blood supply. SCS provides a successful method of treatment for refractory VD and PAD of the upper extremity.Presented at the 36th Annual World Congress of the International College of Angiology, New York City, New York, July 1994     

Intravascular ultrasound: catheter-based Doppler and two-dimensional imaging

Intracoronary Doppler and two-dimensional imaging devices have been developed to aid in the search for more precise information about vessel pathology and local vessel hemodynamics. Measurement of coronary flow reserve using Doppler catheters has been well-validated experimentally and is being used clinically in certain groups of patients. Current designs using Fast-Fourier Transform of the signal and real-time video spectral display allows for instantaneous modification in positioning of the catheter within the artery to minimize artifacts. Studies are underway to assess whether measurement of coronary flow reserve and estimations of absolute flow add practical information to the quantitative assessment of vascular disease. Contrast angiography has been the "gold standard" for in vivo study of vascular disease. The recent development of two-dimensional imaging catheters has potentially opened up a new frontier of clinical assessment of vessel pathology. Imaging catheters can be used in a diagnostic role as a means of guiding therapeutic interventions. Direct analysis of the radiofrequency output of the catheter may allow for more precise characterization of plaque composition.     

彩色超声心动图诊断冠心病的临床价值

目的探讨和分析彩色超声心动图诊断冠心病的临床价值。方法选取我院经初步诊断为冠心病的患者160例,对所有患者进行彩色超声心动图及冠状动脉造影检查,将患者检查结果进行对比分析,并以冠状动脉造影检查的诊断结果作为评价标准,对彩色超声心动图诊断冠心病的临床价值进行评价。结果 160例初诊冠心病均采用彩色超声心动图检查,结果显示153例有不同程度的冠状动脉主干狭窄,再经冠状动脉造影检查后,确诊冠心病的患者有131例。结论对所有患者采用彩色超声心动图和冠状动脉造影检查后,将两种检查方法的诊断结果对比,充分证明彩色超声心动图诊断冠心病具有十分满意的效果且临床价值较高,值得临床推广及应用。     

Impaired glucose tolerance with late hypersecretion of insulin during oral glucose tolerance test in patients with vasospastic angina

Objectives.This study tested whether patients with vasospastic angina have impaired glucose tolerance or impaired insulin response.Background.Hyperinsulinemia has been demonstrated in patients with coronary artery disease and syndrome X.Methods.We performed an oral glucose tolerance test (75 g) in 30 patients with vasospastic angina in whom severe coronary vasospasm was induced by acetylcholine and in a matched group of 30 patients with atypical chest pain in whom no significant vasospasm was induced. The responses of insulin and glucose were compared between the two groups. No subjects had overt diabetes mellitus, hypertension, dyslipidemia, obesity or angiographically detected significant baseline coronary stenosis. Venous blood samples were taken during fasting and at 30, 60, 120 and 180 min after glucose load to obtain plasma glucose and immunoreactive insulin levels.Results.Impaired glucose tolerance was detected in the 19 (63%) of 30 patients with vasospastic angina and in none of 30 patients with atypical chest pain (p < 0.001). The immunoreactive insulin levels at 60 and 120 mins as well as the interval to peak insulin level were significantly greater in patients with vasospastic angina (p < 0.001). Among patients with vasospastic angina, those with acetylcholine-induced multivessel coronary vasospasm showed a significantly higher sum of insulin concentrations than those with single-vessel spasm (p < 0.01). During induction of coronary spasm, 10 patients with vasospastic angina presented ventricular arrhythmias. The sum of insulin concentrations was significantly greater in patients with than in those without ventricular arrhythmias.Conclusions.Patients with vasospastic angina exhibited a high incidence of impaired glucose tolerance and delayed and significantly higher insulin responses. These findings suggest that impaired glucose tolerance with late hypersecretion of insulin may contribute to the pathogenesis of severe coronary vasospasm.     

Time intervals and myocardial performance index by tissue Doppler imaging

The application of tissue Doppler imaging (TDI) has shown remarkable growth in clinical practice during the past few years, especially, in risk stratification of patients with coronary heart disease or heart failure (systolic and diastolic). Myocardial performance index (MPI) is a Doppler echocardiographic parameter defined as the sum of the isovolemic contraction and relaxation times divided by the ejection time. It is considered as a reliable parameter to assess global left ventricular function. Cardiac time intervals and MPI have also been found as new applications in diagnosing cardiotoxicity from chemotherapy, COPD, valvular heart disease, pulmonary hypertension and endocrinopathies.     

Pulmonary function tests at work.

Occupational exposures remain an important cause of lung disease. A number of PFTs are used in the occupational setting, including spirometry, PEF recordings, methacholine challenge testing, lung volume, and DL(CO). These tests are used in a number of situations, including the clinical evaluation and management of patients with possible occupational lung disorders, preplacement and fitness-for-duty examinations, medical screening of exposed workers, impairment and disability evaluations, and research. The diagnosis of occupational lung disease has serious consequences for a worker and, in addition to a careful occupational history, usually requires objective assessment using PFTs. Serial PFTs are useful in following such patients and screening exposed populations of workers for respiratory conditions.     

