非高密度脂蛋白胆固醇与冠状动脉病变Gensini积分的相关性

目的 探讨冠心病病人非高密度脂蛋白胆固醇(non-HDL-C)水平与冠状动脉病变Gensini积分的相关性。方法 选取中国人民解放军总医院心血管内科收治且行冠状动脉造影术的病人246例作为研究对象,并收集其一般资料及生化检查资料。根据冠状动脉造影结果分为冠状动脉病变组(173例)、冠状动脉正常组(对照组,73例)。冠状动脉病变组根据血管病变支数分为单支病变组(64例)、双支病变组(49例)、三支病变组(60例),根据Gensini积分分为低积分组(Gensini积分<32分,54例)、中积分组(Gensini积分32～64分,62例)、高积分组(Gensini积分>64分,57例)。采用Pearson相关性分析法分析non-HDL-C与Gensini积分的相关性,采用多因素Logistic回归分析、受试者工作特征(ROC)曲线评价non-HDL-C与冠心病的关系。结果 单支病变组、双支病变组、三支病变组non-HDL-C水平均高于对照组(P<0.05);non-HDL-C与冠状动脉病变支数、Gensini积分等级均存在线性趋势关系(P<0.05)。Pearson...     

动脉硬化指数和非高密度脂蛋白胆固醇水平与冠状动脉病变程度相关性的初步研究

目的:探讨动脉硬化指数(AI)与冠心病(CHD)患者冠状动脉病变程度的关系。方法:对148例疑诊冠心病患者行冠状动脉造影(CAG)检查,将冠状动脉造影结果阳性者86例作为冠心病组,冠状动脉造影结果阴性者62例作为对照组。检测其TC、TG、LDL-C及HDL-C,计算AI值和非高密度脂蛋白胆固醇(non-HDL-C),并采用Gensini积分法评定冠状动脉病变程度,分析各指标与冠状动脉病变程度的关系。结果:与对照组比较,冠心病组TC、LDL-C、non-HDL-C、AI值显著增高,HDL-C显著降低(P0.05)。Spearman等级相关分析显示,仅non-HDL-C和AI水平与冠状动脉病变程度呈正相关(r=0.247,r=0.314,P0.05)。结论:CHD患者有较高的non-HDL-C和AI水平,可预测并评价冠状动脉病变严重程度。     

血清低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇水平与冠状动脉病变严重程度的相关性研究

目的探究血清低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇(non-HDL-C)水平与冠状动脉病变严重程度的相关性。方法选取2015年2月—2016年8月因胸口疼痛或胸闷等症状在东营胜利石油管理局胜利医院行冠状动脉造影的患者194例,根据造影结果分为正常组71例、冠状动脉粥样硬化组30例、冠心病组93例;根据冠状动脉病变支数将93例冠心病患者分为单支病变组34例、双支病变组30例和三支病变组29例。比较正常组、冠状动脉粥样硬化组及冠心病组患者血生化检查指标,不同冠状动脉病变支数冠心病患者血生化检查指标及Gensini积分,并分析血清LDL-C、non-HDL-C水平及non-HDL-C/高密度脂蛋白胆固醇(HDL-C)比值与Gensini积分的相关性。结果正常组、冠状动脉粥样硬化组及冠心病组受试者血糖及血清总胆固醇(TC)、三酰甘油(TG)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、丙氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)水平比较,差异无统计学意义(P>0.05);冠心病组患者血清HDL-C水平低于正常组和冠状动脉粥样硬化组,血清LDL-C、non-HDL-C水平及non-HDL-C/HDL-C比值高于正常组和冠状动脉粥样硬化组(P<0.05)。不同冠状动脉病变支数冠心病患者血糖及血清TC、LDL-C、BUN、Cr、UA、ALT及AST水平比较,差异无统计学意义(P>0.05);双支病变组患者血清TG、non-HDL-C水平及non-HDL-C/HDL-C比值高于单支病变组,血清HDL-C水平低于单支病变组(P<0.05);三支病变组患者血清non-HDL-C水平及non-HDL-C/HDL-C比值高于单支病变组(P<0.05);双支病变组和三支病变组患者Gensini积分高于单支病变组,三支病变组患者Gensini积分高于双支病变组(P<0.05)。Pearson相关性分析结果显示,血清LDL-C水平与Gensini积分呈正相关(r=0.157,P=0.031),血清non-HDL-C水平与Gensini积分呈正相关(r=0.301,P=0.010),non-HDL-C/HDL-C比值与Gensini积分呈正相关(r=0.401,P=0.020)。结论血清LDL-C和non-HDL-C水平均与冠状动脉病变严重程度相关,且血清non-HDL-C水平与冠状动脉病变严重程度的相关性优于血清LDL-C水平。     

