EBT检测对冠脉病变危险因素的价值

目的:应用电子束CT（EBT）心脏扫描,了解受检者冠脉病变的发生情况,分析冠脉病变发生的危险因素。方法:107例受试者行心脏EBT扫描,计算冠脉钙化发生率、钙化积分、冠脉狭窄支数和软斑数,同时收集血糖、糖化血红蛋白（HbA1 c）、血脂等相关临床信息,进行冠脉病变危险因素的分析。结果:糖耐量受损组、糖尿病组、高血压病组冠脉钙化发生率较正常对照组显著升高（93%,96%,90%vs56%,P<0.01）。钙化积分有明显升高趋势,但统计学检验无显著性差异。冠脉狭窄支数和软斑数显著增加（2.2±2.0,3.0±1.9,2.2±1.1vs0.5±1.3,P<0.05和2.5±2.4,2.9±1.8,2.3±1.8vs0.5±1.2,P<0.05）。Logistic回归分析,发现糖尿病、高血压两因素对冠脉病变的影响有统计学意义（P<0.05）,OR值分别为7.514（95%可信区间0.88563.778）、6.653（95%可信区间1.34432.928）。结论:糖尿病、高血压病患者发生冠脉病变有高度的危险性。     

冠心病合并糖耐量异常患者冠脉病变特点及其危险因素研究

目的　探讨糖尿病前期冠脉病变的特点及危险因素。方法　 193例冠心病患者根据 1997年美国糖尿病学会诊断标准分为单纯冠心病组 12 2例 ,冠心病合并糖耐量异常组 39例 ,冠心病合并糖尿病组 32例 ,所有研究对象均行冠脉造影和口服 75 g葡萄糖耐量实验 ,检测血糖、胰岛素、血脂、血压、BUN、Cr。冠脉病变程度应用 CAG分析 ,冠脉狭窄程度根据 AHA分类标准评价 ,冠脉病变的危险因素应用多元逐步直线回归分析。结果　 (1)冠心病合并糖耐量异常组多支冠脉病变的发生率明显高于单纯冠心病组 (6 6 .5 % vs 35 .1% ,P <0 .0 5 )。冠脉狭窄程度 (8.9± 3.6 vs 6 .5± 3.9,P<0 .0 5 )及钙化的程度明显高于单纯冠心病组 (6 .6± 6 .1vs 3.9± 4 .1,P <0 .0 5 ) ,冠脉远端的病变发生率明显高于单纯冠心病组 (40 .8% vs 13.1% ,P <0 .0 5 )。 (2 )冠心病合并糖耐量异常组与冠心病合并糖尿病组相比 ,多支冠脉病变的发生率、冠脉粥样硬化及钙化的程度及冠脉远端的病变发生率差异性不明显。(3)血脂、胰岛素、血压、肥胖与冠脉粥样硬化程度有明显相关性。结论　与糖尿病患者相似 ,糖耐量异常患者多支冠脉病变的发生率明显升高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率较高 ,程度严重 ,血脂、胰岛素、血压、肥胖为发生冠脉     

冠心病患者冠状动脉病变与糖耐量变化的关系

目的　探讨冠心病患者糖耐量变化与冠脉病变之间的关系。方法　 193例冠心病患者根据WHO(1985 )和美国糖尿病学会 (1997)糖尿病诊断标准分为单纯冠心病〔糖耐量正常 (NGT)〕组12 2例 ,冠心病合并糖耐量异常 (IGT)组 39例 ,冠心病合并 2型糖尿病 (DM)组 32例 ,所有研究对象均行冠脉造影 (CAG)和口服 75克葡萄糖耐量试验 ,检测血糖、胰岛素、血脂。冠脉病变程度应用CAG分析 ,冠脉狭窄程度根据美国心脏学会分类标准评价 ,冠脉病变的危险因素应用多元逐步直线回归分析。结果　 (1)冠心病合并IGT组多支冠脉病变的发生率明显高于单纯冠心病组 (6 6 .5 %vs 35 .1% ,P <0 .0 5 ) ,冠脉狭窄程度 (8.9± 3.6vs 6 .5± 3.9,P <0 .0 5 )及钙化的程度 (6 .3± 3.6vs 3.9± 4 .1,P <0 .0 5 )明显高于单纯冠心病组 ,冠脉远端的病变发生率明显高于单纯冠心病组 (40 .8%vs 13.1% ,P<0 .0 5 )。 (2 )冠心病合并IGT组与冠心病合并DM组相比 ,多支冠脉病变的发生率、冠脉粥样硬化及钙化的程度及冠脉远端的病变发生率差异无显著性。 (3)血脂、胰岛素、血压与冠脉粥样硬化程度有明显相关性。结论　与冠心病合并DM患者相似 ,冠心病合并IGT患者多支冠脉病变的发生率高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率较高 ,程度严重。血     