Differentiation of Pancreatic Tumours by Conventional Ultrasound,Unenhanced and Echo-Enhanced Power Doppler Sonography

Background: Echo-enhanced power Doppler sonography (power Doppler sonography after injection of a contrast agent) is a non-invasive and increasingly used procedure for differentiating between pancreatic tumours. However, the diagnostic accuracy of this method compared to conventional ultrasound or unenhanced power Doppler sonography has never been investigated in a large prospective controlled study. Methods: 137 patients were included in the study, selected from 190 consecutive patients with a mean age of 60 years (range 16-85) who presented at our department in the period January 1998 through June 2001 with clinical suspicion of a pancreatic tumour. Sonography was performed by an experienced examiner blind to the patients' clinical diagnoses. The exact diagnosis was based on histological evidence from biopsy examination (surgical and fine needle biopsy) or on a follow-up of at least 18 months. Results: Of the 137 patients, 47 had pancreatic cancer; 41 had masses associated with pancreatitis; 17 had neuroendocrine tumours; 12 had cystic lesions of the pancreas; and 10 had other pancreatic diseases. A normal pancreas was found in 10 patients. The sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing pancreatic carcinoma was 87% and its specificity 94%. The corresponding values for chronic pancreatitis were 85% and 99%, respectively. Conclusions: Echo-enhanced power Doppler sonography has a high sensitivity and specificity in the differential diagnosis of pancreatic tumours. However, histology is the standard of reference.     

Pulsed Doppler in the diagnosis of tricuspid insufficiency

Forty-eight patients underwent M-Mode, 2D and pulsed Doppler echocardiography with systematic apical and subcostal examination of the mitral and tricuspid orifices to determine the value of pulsed Doppler echo in the detection of tricuspid regurgitation. The fourty-eight patients, aged 12 to 69 years, were divided into 2 groups: Group I: 27 patients referred for cardiac catheterisation usually with a view to surgery. The majority of patients had rheumatic valvular, congenital heart disease or cardiomyopathies. All of these patients had phonocardiography, right and left heart catheterisation, right ventricular angiography and measurement od cardiac output. Group II: 21 control patients with no auscultatory, radiological or electrocardiographic changes. This group was studied to determine the specificity of pulsed Doppler examination of the tricuspid valve and the patients only underwent echocardiography. Selective right ventricular angiography was selected as the reference. The sensitivity, specificity and predictive value of pulsed Doppler echocardiography in the positive diagnosis of tricuspid regurgitation were determined. Its value in quantifying tricuspid regurgitation was also analysed. The sensitivity of pulsed Doppler was 93 p. 100 in this series: all but one case of angiographically proven tricuspid regurgitation were detected by the finding of unequivocal systolic turbulence in the right atrium. The specificity of pulsed Doppler was 91 p. 100. The positive predictive value of systolic turbulence in the right atrium was 81 p. 100. The only reliable criteria for quantifying the regurgitation were the intensity of the acoustic signal and the spatial extension of intraatrial turbulent flow: all patients with turbulent flow propagating as far as the superior wall of the right atrium or the inferior vena cava had angiographically severe tricuspid regurgitation. A comparison with other paraclinical methods of detecting tricuspid regurgitation showed that pulsed Doppler echocardiography is the most sensitive tool at the clinician's disposal for diagnosing this lesion: the sensitivity of auscultation and phonocardiography was 50 p. 100, jugular pulse tracings 54 p. 100, right heart catheterisation 50 p. 100, and pulsed Doppler echocardiography 93 p. 100. Pulsed Doppler echocardiography may even be superior to angiography which has, until now, been the method of reference for diagnosing tricuspid regurgitation.     

Cut-off value of coronary flow velocity reserve by transthoracic Doppler echocardiography for diagnosis of significant left anterior descending artery stenosis in patients with coronary risk factors

The purpose of this study was to evaluate the adequate cut-off value of coronary flow velocity reserve (CFVR) with transthoracic Doppler echocardiography for diagnoses of significant left anterior descending (LAD) artery stenosis in a large study population with various coronary risk factors. CFVR, which has been used for evaluation of significant coronary artery stenosis, can be reduced despite angiographically normal coronary arteries in patients with various coronary risk factors. However, the adequate cut-off value of CFVR for diagnosing significant LAD stenosis has not been fully established in patients with coronary risk factors. We examined 138 consecutive patients who underwent coronary angiography. Clinical histories of coronary risk factors were determined from interviews or medical records. CFVR assessment in the LAD artery by transthoracic Doppler echocardiography was performed in all patients. Of the 138 patients, 30 had significant stenosis, and the remainder had no stenotic lesions in the LAD artery. Receiver-operating characteristic curves for detection of significant LAD stenosis showed that a cut-off value of <2.0 was extremely precise. A cut-off value <2.0 of CFVR had a sensitivity of 90%, a specificity of 93%, a positive predictive value of 77%, and a negative predictive value of 97% for the presence of significant LAD stenosis. A cut-off value <2.0 of CFVR by transthoracic Doppler echocardiography was adequate for the diagnosis of significant LAD stenosis in a population that included patients with coronary risk factors.     