血清尿酸非高密度脂蛋白胆固醇与冠状动脉病变的关系

目的探讨尿酸(UA)及血清非高密度脂蛋白胆固醇(non-HDL-C)水平与冠心病患者冠状动脉病变程度的关系。方法对326例疑诊冠心病(CHD)患者进行冠状动脉造影(CAG),将冠状动脉造影结果阴性者160例作为对照组,冠状动脉造影结果阳性者166例作为冠心病组。对两组患者的血脂、尿酸进行比较,并将冠心病组按病变程度分为单支、双支、三支病变组,进行血清UA、non-HDL-C结果比较。结果冠心病组UA和non-HDL-C高于非冠心病对照组(P0.05)。冠状动脉病变支数越多,血清UA、non-HDL-C水平越高,以三支病变组升高最为明显,与单支病变组、双支病变组比较差异有统计学意义(P0.05)。结论血清non-HDL-C、UA水平与冠状动脉硬化严重程度呈正相关,non-HDL-C比LDL-C对CAD的发生有更好的预测评价作用,高水平UA可能是导致CHD的危险因素。     

非高密度脂蛋白胆固醇与冠脉病变支数和狭窄程度的相关分析

目的 探讨冠心病患者非高密度脂蛋白胆固醇(HDL-C)水平与冠状动脉病变支数和狭窄程度的关系.方法 340例患者均行冠状动脉造影,采用Gensini积分评定冠状动脉狭窄程度.结果 冠造阳性组患者血清非HDL-C水平高于冠造阴性组(P＜0.05);血清非HDL-C水平随着冠状动脉病变支数和Gensini积分的增加而升高;非HDL-C水平与冠状动脉病变支数和狭窄程度均有明显的相关性.结论 在临床工作中,控制非HDL-C增高对冠心病的预防和治疗有积极的意义.     

非高密度脂蛋白胆固醇水平与冠心病病情的相关性分析

目的探讨非高密度脂蛋白胆固醇水平与冠心病患者病情的相关性。方法对522例行冠状动脉造影检查的患者进行回顾性分析,根据冠状动脉造影结果结合临床特点、心电图表现、心肌标志物结果分为非冠心病组、心绞痛组、心肌梗死组,平均年龄60.00±10.02岁。采用Gensini评分评估冠心病患者冠状动脉病变程度,收集所有患者临床资料,采集静脉血检测血脂指标并计算非高密度脂蛋白胆固醇值,分析非高密度脂蛋白胆固醇水平与冠心病病情的相关性。结果三组间的非高密度脂蛋白胆固醇水平、Gensini积分差异有统计学意义(P0.05);心绞痛组非高密度脂蛋白胆固醇水平与Gensini积分正相关(r=0.130,P=0.022),心肌梗死组非高密度脂蛋白胆固醇水平与Gensini积分正相关(r=0.213,P=0.048);多元无序Logistic回归分析显示,年龄、性别、非高密度脂蛋白胆固醇水平是影响冠心病病情的危险因素(P0.05)。结论非高密度脂蛋白胆固醇水平是影响冠心病患者病情的一项重要指标。     

