主动脉瓣疾病冠脉造影分析

目的　观察主动脉瓣疾病患者合并冠状动脉病变的发生情况。方法　对 10 5例主动脉瓣疾病不合并二尖瓣病变的患者术前临床资料和选择性冠状动脉造影的结果进行综合分析。结果　 10 5例患者中 5 1例有心绞痛症状 ,心绞痛发生率为 48 6% ,但冠脉造影显示只有 7例诊断冠心病。主动脉瓣狭窄病变为主者心绞痛的发生率为 68 2 % ,以主动脉瓣关闭不全病变为主者 ,心绞痛的发生率为 3 2 0 % ,两者比较有统计学差异 (P <0 0 1)。但是 ,两者冠心病的发病率无统计学差异。主动脉瓣退行性变组合并冠心病率(3 3 3 % )显著高于风心病组和先天性二叶瓣组 (P <0 0 1)。结论　在单纯主动脉瓣病变中以心绞痛预测冠心病的敏感性、特异性、准确率低。而主动脉瓣退行性变合并冠心病的发病率大于风心病和先天性的主动脉瓣病变。在单纯主动脉瓣病变者明确有无合并冠心病 ,冠脉造影是必要的 ,尤其是主动脉瓣退行性变病人     

冠状动脉造影正常的冠状动脉疾病研究进展

有些冠状动脉疾病(如冠状动脉痉挛、心肌桥、冠脉微血管性心绞痛等)冠状动脉造影表现正常.有资料显示临床明确诊断为冠状动脉疾病的患者中有10%～30%冠状动脉造影正常.近年来随着血管内超声(IVUS)等新技术的飞速发展,对冠状动脉造影正常的冠状动脉疾病的研究有了更深入的进展.现就这一问题总结了几种冠状动脉造影正常的冠状动脉疾病,目的 是为正确的诊断和治疗这类疾病提供帮助.     

冠状动脉造影适应证与冠状动脉造影结果分析

目的:探讨采用ACC和AHA冠状动脉造影(CAG)委员会1999年制定的CAG适应证标准与CAG结果的关系。方法:对332例行CAG患者按ACC和AHA的CAG委员会1999年制定的CAG适应证的标准进行分类:Ⅰ级、Ⅱa级、Ⅱb级和Ⅲ级,分析其与CAG结果的关系。结果:Ⅰ级与Ⅱa级适应证患者CAG阳性率(161/164,98·2%和35/37,94·6%,P>0·05)Ⅰ级、Ⅱa级的阳性率明显高于Ⅱb级(27/41,65·9%,均P<0·01)和Ⅲ级(5/90,5·6%,P<0·01)。Ⅱb级适应证组与Ⅲ级适应证组比较差异有统计学意义(P<0·01)。Ⅰ级加Ⅱa级适应证患者的3支或左主干血管病变检出率(46/201,22·9%)明显高于Ⅱb级(3/41,7·3%,P<0·05)和Ⅲ级(0/90,P<0·01),Ⅱb级适应证组与Ⅲ级适应证组比较差异有统计学意义(P<0.05)。结论:对准备进行CAG的冠心病或怀疑冠心病患者Ⅰ级、Ⅱa级适应证是恰当的,Ⅱb级适应证是不确定的,而Ⅲ级适应证是不恰当的,CAG适应证可以预测CAG阳性率和血管病变数。     

定量冠状动脉造影分析

定量冠状动脉造影分析重庆医科大学附一院心内科王春晖综述李永安审校自３０多年前Ｓｏｎｅｓ首次成功实施选择性冠状动脉造影以来，这一技术取得了长足的进步，推动了冠心病研究的发展。冠脉造影结果的定量分析是诊断冠心病及侵入性冠脉治疗的可靠依据，其结果的精确性和...     

钙化性主动脉瓣疾病的诊疗进展

随着社会老龄化进程的加快,钙化性主动脉瓣疾病发病率逐渐升高,相关的心力衰竭（心衰）等不良事件显著增加,给社会带来沉重负担,同时,目前对于严重的钙化性主动脉瓣的治疗方法和效果有限、并发症多,其原因是钙化性主动脉瓣疾病的发生机制不明确、缺少预防其发生发展的有效手段。因此,深入探究钙化性主动脉瓣疾病的发生机制,寻找干预其发生进展的分子靶点,对于降低钙化性主动脉瓣疾病的发生具有重要意义。本文针对钙化性主动脉瓣疾病的流行病学、发病机制和临床治疗的现状及进展进行综述。     