电子束CT对判断2型糖尿病患者冠状动脉病变的意义

目的应用电子束CT(EBT)心脏扫描,评价EBT在判断2型糖尿病冠状动脉病变中的应用价值。方法94例受试者行心脏EBT扫描,计算冠状动脉钙化(CAC)率、钙化积分、冠状动脉狭窄支数和软斑数,同时收集血糖、糖化血红蛋白(HbA1c)、血脂等相关临床信息。结果血糖异常组(包括糖耐量减低者、糖尿病者)、冠心病组CAC发生率较血糖正常组明显升高(93.33%,96.43%,90.91%∶56.00%,P<0.01),钙化积分有明显升高趋势,但差异无统计学意义,冠状动脉狭窄支数和软斑数有明显增加(2.200±2.024,2.964±1.915,2.273±1.679∶0.520±1.295,P<0.01和2.467±2.360,2.893±1.771,2.372±1.819∶0.511±1.197,P<0.01)。Pearson相关分析,发现钙化积分与年龄有明显相关(r=0.423,P<0.01),冠状动脉狭窄数与年龄(r=0.215,P<0.05)、餐后血糖(r=0.224,P<0.05)、胆固醇(r=0.275,P<0.01)密切相关。结论2型糖尿病患者有明显的冠状动脉病变,EBT钙化需与EBT增强扫描、三维血管重建结合,来共同判断糖尿病患者的冠状动脉病变状态。     

尿微量白蛋白与冠状动脉病变的关系

目的 探讨尿微量白蛋白(MA)与冠状动脉(冠脉)病变的关系.方法 169例冠心病患者分为非糖尿病组99例,糖尿病组70例,均行冠脉造影(CAG),检测尿白蛋白/肌酐、尿素氮、肌酐、空腹血糖、2 h血糖、血脂等.冠脉病变程度通过病变血管数和冠脉病变积分两个指标表示.结果 (1)在非糖尿病组中,MA阳性组的冠脉病变积分(7.90±3.07比5.77±2.87,P＜0.05)和冠脉病变血管数(1.84±0.17比1.38±0.93,P＜0.05)明显高于MA阴性组.(2)在糖尿病组中,MA阳性组的冠脉病变积分(8.15±3.40比5.86±3.06,P＜0.05)和冠脉病变血管数(2.03±0.91比1.51±0.76,P＜0.05)明显高于MA阴性组.多元逐步回归分析示:男性、MA、LDL-C、射血分数是冠脉病变积分的独立预测因子.结论 筛查MA有助于发现冠脉病变严重的患者及疾病预后差的患者.     

原发性高血压患者尿微量白蛋白和冠脉病变程度

目的 研究原发性高血压患者尿微量白蛋白(MAU)和冠状动脉狭窄性病变程度的关系.方法 从资料完整的原发性高血压患者中,据24 h尿白蛋白定量结果 分为MAU阳性组(74例),从MAU阴性患者中选择和阳性组血压匹配的74例作为阴性对照组进行分析,比较两组患者冠脉造影显示的冠脉狭窄支数和冠脉Gensini积分.结果 冠脉造影示原发性高血压患者冠心病发病率在MAU阳性组(54/74,73%)显著高于阴性组(38/74,52%),且双支病变发病率较高(24% vs 12%,P＜0.01),三支病变发病率也较高(14% vs 3%,P＜0.01);在MAU阳性组冠脉Gensini积分高于阴性组(36.8±7.5 vs 24.1±5.8,P＜0.05).结论 在原发性高血压患者中,MAU阳性者比阴性者有更高的冠心病发病率和更加严重的冠状动脉狭窄性病变.     

