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。     

糖尿病对冠状动脉狭窄左室舒张末压的影响

目的:探讨糖尿病对冠状动脉狭窄患者左室舒张末压的影响。方法:选择行冠状动脉造影及左室造影的冠脉狭窄的患者662例,将之分为冠状动脉狭窄并发糖尿病组（CHD+DM组）110例,及单纯冠状动脉狭窄组（CHD组）552例,所有患者都进行左室造影,测定左室射血分数（LVEF）及左室舒张末压（LVEDP）。结果:两组患者LVEF间无明显差异,但CHD+DM组患者的LVEDP显著高于CHD组。结论:糖尿病可以加重冠状动脉狭窄对左室舒张功能的损害,引起LVEDP增高。     

冠心病患者冠状动脉病变与心率变异性的关系

目的了解冠心病患者冠状动脉病变与心率变异性（HRV）的关系。方法回顾性分析111例患者冠状动脉造影及24小时动态心电图检查资料,按冠状动脉造影结果分为3组:冠状动脉造影完全正常（正常组）、至少有一支冠状动脉狭窄>50%（狭窄组）、至少有一支冠状动脉完全阻塞（闭塞组）;通过动态心电图检查分析HRV的时域指标:SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果①随冠状动脉狭窄程度加重,SDNN、SDANNind、SDNNind逐渐下降,完全阻塞组这些指标下降最显著;②随冠状动脉病变支数增加,SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势,但只有3支病变HRV下降才有统计学意义;③左冠状动脉病变SDNN、SDAN-Nind显著下降,而右冠状动脉病变下降不显著。结论冠心病患者HRV显著下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉。     

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     

单支或多去冠状动脉完全闭塞病变侧支循环建立对左室？…

目的：探讨冠状动脉完全闭塞或近乎完全闭塞病变冠脉侧支循环的建立及其整体病变程度对左室收缩功能的影响。方法：通过Ｌｅａｍａｎ冠状动脉记分判定冠脉病变程度,左室造影测定左室射血分数（ＬＶＥＦ）,左室壁运动Ｃｏｒｔｉｎａ记分判断左室功能,并研究Ｌｅａｍａｎ记分和侧支循环建立对ＬＶＥＦ,Ｃｏｒｔｉｎａ记分的影响。结果：侧支循环建立组２５例与无侧支循环组２０例比较ＬＶＥＦ升高有显著差异（Ｐ〈０．０１）;侧支     

三维超声斑点追踪技术在不同冠状动脉狭窄程度患者心肌收缩功能评估中的价值

目的探讨三维超声斑点追踪技术(3D-STI)对不同冠状动脉狭窄程度患者心肌收缩功能的评估价值。方法接受冠状动脉造影检查确认存在冠状动脉狭窄的患者133例,根据冠状动脉造影病变动脉支数分为单支病变组、多支病变组,根据各节段动脉对应的冠状动脉狭窄程度分为五组(0级组、1级组、2级组、3级组、4级组),另选择同期体检健康人50例作为对照组;比较各组3D-STI检查结果,各节段的心肌节段径向收缩期峰值应变率(RS)和径向应变达峰时间(TRS)。结果单支病变组、多支病变组和对照组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、每搏量(SV)、心输出量(CO)比较差异无统计学意义(P>0.05),单支病变组、多支病变组二尖瓣口血流速度E峰与A峰比值(E/A)显著低于对照组(P<0.05),多支病变组E/A显著低于单支病变组(P<0.05);随冠状动脉狭窄级别增高,室壁节段RS显著降低(P<0.05),与0级组比较,3、4级组不同节段RS显著降低(P<0.05),0级组与1级组不同节段RS比较差异无统计学意义(P>0.05);4级组不同节段RS显著低于3级组、2级组、1级组和0级组(P<0.05);与0级组比较,2、3级组不同节段TRS显著延长(P<0.05),0级组与1级组不同节段TRS比较差异无统计学意义(P>0.05);4级组部分节段TRS较3级组提前(P<0.05)。结论 3D-STI可以评价不同冠状动脉狭窄程度患者心肌收缩能力,对冠心病的早期诊断具有一定价值。     