经导管主动脉瓣置换术患者冠状动脉疾病高质量管理

<正>自2002年Cribier等^[1]在Circulation上发表首个病例报道以来,经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)已成为症状性、外科主动脉瓣置换术(surgical aortic valve replacement,SAVR)高危患者治疗的“金标准”^[2-3]。近年来的研究表明,TAVR也有望成为中、低危主动脉瓣病变患者一种实用的治疗选择^[4]。显然,由于退行性主动脉瓣病变(尤其是主动脉瓣狭窄)与冠状动脉疾病的发病机制和易患因素具有多方面相似性(例如糖尿病、高胆固醇血症、高血压),加上老龄化社会的形成,     

老年退行性心瓣膜病合并冠心病患者冠状动脉造影结果分析

老年退行性心瓣膜病（SDHVD）系一种增龄性疾病，随着年龄的增长瓣膜钙化发生率明显增加。本研究对老年冠心病患者合并与未合并SDHVD的临床资料及冠状动脉造影结果进行回顾性分析，以期更好的指导临床治疗。     

106例冠状动脉造影分析

冠状动脉造影 (ＣＡＧ)是显示冠状动脉病变部位及狭窄程度的重要方法 ,对临床冠心病、心绞痛及心律失常等的诊断及治疗有重大意义。现将我院自 1997年 6月至2 0 0 2年 6月资料完整的 10 6例ＣＡＧ报告如下。1　资料与方法1.1　一般资料 :本组 10 6例中 ,男 84例 ,女 2 2例 ,年龄 19～ 81岁 ,平均 5 8.0± 8.2岁。其中心肌梗死组 2 1例 ,典型心绞痛组 3 8例 ,不典型心绞痛组 2 2例 ,其他组 2 5例 (主要包括心律失常 16例、心瓣膜病 5例及病因不明心衰患者 4例 )。1.2　方法　以常规ｓｅｌｄｉｎｇｅｒ法行股动脉穿刺成功后 ,运用ｊｕｄｋｉｎ…     

经导管主动脉瓣置换术患者冠状动脉疾病的管理与处理策略

接受经导管主动脉瓣置换术（TAVR）的患者常合并冠状动脉疾病（CAD）,此外,TAVR术中可能存在冠状动脉闭塞的风险。随着TAVR适应证的扩展,对于TAVR患者CAD管理变得尤为重要。本文对TAVR患者合并冠状动脉病变的流行病学及预后、处理原则及策略,TAVR术中冠状动脉风险的评估及应对进行综述。     

97例冠状动脉造影分析

目的　了解临床确诊为冠心病患者的冠状动脉造影结果及老年组冠状动脉病变特点。方法　对我院 97例临床确诊为冠心病患者按年龄分成老年组 ( n=49)和中年组 ( n=48)分别行冠状动脉造影。结果　 97例冠状动脉造影中 78例阳性 (冠状动脉狭窄≥ 5 0 % ) ,其中心肌梗死患者造影阳性率 97.9% ,心绞痛患者为 62 .5 %。在冠状动脉造影阳性病例中 ,左前降支受累者占 73 .0 8% ,右冠状动脉 5 8.97% ,左回旋支占 5 6.41%。老年组冠状动脉狭窄阳性率占 89.80 % ,中年组 70 .83 % ( P<0 .0 5 ) ;老年组冠状动脉单支受累占 2 0 .45 % ,双支、多支受累占 79.5 5 % ,中年组分别为 5 2 .94% ,47.0 6% ( P<0 .0 1)。结论　冠状动脉造影对临床诊断及治疗可提供依据 ,老年组冠状动脉病变以双支、多支受累多见。     

主动脉瓣钙化与冠心病的相关性研究

目的 探讨珠海地区汉族人群主动脉瓣钙化（AVC）与冠心病的相关性.方法 回顾性研究心内科住院患者1140例.所有患者均同期行超声心动图和冠状动脉造影检查,分析AVC与冠心病的相关性.结果 冠心病组中检出AVC的比率明显高于非冠心病组（32.3％比13.8％,P＜0.01）.冠心病组AVC患者冠脉受累严重程度高于无AVC患者.多因素分析显示,AVC、年龄、性别、高脂血症和糖尿病为全组冠心病的独立预测因子（P＜0.05）.结论 AVC与冠心病之间存在显著的相关性,对预测冠心病有一定参考价值.     