空腹血糖受损冠心病患者冠脉病变特点与血高敏C反应蛋白的关系

目的探讨空腹血糖受损(IFG)冠心病患者冠状动脉病变特点,与血高敏C反应蛋白(hs-CRP)水平的关系及意义。方法对经冠脉造影确诊的冠心病患者行口服葡萄糖耐量试验(OGTT),据结果用1999年WHO标准选取冠心病合并IFG组69例,另设糖代谢正常冠心病组64例(对照组)。测定两组体重、血压、血脂、血肌酐、血hs-CRP,记录其年龄、冠心病危险因素(性别、高血压、高胆固醇血症、吸烟)和冠状动脉造影结果并计算冠脉病变积分。结果血hs-CRP水平、冠脉病变积分在IFG组较对照组明显升高(P<0.01);相关分析显示,在冠心病合并IFG患者中,空腹血糖水平、血hs-CRP水平与冠脉病变Gensini评分呈正相关(r分别=0.2685,0.5232均P<0.05)。结论冠心病合并IFG患者冠脉病变严重,多支冠脉病变发生率高,病变呈弥漫性狭窄。冠心病合并IFG患者存在炎症反应,血hs-CRP水平与冠脉狭窄程度相关。     

不同年龄患者空腹血糖与冠脉病变的相关性

目的:探讨不同年龄患者空腹血糖(FPG)与冠脉病变之间的相关性. 方法:回顾性分析拟诊冠心病行冠脉造影的患者580例,按FPG水平分为3组,对患者临床及冠脉造影资料进行分析. 结果:随着FPG增加,病变部位的比例、病变支数、狭窄程度、病变积分及支架数均增加.年龄＜60岁的患者,空腹血糖受损(IFG)组及糖尿病(DM)组的冠脉病变均重于正常空腹血糖(NFG)组;年龄60～74岁的患者,DM组的冠脉病变较NFG组严重;而年龄≥75岁的患者,FPG并不为冠心病的独立危险因素.结论:冠脉的病变程度随着FPG增加而增加;＜60岁的患者FPG＞5.6 mmol/L或60～74岁的患者FPG＞7.0 mmol/L,其冠脉的病变程度较同龄正常FPG组严重.     

快速多层螺旋电脑断层摄影检测老年高血压患者冠状动脉钙化及狭窄

目的 运用多排(16排)螺旋电脑断层摄影(MSCT)检测老年高血压患者冠状动脉钙化及狭窄情况,并探讨其与外周动脉粥样硬化及靶器官损伤的相关性.方法 选择老年病例64例,分为2组:老年高血压组50例,年龄(76.1±6.5)岁;正常血压组14例,年龄(73.4±6.8)岁.所有50例病例行MSCT冠脉平扫,由CT软件计算得到AJ130和Volume2个冠脉钙化积分值.高血压组中44例进行MSCT冠脉增强扫描.所有病例行两侧颈动脉和股动脉超声、心脏彩超、踝/肱指数(ABI)超声检查和清晨尿微量蛋白测定,并测量身高、体质量及计算体质量指数(BMI),空腹静脉血测定血糖(FPG)、血脂系列、高敏C反应蛋白(hsCRP),并计算胰岛素抵抗指数(HOMA-IR).结果 (1) 除hsCRP、SBP、DBP外,两组年龄、性别、BMI、血脂系列、FPG、HOMA-IR无显著性差异(P＞0.05).老年高血压组前降支(LAD)、左旋支(LCX)的钙化积分及冠脉钙化总积分显著高于对照组(P＜0.05);(2)MSCT冠脉增强造影显示,冠脉狭窄的老年高血压病例的冠脉钙化积分显著高于无冠脉狭窄的病例(P＜0.05).冠脉狭窄≥50%组的冠脉钙化积分虽较冠脉狭窄＜50%组有增高趋势,但无明显差别(P＞0.05);双支及以上显著狭窄的老年高血压病例的冠脉钙化积分高于单支显著狭窄病例和无冠脉病变病例(P＜0.05);(3)心脏彩超向心性肥厚组与离心性肥厚组的冠脉钙化积分显著高于正常构型组和向心性重构组(P＜0.05);老年高血压组中微量蛋白尿阳性组的冠脉钙化积分显著高于微量白蛋白尿阴性组(P＜0.05);老年高血压组冠脉钙化积分与颈动脉分叉IMT、股动脉IMT、颈动脉斑块积分、股动脉斑块积分及ABI显著相关(P＜0.05).结论 MSCT是评价老年高血压患者冠脉粥样硬化程度和进展的较好无创性方法,在老年人中有助于评估高血压靶器官损伤.     