冠状动脉病变影像特征与左心室功能的关系

目的:探讨冠心病患者冠状动脉(冠脉)病变影像特征与左室功能的关系。方法:79例接受冠脉和左室造影的冠心病患者,分别以病变血管支数、冠脉病变积分及闭塞或濒临闭塞病变侧支循环情况,比较其左室射血分数、左室室壁运动积分、左室舒张末压和左室最低压的差异。结果:冠心病组中3支病变者左室功能损害最严重,双支病变者次之,单支病变者仅LVEDP显著升高;冠脉病变积分高值者左室功能损害最严重,中值者次之,低值者与正常人无明显差异;冠脉闭塞或濒临闭塞患者中无侧支循环者较有侧支循环者左室功能损害更严重。结论:冠心病左室功能损害与冠脉病变的严重程度有密切关系。     

52例急性下壁心肌梗死患者的冠状动脉造影特征

目的：探讨临床传统方法诊断为急性下壁心肌梗死（AIMI）患冠状动脉的特征。方法：对52例急性胸痛伴心电图Ⅱ，Ⅲ,aVF导联ST段抬高患行急诊冠状动脉造影，观察，分析相关血管的改变情况。结果：冠脉造影证实48例AIMI中相关病变血管为右冠脉（RCA）为37例（77．1％，37／48），其中闭塞为25例（占52．1％），左回旋支（LCX）病变20例（41．7％），其中闭塞10例（占20．8％），左前降支（LAD）不同程度狭窄6例（闭塞3例），左主干（LM）病变2例。4例冠脉造影无异常。结论：急性下壁心肌梗死相关病变血管主要为右冠状动脉和左冠状动脉回旋支。     

心电图正常的冠状动脉造影阳性病例分析

目的探讨心电图正常的冠心病病人冠状动脉造影特点.方法有典型的心前区疼痛病史而心电图正常的病人进行诊断性冠状动脉造影,收集冠状动脉造影阳性（冠状动脉狭窄直径≥50%）的完整冠心病病例共88例,其中合并有高血压病40例,糖尿病36例,进行分析.结果88例病人冠状动脉造影共累及病变数487处.其中左主干（LM）13例13处,左前降支（LAD）74例150处,左回旋支（LCX）59例106处,右冠状动脉（RCA）63例112处,对角支49例56处,间隔支1例1处,钝缘支15例15处,锐缘支4例4处,左室后支6例7处,后降支18例22处,中间支1例1处,左前降支心肌桥2例2处（其中1例心肌桥收缩期100%闭塞）;88例病人中100%闭塞病变18例（占20.5%）,存在侧支循环22例（占25%）;单支病变14例（占15.9%）,以左前降支为多,占78.6%（11/14）,双支病变28例（占31.8%）,左前降支＋右冠状动脉相对多,占46.4%（13/28）,三支病变33例（其中1例为LCX合并RCA及中间支）,占37.5%（33/88）,且多合并有高血压病及糖尿病.左主干病变13例,占14.8%（13/88）,其中左主干合并单支病变3例（占3.4%）,左主干合并双支病变4例（占4.5%）,左主干合并三支病变6例（占6.8%）.结论冠心病患者心电图正常的原因：病灶小、局限;病变狭窄程度轻;狭窄病变供血的心肌存在良好的侧支循环;冠状动脉存在广泛病变;心电图伪改善.因此,心电图与冠状动脉造影的不一致性提醒临床医师不应根据体表心电图无缺血改变而除外冠心病诊断.     

左冠状动脉主干慢性完全闭塞13例临床分析

目的：探讨左冠状动脉主干（左主干）慢性完全闭塞患者的临床特征,冠状动脉及左心室造影所见、治疗及预后。方法：对经冠状动脉造影确诊为左主干完全闭塞的13例患者的左心室功能、右冠状动脉侧支循环及临床资料进行分析。结果：①冠状动脉造影4336例中检出左主干完全闭塞13例,占0.29％。②本组13例患者均有典型劳力型心绞痛,11例（84．6％）于心绞痛发作时V3～6导联ST段下移≥0.2mV。③13例患者均为右优势型冠状动脉分布。④12例患者可见来自右冠状动脉丰富的侧支循环,其左心室射血分数（EF）均在正常范围,另1例严重左心室功能障碍者（EF=0.26）侧支循环较差。11例行冠状动脉旁路移植术,术后心绞痛消失。结论：左主干完全闭塞临床上很少见,来自右冠状动脉丰富的侧支循环对维护左心室功能非常重要．但不能防止心绞痛发作。冠状动脉旁路移植术是最佳治疗方法。     