A new noninvasive method of diagnosing vasospastic angina based on dilation response of the left main coronary artery to nitroglycerin as measured by echocardiography

Objectives.The purpose of the present study was to evaluate the feasibility of diagnosing vasospastic angina based on coronary artery tone as assessed by M-mode echocardiographic measurement of the dilation response of the left main coronary artery to nitroglycerin.Background.The definite diagnosis of vasospastic angina is done by a coronary spasm provocative test using ergonovine maleate or acetylcholine during cardiac catherization. Current noninvasive, nonpharmacologic diagnostic methods are not sensitive enough for the diagnosis of vasospastic angina.Methods.Thirty-eight patients who had an angiographically normal left main trunk were studied. These patients were classified into four groups based on the presence or absence of more than 50% stenosis in the coronary arteries except for the left main trunk and the results of the acetylcholine or ergonovine provocative test. At 7 a.m. and at noon on the same day, the left main trunk diameter was measured by M-mode echocardiography before and after sublingual administration of nitroglycerin (0.3 mg), and its percent dilation was calculated to assess coronary artery tone.Results.The percent dilation of the left main trunk diameter induced by sublingual nitroglycerin at 7 a.m. and at noon was 22.4 ± 4.7% (mean ± SD) and 18.1 ± 4.0% in 11 patients with vasospastic angina and without coronary stenosis, 14.9 ± 7.1% and 11.2 ± 6.9% in 9 patients with vasospastic angina and coronary stenosis, 6.1 ± 3.5% and 7.0 ± 5.1% in 8 patients without vasospastic angina but with coronary stenosis and 8.1 ± 5.6% and 7.8 ± 5.7% in 10 control subjects. The percent dilation at 7 a.m. was significantly greater in the vasospastic angina without coronary stenosis group than in the remaining three groups, and in the vasospastic angina groups, the percent dilation at 7 a.m. was significantly greater than that at noon. When percent dilation at 7 a.m. exceeding 15% was defined as positive for the diagnosis of vasospastic angina, the sensitivity was 80% and the specificity 94%.Conclusions.Basal tone of the left main trunk is elevated in the early morning in vasospastic angina. Dilation of the left main trunk diameter exceeding 15% induced by sublingual nitroglycerin in the early morning as measured by M-mode echocardiography is a highly sensitive and specific criterion for the diagnosis of vasospastic angina.     

Lack of association of migraine with coronary vasospasm

Previous reports have found an association between coronary vasospasm and migraine. It has been speculated that migraine and variant angina might be manifestations of a generalized vasospastic disorder. To investigate this hypothesis, 74 patients with frequent attacks of migraine were studied using 24-h continuous ambulatory electrocardiography to identify the presence of coronary vasospasm. Control groups consisted of 19 patients with tension headaches, and 38 healthy individuals. All subjects were free of heart disease. One patient in the migraine group and one patient in the control group had symptomless episodes of ST-segment depression not indicative of coronary vasospasm. Our data do not support the hypothesis that migraine and variant angina are components of a generalized vasospastic disorder.     

糖尿病足动脉血管早期病变行彩色多普勒超声诊断对定位准确、无创性的价值研究

目的分析探讨给予糖尿病足动脉血管早期病变患者彩色多普勒超声诊断取得的临床应用价值,分析探究其定位准确以及无创价值。方法选取2018年1月—2020年8月该院收治的糖尿病足动脉血管早期病变患者作为研究对象,确诊患者共计112例,在诊断过程中均采取彩色多普勒超声诊断、超声造影检查,同时将X线数字减影血管造影的诊断结果作为金标准,评估分析应用彩色多普勒超声诊断、超声造影检查取得的诊断效果。结果彩色多普勒超声诊断的确诊率为98.21%,误诊率为1.79%,和超声造影检查结果、金标准进行比较,差异无统计学意义(χ²=4.073,P>0.05);对比分析采取3种诊断措施以后患者血管病变状况,差异无统计学意义(Z=0.500,P>0.05)。对比分析超声造影以及彩色多普勒超声应用后脉搏波传导速度以及踝肱指数、脉压指数,差异有统计学意义(t=12.027、11.685、25.017,P<0.05)。结论给予糖尿病足动脉血管早期病变患者彩色多普勒超声诊断措施对于准确分析血管病变情况具有积极意义,具有较高的定位准确以及无创价值。