冠心病与糖代谢异常的关系

目的:探讨冠心病与糖代谢异常的关系。方法:对本院心血管内科住院的512例冠心病患者进行糖耐量试验和冠脉造影检查,统计糖耐量异常患者比例,对比不同糖耐量患者之间的冠脉病变程度。结果:除已确诊为糖尿病的166例患者外,余下接受口服葡糖耐量试验(OGTT)的346例患者中,新发糖尿病74例(21.39%),糖调节异常152例(43.93%)。512例冠心病患者中,糖尿病患者240例,高达46.88%。空腹血糖(FPG)与OGTT试验结果对比,单纯检测FPG糖尿病漏诊率为43.2%,糖调节异常漏诊率为73.7%;与糖耐量正常和糖耐量异常组比较,糖尿病组冠脉病变3支及以上病变比例明显升高(20.83%比30.92%比58.75%),P0.05~0.01。结论:冠心病大多数合并有糖代谢异常,糖尿病组冠脉病变3支及以上病变比例明显高于糖耐量正常和糖耐量异常组;口服葡萄糖耐量试验能显著提高糖代谢异常的检出率。     

Case Report: A Rare Case of a Giant Right Coronary Artery Aneurysm

We report the case of a 34-year-old female patient with a giant thrombus-filled aneurysm of the right coronary artery presenting as a spherical cardiac mass on echocardiography. The cardiac mass was found to be an 8-cm right coronary artery aneurysm on cardiac magnetic resonance imaging, which also revealed a 3.5-cm proximal left coronary aneurysm and a very small aneurysm at the origin of the obtuse marginal coronary artery. Due to the extent and size of the right coronary aneurysm, a decision for surgical intervention was made. Resection of the right coronary artery aneurysm with vein graft replacement and a bypass to the left anterior descending followed by subsequent exclusion of the aneurysm was successfully performed.     

A Clinically Useful Coding System for Normal Coronary Artery Anatomy

Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50–70%, or greater than 70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.     

Spontaneous regression of post-percutaneous transluminal coronary angioplasty aneurysm

We report a case of a 67-year-old male with spontaneous regression of post-percutaneous transluminal coronary angioplasty (PTCA) aneurysm. This case substantiates the benign prognosis of post-PTCA aneurysms.     

Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the “normal” vessel

Seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a “normal” vessel. All patients had one or more episodes of rest angina and six had exertional angina as well. Four sustained previous myocardial infarction. During spontaneous angina, five patients had ST-segment elevation in the inferior electrocardiographic leads. One patient had ST-segment elevation in anterior leads. During angiography, spasm was demonstrated in the right coronary artery in three patients and in the left anterior descending coronary artery in one patient. This study emphasizes the interaction of fixed and vasospastic disease and has strong implications concerning the management of patients with ischemic heart disease.     

Coronary artery aneurysms

There is no consensus on the best management of coronary artery aneurysms (CAA) in adults. We describe two patients with CAA and review transcatheter approaches to exclude them from the circulation. © 2013 Wiley Periodicals, Inc.     

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.     

Anomalous right coronary artery arising from left mainstem

Various coronary artery anomalies occur in both symptomatic and asymptomatic individuals. We have described a unique case of an aberrant right coronary artery arising from the left mainstem, resulting in clinical myocardial infarction in the absence of coronary atherosclerosis. Though different anomalies of the right coronary artery have been described, we feel this case is unique in that the right coronary artery arises from the left mainstem, truly forming a single coronary artery.     

Anomalous origin of the right coronary artery from the left anterior descending: Angiographic diagnosis in a patient with coronary artery disease

The coronary angiographic findings of an individual whose right coronary artery originates from the proximal left anterior descending coronary artery are described.     

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.     

Coronary artery-left ventricular communications: A report of two cases and review of the literature

Two patients with chest pain had angiographically-demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo-dynamic effect of the shunt flow than often suspected angiographically.