非高密度脂蛋白胆固醇水平与青年冠心病的相关性

目的本研究探讨非高密度脂蛋白胆固醇水平(non-HDL-C)与青年冠状动脉粥样硬化性心脏病(冠心病)的相关性。方法选取2015年6月~2017年7月于中国医科大学附属盛京医院心血管内科住院行冠状动脉造影术的青年患者196例作为研究对象,其中冠状动脉病变组(病例组)132例,冠状动脉正常组(对照组)64例,并收集患者的一般资料及相关化验检查。根据Gensini评分将病例组分为两个组,轻中度冠脉病变组(GS 1-59,n=78)及重度冠脉病变组(GS≥60,n=54);应用Pearson相关分析方法分析non-HDL-C水平与Gensini积分的相关性;应用Logistic回归分析重度冠心病的独立危险因素;应用ROC曲线评估non-HDL-C水平预测重度冠脉病变的最佳切点。结果病例组的non-HDL-C水平高于对照组(P0.001);重度冠脉病变组的non-HDL-C水平高于轻中度冠脉病变组(P0.001);nonHDL-C水平与青年冠心病患者Gensini评分相关(r=0.390,P0.001);non-HDL-C可作为评估冠脉病变严重程度的独立危险因素(OR=1.061,P=0.041,95%CI:1.002~1.123);ROC曲线分析结果提示nonHDL-C预测重度冠脉病变的最佳切点是3.58 mmol/L,敏感度为0.796,特异度为0.641。结论 Non-HDL-C与青年冠心病发生及冠脉病变严重程度相关,non-HDL-C水平升高是重度冠脉病变的独立危险因素,当non-HDL-C3.58 mmol/L,可预测出现冠状动脉严重病变。     

老年冠心病患者高密度脂蛋白胆固醇与冠状动脉狭窄程度的相关性

目的 评价高密度脂蛋白胆固醇(HDL-C)与老年冠心病(CHD)患者冠状动脉狭窄程度的相关性.方法 选择行冠脉造影的住院患者279例,其中临床确诊为CHD患者228例,用Gensini评分系统对冠状动脉造影结果评分,按评分结果CHD患者分为轻度狭窄组、中度狭窄组和重度狭窄组,分别检测各组患者的总胆固醇(TC)、甘油三酯(TG)、HDL-C、低密度脂蛋白胆固醇(LDL-C),游离脂肪酸(FFA)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白LP(a),进行one-way ANOVA检验和Logistic回归分析.结果 CHD组HDL-C、ApoA1较非CHD组显著降低,而TC和LDL-C显著增加,随冠脉狭窄严重程度的升高,TC水平升高而HDL-C水平降低.Logistic回归分析结果显示HDL-C与CHD及冠状动脉狭窄程度呈负相关,而TC与CHD及冠状动脉狭窄程度呈正相关.结论 HDL-C异常与老年CHD患者的关系密切,可作为老年CHD患者的独立危险因素.     

非高密度脂蛋白胆固醇与冠状动脉病变严重程度的相关性

目的观察冠状动脉粥样硬化性心脏病(CHD)患者非高密度脂蛋白胆固醇与冠状动脉病变严重程度的相关性,及其预测严重冠状动脉狭窄的能力。方法收集843例CHD患者,根据冠状动脉造影结果将患者分为单支、双支、三支病变组,用Gensini积分评估患者冠状动脉病变狭窄严重程度并按积分四分位数分成Q1～Q4组共4组,分别比较各组间血脂参数差异。用Spearman相关系数分析患者低密度脂蛋白胆固醇(LDLC)、非高密度脂蛋白胆固醇(non-HDLC)、总胆固醇/高密度脂蛋白胆固醇(TC/HDLC)、甘油三酯/高密度脂蛋白胆固醇(TG/HDLC)与Gensini积分的关系。采用受试者工作特征曲线(ROC)和多因素Logistic回归评价LDLC、non-HDLC、TC/HDLC、TG/HDLC预测严重冠状动脉狭窄的能力。结果患者LDLC、non-HDLC、TC/HDLC水平随Gensini积分增高显著增加(P均0.05),Q4组TG/HDLC显著高于Q1和Q2组(P均0.05)。LDLC、non-HDLC、TC/HDLC水平随冠状动脉病变支数增加显著增加(P均0.05),TG/HDLC在各组间差异无显著性。non-HDLC与Gensini积分(r=0.315,P0.01)相关性高于LDLC(r=0.252,P0.01)、TC/HDLC(r=0.242,P0.01)、TG/HDLC(r=0.123,P0.01)。non-HDLC预测高Gensini积分的ROC曲线下面积是0.729(95%Cl 0.691～0.767,P0.01),分别大于LDLC的0.694(95%Cl 0.653～0.734,P0.01)、TC/HDLC的0.681(95%Cl 0.640～0.721,P0.01)、TG/HDLC的0.564(95%Cl 0.521～0.607,P0.01)。用多因素Logistic回归校正冠心病危险因素后,non-HDLC(OR=2.472, 95%Cl 1.962～3.115)预测严重冠状动脉病变的能力轻微优于LDLC(OR=2.265, 95%Cl 1.785-2.875)、TC/HDLC(OR=1.796, 95%Cl 1.483～2.175)、TG/HDLC(OR=1.022, 95%Cl 0.927～1.127)。结论 non-HDLC在预测严重冠状动脉病变方面优于LDLC、TC/HDLC、TG/HDLC,有助于对CHD患者的危险分层。     