The value of percutaneous coronary intervention in aortic valve stenosis with coronary artery disease

Objectives

The study determines whether treatment of coronary disease by percutaneous coronary intervention (PCI) in the presence of severe aortic stenosis (AS) is feasible and defines which patients might benefit most.

Background

Severe symptomatic AS is considered a class I indication for aortic valve replacement (AVR). Many patients with AS have concomitant coronary artery disease (CAD), and the true reason for symptoms is often unclear. It is common practice to combine AVR with coronary artery bypass grafting. However, in some cases PCI alone might improve symptoms and allow surgery to be deferred.

Methods

We analyzed 38 consecutive patients who underwent PCI for CAD in the presence of significant AS between 1989 and 2004. Data included demographic factors, clinical features, angiographic, and echocardiographic information. Events during follow-up included PCI complications, improvement post-PCI, AVR, and death. Statistical analysis was used to assess the impact of PCI on outcome and survival.

Results

The mean age of the study group was 71 ± 9.3 years, and the mean aortic valve area was 0.84 ± 0.28 (0.4-1.2) cm². Reasons for choosing PCI over surgery were patients’ preference, high surgical risk, and cardiologist recommendation. Thirty-five patients (92.1%) reported symptomatic improvement after PCI, and no major PCI-related complications were recorded. Significant predictors for long-term event-free survival were good functional class (P = .006) and single-vessel coronary disease (P = .017).

Conclusion

PCI in patients with severe AS and significant CAD is safe, offers relief of symptoms in most cases, and has good long-term outcome in a subset of patients who have mild CAD and good functional class. This therapeutic approach should be considered in such patients and in those with high surgical risk.     

Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

Background

In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA) was evaluated in patients with aortic valve stenosis referred for surgical AVR.

Methods

Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses were performed blinded to each other.

Results

The mean ± SD age of the included patients was 71 ± 9 years and 59% were male. The prevalence of significant coronary artery stenosis > 70% by ICA was 36%. Average heart rate during coronary CTA was 65 ± 16 bpm. In a patient based analysis 94% of the patients (171/181) were considered fully evaluable. Coronary CTA had a sensitivity of 68%, a specificity of 91%, a positive predictive value of 81%, and a negative predictive value of 83%. Advanced age, obstructive lung disease, NYHA function class III/IV, and high Agatston score were found to be significantly associated with disagreement between ICA and coronary CTA in univariate analysis.

Conclusion

In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients with low age, no chronic obstructive lung disease, NYHA function class < III and low coronary Agatston score.     

Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease

There are no studies analyzing the association between aortic valve sclerosis (AVS) and coronary artery disease (CAD) in a large and multicenter patient population with an overall low prevalence of CAD. We hypothesized that AVS could predict the presence and degree of CAD in patients with severe organic mitral regurgitation.     

冠状动脉旁路移植术同期行瓣膜手术临床分析

目的总结在冠状动脉旁路移植术同期行心脏瓣膜手术的临床经验。方法30例患者在冠状动脉旁路移植术同期进行瓣膜手术,年龄40-76（62．9±10．4）岁。其中缺血性瓣膜病变22例,风湿性瓣膜病变8例。术前冠状动脉造影诊断26例,术中发现冠脉严重病变4例。全组共移植血管133支（平均4．43支）。同期行主动脉瓣置换术3例、二尖瓣置换术12例、二尖瓣成形术8例、双瓣膜手术7例。结果术后住院死亡1例（3．3％）,死于严重低心排血量。术后心功能Ⅰ级22例、Ⅱ级7例,均较术前明显改善。结论同期行冠状动脉旁路移植术和瓣膜手术安全、有效。冠心病与心脏瓣膜病同时存在明显加重了心肌损害,完善纠治瓣膜病变、充分心肌再血管化和严格的术中心肌保护是手术成功的关键。     