老年冠心病患者冠状动脉病变程度及其侧支循环对左室舒张功能的影响

目的　探讨老年冠心病患者冠状动脉病变程度及侧支循环对左室舒张功能 (LVDF)的影响。方法　 6 8例选择性冠状动脉造影主要分支狭窄≥ 75 %的老年冠心病患者作Leaman冠状动脉记分 ,左室造影测左室射血分数 (LVEF) ,左室壁运动作Cortina记分 ,经胸多谱勒超声血流仪测LVDF ,研究侧支循环对Leaman冠状动脉记分与LVEF、LVDF及Cortina记分间关系的影响。结果　全组Leaman冠状动脉记分与LVEF及Cortina左室壁运动记分无相关 ,与LVDF相关。有侧支循环建立两亚组LVDF差异无显著性意义 ,无侧支循环建立两亚组LVDF差异有显著性意义。结论　老年冠心病患者冠状动脉病变程度与LVDF有关 ,侧支循环的建立对老年冠心病患者的LVDF有保护作用。     

Severity of residual stenosis of infarct-related lesion and left ventricular function after single-vessel anterior wall myocardial infarction: implication of ST-segment elevation in lead aVL of the admission electrocardiograms

BACKGROUND: The relationship between the severity of chronic-phase stenosis of infarct-related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated. HYPOTHESIS: This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI. METHODS: One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with < or =75% stenosis (Group L). Patients with ST elevation > or =0.1 mV in the aVL lead on their admission ECG were included in the ST-elevation group, and those with ST elevation <0.1 mV were included in the non-ST-elevation group. RESULTS: The LVEF was greater in the non-ST-elevation group than in the ST-elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST-elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST-elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis > or =90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024). CONCLUSION: Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.     

Aortic pulse pressure is associated with the localization of coronary artery disease based on coronary flow lateralization

BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (CAD). Besides, the left coronary artery (LCA) has a predominantly diastolic flow while the right coronary artery (RCA) receives systolic and diastolic flow. Thus, we hypothesized that increased systolic-diastolic pressure difference had a greater atherogenic effect on the RCA than on the LCA.MethodsA random sample of 433 CAD patients (145 females, 288 males, mean age 65.0 ± 11.1 years) undergoing coronary angiography at Staten Island University Hospital between January 2005 and May 2008 was studied. Coronary lesion was defined as a ≥50% luminal stenosis. Patients were divided into three groups, with isolated LCA lesions (n = 154), isolated RCA lesions (n = 36) or mixed LCA and RCA lesions (n = 243).ResultsAPP differed significantly between groups, being highest when the RCA alone was affected (67.6 ± 20.3 mm Hg for LCA vs. 78.8 ± 22.0 for RCA vs. 72.7 ± 22.6 for mixed, P = 0.008 for analysis of variance (ANOVA)). Age and gender were not associated with CAD location. Heart rate was associated with CAD location, lowest in RCA group, and negatively correlated with APP. However, left ventricular ejection fraction (LVEF) was lower in the mixed CAD group and positively correlated with APP. The association between APP and right-sided CAD persisted in multivariate logistic regression adjusting for confounders, including heart rate, LVEF and medication use. A similar but less significant pattern was seen with brachial arterial pressures.ConclusionsAortic pulse pressure may affect CAD along with coronary flow phasic patterns.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.87.     