老年冠心病患者血浆非高密度脂蛋白胆固醇水平的差异

目的探讨在老年冠心病患者的血清非高密度脂蛋白胆固醇的差异。方法选择120例行冠状动脉造影检查的老年患者,冠状动脉造影前空腹采静脉血,分析冠状动脉造影阳性组和对照组之间非高密度脂蛋白胆固醇与其它血脂数据(总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)差异的显著性及非高密度脂蛋白胆固醇对冠状动脉病变程度的相关性。结果冠状动脉造影阳性组非高密度脂蛋白胆固醇水平显著高于阴性组2.99±1.08mmol/L,一支病变组为3.41±0.59mmol/L,两支病变组为3.70±1.30mmol/L,三支病变组为3.77±1.10mmol/L,(P<0.001)并且非高密度脂蛋白的水平随冠状动脉病变支数逐渐增高,与冠状动脉狭窄分数相关(r=0.36,P<0.001);而两组间甘油三酯,高密度脂蛋白水平无统计学差异(P>0.05)。结论血清非高密度脂蛋白胆固醇对于老年人是一项简便实用的冠心病风险评估指标。     

Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery

A rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.     

Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty-two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals. All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.     

Left main stem coronary artery dissection during coronary angiography

This paper describes a case of dissection of the main stem of the left coronary artery during coronary angiography with an uneventful clinical course. As far as we know, only one comparable case has been reported before. A brief survey of the pertinent literature is presented. Some possible pathogenetic factors are considered. No specific preventive or therapeutic measurement can be recommended.     

The incidence of coronary anomalies on routine coronary computed tomography scans

The incidence of coronary anomalies (CCAs) in a typical angiographic study was 1.3%.1 Studies have been conducted on CCAs using conventional invasive coronary angiography in highly selected groups of patients but these studies may not reflect the true incidence of CCAs.Although the majority of CCAs are benign and incidentally detected during conventional angiography, certain CCAs may cause syncope, heart failure or sudden death, especially among young athletes.2,3 The US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry found that CCAs were the second most common cause of sudden cardiac death (out of 17% of the population who died of cardiac-related causes).4Although conventional invasive coronary angiography is considered the gold standard for the diagnosis of CCAs, transthoracic two-dimensional echocardiography, transoesophageal echocardiography, magnetic resonance imaging and multi-slice computed tomography (MSCT) can all identify for diagnosis, CCAs in certain groups of patients.5-10 Transthoracic twodimensional echocardiography may depict the origin of the coronary arteries, especially the left main artery, but successful detection of coronary anomalies depends on the age and size of the patient.5,6Transoesophageal echocardiography has an increased success rate of identifying coronary anomalies in comparison with two-dimensional echocardiography. Nevertheless, the position of the transducer, cardiac motion, and the curvilinear course of the vessel all affect visualisation of coronary anomalies. Moreover, transoesophageal echocardiography is a semi-invasive method and is time consuming.6,7Magnetic resonance (MR) imaging provides an accurate assessment of the course of anomalous coronary arteries.8,9 However, this technique cannot be performed in patients with pacemakers, certain types of arrhythmias or defibrillating devices, and it may be difficult to perform in claustrophobic patients. Furthermore, the spatial resolution of MR imaging is substantially inferior to that of the newest generation of CT scanners.10Myocardial bridging (MB) is defined as the compression of a coronary artery during systole while it is normal in diastole. MB has been linked to serious cardiac events.11 The incidence of myocardial bridging in the population varies substantially according to invasive coronary angiography (13%) and autopsy (15–85%).12,13 The reported incidence of MB has increased up to 44% when using 64-MSCT.14 Because of its ability to cause serious cardiac events, diagnosing MB is clinically important.MSCT is a minimally invasive method that provides excellent temporal and spatial resolution of the coronary arteries. There have been a limited number of studies evaluating CCAs and MB with 64-MSCT. The aim of this study was to assess the incidence of CCAs and MB using 64-MSCT in a relatively large population.     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