主动脉瓣钙化危险因素分析及其与冠心病关系的探讨

目的 探讨主动脉瓣钙化的相关危险因素及其与冠状动脉(冠脉)病变程度的关系.方法 2010年4月至2011年4月在天津医科大学第二医院行冠脉造影和超声心动图检查患者188例,将其分为主动脉瓣钙化组(AVC) 101例和非主动脉瓣钙化组(NAVC) 87例,记录性别、年龄、身高、体质量和高血压、糖尿病、吸烟史等一般情况,血糖、血脂、同型半胱氨酸水平等相关化验结果,并对上述指标和主动脉钙化间的关系进行分析.结果 AVC组和NAVC组比较,年龄分别为(67.0±9.0)岁和(59.4±6.9)岁(t=6.74,P=0.000)、男性36例(35.6％)和44例(50.6％)(x2=4.26,P=0.039)、高血压72例(71.3％)和50例(57.5％)(x2=3.92,P=0.048)、胆固醇(5.4±1.0) mmol/L和(4.5±1.0)mmol/L(t=5.70,P=0.000)、三酰甘油(2.2±1.1)mmol/L和(1.6±0.8)mmol/L(t=4.04,P=0.000)、同型半胱氨酸(17.6±8.8)μmol/L和(14.9±6.6)μmol/L(t=2.86,P=0.028).单因素分析结果显示,年龄、性别、高血压、胆固醇、三酰甘油与主动脉钙化具有相关性;按是否患冠心病进行分组后,同型半胱氨酸水平差异无统计学意义(t=0.88,P=0.382).进一步Logistic逐步回归,年龄、胆固醇、三酰甘油、同型半胱氨酸水平均为主动脉瓣钙化的独立危险因素,心脏瓣膜钙化与冠脉病变程度相关(x2 =9.48,P=0.024).结论 主动脉瓣钙化的独立危险因素为年龄、胆固醇、三酰甘油、同型半胱氨酸水平;冠脉病变程度重者主动脉瓣钙化发生率高.     

Risk score for coronary heart disease (CHD-RISK) and hemodynamically significant aortic valve stenosis

Background and aimMultiple studies have investigated the association between coronary heart disease (CHD) risk factors and aortic valve stenosis (AS). However, limited studies have explored the relationship between CHD risk scores and AS. Whether incident risk scores for coronary heart disease (CHD-RISK) may be applied to predict AS remains unclear. We aim to investigate the association between AS and CHD-RISK.Methods and resultsWe included 4791 participants (age 54.6 ± 5.0 yrs, 58.7% women, 81% were of European origin), and CHD-RISK was estimated in 1990–1992. The participants were then followed-up until December 31, 2013. The primary outcome was hemodynamic significant AS identified by Doppler echocardiography in 2011–2013. We used multivariate-logistic regression models to assess the associations between CHD-RISK and AS. During follow-up, 963 (20.1%) cases of AS were identified. Per-standard deviation (6%) increase in CHD-RISK was associated with OR 95% Cl [1.194, 95% CI 1.068 to 1.335, p = 0.002] risk of AS in the fully adjusted models. Results were similar when stratified by quintiles of CHD-RISK, using the lowest quintiles <0.94% of CHD-RISK as the reference, 0.94%–2.26%, 2.26%–4.83%, 4.83%–9.21%, and >9.21% were; 1.33 (95% CI, 0.99–1.78, p = 0.055), 1.64 (95% CI, 1.17–2.29, p = 0.004), 2.23 (95% CI, 1.49–3.32, p = <0.001), 2.66 (95% CI, 1.65–4.31, p = <0.001) respectively.ConclusionsCHD-RISK was associated with AS. CHD-RISK and AS were high in females, age ≥55 yrs, current smokers, and BMI ≥ 30 kg/m². This investigation suggests CHD-RISK may be applied to forecast AS risk similar to CHD. Future studies are required to detect, manage, and establish better treatment strategies in these high-risk subgroups.     

668例女性冠心病患者临床及冠脉病变特点分析

目的分析女性冠心病的临床及冠脉病变特点。方法回顾性分析668例经冠脉造影确诊的女性冠心病患者的临床及冠脉病变特点,并与男性冠心病患者进行比较。结果女性冠心病患者年龄大,临床出现典型心绞痛症状及心电图缺血表现较男性少,合并糖尿病、高脂血症的发生率较男性高。冠脉双支及三支病变、B型及c型病变的发生率均较男性高。结论女性冠心病患者临床表现不典型,糖尿病、高脂血症的发生率高,冠脉病变程度较男性更严重。     

股动脉超声预测糖尿病患者冠状动脉病变严重程度的意义

对比研究冠心病伴2型糖尿病患者（n=203）和不伴糖尿病患者（n=251）的股动脉超声结果显示：（1）冠心病伴糖尿病者股动脉内径和阻力增大；（2）该组股动脉内中膜厚度和斑块指数随着冠状动脉病变程度加重而增加。因此，股动脉超声指标可能预测冠状动脉病变程度。