冠状动脉病变程度对左室功能的影响

目的　探讨冠心病患者冠状动脉病变程度与左室功能的关系。方法　 30 6例选择性冠状动脉造影 ,193例冠状动脉造影证实冠心病患者按病变程度、范围及Gensini积分分组 ,测定左室射血分数、短轴缩短分数、舒张早期充盈峰及舒张晚期充盈峰的最大峰值速度 ,并计算E/A比值。结果　冠状动脉轻度、中度病变、单支病变及Gensini积分小于 2 0分时 ,左室收缩功能改变不明显 (P >0 .0 5 ) ,舒张功能出现减退 (P <0 .0 5或P<0 .0 1)。收缩功能减退与受累血管数量、病变程度重及Gensini积分高有明显相关性。结论　冠心病患者左室舒张功能减退常先于收缩功能减退 ,舒张功能的异常是冠心病心功能受累早期改变的敏感指标     

左心导管与超声心动图检查对比评价冠状动脉病变对左心室舒张功能的影响

目的探讨冠心病患者冠状动脉病变程度对左心室舒张功能的影响。方法应用心导管及超声心动图检查,对75例经选择性冠状动脉造影确诊的冠心病患者进行了研究。根据冠状动脉造影结果 ,将冠心病患者按病变狭窄所累及的动脉支数分为4组:轻度狭窄组、单支病变组、双支病变组及三支病变组。应用导管法测定主动脉内的收缩压、舒张压、心率、左心室舒张末期压(LVEDP),收缩期及舒张期左室压力最大变化率(dp/dtmax,dp/dtmin)及等容舒张期压力衰减时间常数。比较不同的冠状动脉狭窄程度与心室舒张功能的关系。应用心导管法与超声心动图检查分析左心房内径(LAD)、左心室舒张末期容积(EDV)、收缩末期容积(ESV)、舒张期前1/3充盈量(1/3V)及舒张早期充盈分数(1/3FF),并计算左心室射血分数。应用超声应变率显像分别测量左心室各壁不同节段收缩期、快速充盈期及舒张晚期的峰值应变率,对各峰值应变率与导管法所测的相应指标进行相关性分析。结果常规超声心动图指标比较,在不同冠状动脉狭窄病变组,仅LAD在三支病变组〔(38.74±4.57)mm〕较轻度冠脉病变组〔(33.87±3.80)mm〕及单支血管病变组〔(33.77±3.94)mm〕显著增加。左心导管测定的LVEDP、dp/dtmax、dp/dtmin、EDV、ESV各组比较均无显著的统计学差异。而轻度冠脉病变组的等容舒张期压力衰减时间常数〔(30.31±6.50)ms〕低于其他各组。舒张早期充盈的1/3V及1/3FF在冠状动脉显著狭窄组低于轻度冠脉病变组。结论不同程度的冠状动脉病变对心室的舒张功能具有一定的影响,而且随着病变程度的加重影响增大。超声应变率显像技术可以准确判断冠心病患者的心室舒张功能。     

Predictors of improvement in left ventricular function after initially successful angioplasty of unprotected left main coronary artery stenoses

BACKGROUND: Percutaneous coronary intervention (PCI) has been increasingly applied to unprotected left main coronary artery (LMCA) lesions, with varied procedural success and clinical outcomes. However, the effect of PCI on left ventricular performance is still unclear, and there are no clinical studies assessing factors that influence left ventricular ejection fraction (LVEF) in these cases. METHODS: Between April 1986 and August 2002, de novo PCI was performed for unprotected LMCA stenoses in 199 patients. Close clinical and angiographic follow-up were conducted after the procedure. RESULTS: One hundred eighty patients survived over six months and analysis of paired left ventriculography was possible in 175 patients. Improvement in LVEF was observed in the entire population (52.9?±?15.7% to 56.1?±?14.3%, p?= 0.048). The LVEF change was 6.7?± 9.5% (p?&lt;?0.01) in group with baseline LVEF?≤??50% and 0.7?±?6.7 % (p?=?NS) in group with LVEF?&gt;?50%. There was significant intergroup difference (p?&lt;?0.001). Patients with baseline diameter stenosis ≥60% had an improvement of 5.3?±?8.3% (p?&lt;?0.05) whereas those with stenosis?&lt;?60% had no improvement (2.0?±?8.4%, p?=?NS). CK-MB elevation ≥3 times normal after PCI had a significant inverse association with improvement in LVEF (p?&lt;?0.05). Multivariate analysis revealed baseline LVEF ≤?50% was the only independent predictor of improvement in LVEF (standard estimate?=?3.509, 95% CI: 2.164-4.854, p?&lt;?0.001). CONCLUSIONS: Successful PCI procedure is associated with significant improvement in LVEF, especially in patients with depressed left ventricular function. (Int J Cardiovasc Intervent 2004; 6: 119-127)