The disappearing coronary stenosis: reemphasizing the importance of excluding coronary vasospasm before coronary intervention.

We describe a case of resting angina with multiple angiographic stenoses that were highly suitable for stenting. These classic lesions resolved after intracoronary nitroglycerin while positioning a stent. This case reemphasizes the need to exclude vasospasm prior to any interventional coronary procedure.     

Percutaneous transluminal coronary angioplasty of a right coronary artery arising from the left main coronary artery

Angioplasty of anomalous coronary arteries presents unique technical challenges. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and to provide support to cross the lesion. A case of successful PTCA of a lesion in an anomalous right coronary artery arising from the left main coronary artery is presented. © 1993 Wiiey-Liss, Inc.     

冠状动脉造影检查在冠心病诊断中作用的再探讨

目的探讨冠状动脉造影（CAG）检查在诊断冠心病中作用,就其对多年来被认为是金标准作用进行再探讨。方法对138例怀疑有冠心病的患者,均经普通ECG,动态ECG,活动平板和CAG。结果只有71例患者的冠状动脉造影检查符合目前冠心病标准,其余67例患者冠状动脉未达标（轻度-中度狭窄,或完全正常或仅见散在斑块形成）。结论冠心病的诊断是一个较为复杂的问题,CAG检查是诊断冠心病的一个重要依据,有相当比例的冠心病患者（CAG）无明显异常。     

Detection of impaired coronary flow reserve in coronary artery disease using transthoracic echocardiographic assessment of coronary sinus blood flow

In order to establish whether coronary flow reserve (CFR) can be measured by transthoracic echocardiography (TTE) with pulse wave Doppler echocardiography, 14 patients with coronary artery disease (CAD) and 12 normal subjects were studied. Coronary sinus blood flow was measured at rest and 2 minutes after intravenous injection of 0.56 mg/kg dipyridamole (DP). CFR was calculated as the DP to rest flow ratio. Patients with CAD were found to have significantly decreased CFR when compared to normal subjects. These findings suggest that TTE may be useful in diagnosing CAD.     

Sudden coronary death

Many reports have described the amounts of atherosclerotic plaque in victims of sudden coronary death, defining the number of coronary arteries narrowed at some point greater than 75% in cross-sectional area (XSA). In order to quantitate more precisely the amount and distribution of plaque, 70 victims of sudden coronary death aged 22-81 years (mean 50) were studied. The four major epicardial coronary arteries (left main, left anterior descending, left circumflex, and right) from each of 70 victims were cut into 5-mm segments (average 50 per patient) and a histologic section prepared from each segment. The amount of luminal narrowing by plaque was categorized into five groups (0-25%, 26-50%, 51-75%, 76-95%, 96-100%). Of 3,484 five-mm segments, 950 (27%) were narrowed 76-100% in XSA. Comparison of 31 previously symptomatic victims (angina pectoris and/or myocardial infarction) to 39 victims who had been asymptomatic disclosed a higher mean percent of severely narrowed segments (30% vs. 25%, p = less than 0.005) and a lower mean percent of minimally narrowed segments in the symptomatic group. Comparison of the 31 patients with a healed myocardial infarction at necropsy with 39 patients with no left ventricular scar disclosed a higher mean percent of segments severely narrowed (33% vs. 24%, p = less than 0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13% vs. 26%, p = less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)