冠状动脉CT血管成像对急性冠脉综合征患者斑块性质的诊断价值

目的探讨冠状动脉CT血管成像(CTA)对急性冠脉综合征(ACS)患者斑块性质的诊断价值。方法选取本院100例ACS患者为研究组,同期选取50例稳定型心绞痛患者为对照组,均实行CTA诊断。以冠状动脉血管造影检查结果作为金标准,评估CTA对本组ACS患者斑块性质的诊断准确度、特异度、敏感度。结果 CTA对本组ACS患者斑块性质的诊断准确度是96. 00%(96/100)、特异度是90. 00%(27/30)、敏感度是98. 57%(69/70);研究组非钙化斑块负荷、阻力指数(RI)均显著高于对照组,而斑块最小密度值显著低于对照组(P 0. 05)。结论 CTA对ACS患者斑块性质的诊断准确度、特异度、敏感度均较高,可准确鉴别ACS患者和稳定型心绞痛患者斑块负荷。     

冠脉狭窄患者的冠状动脉CT血管成像及斑块特征分析

目的:分析冠脉狭窄患者的冠状动脉CT血管成像及斑块特征。方法:选取2020年3月至2022年11月于本院就诊的冠脉缺血性狭窄患者68例,均接受数字减影血管造影(DSA)和CT血管成像检查,以DSA为临床诊断的“金标准”,比较两种检测方式的狭窄程度(轻度狭窄、中度狭窄、重度狭窄、闭塞),比较两种检测方式的检测参数(最小管腔直径、平均血管直径、最小管腔面积),比较两种检测方式的斑块特征(斑块长度、斑块负荷、斑块体积),评价CT血管成像诊断不同的冠脉狭窄程度的诊断价值(敏感性、特异性、准确率、阳性预测值、阴性预测值)。结果:CT血管成像诊断轻度狭窄22例,诊断中度狭窄23例,诊断重度狭窄22例,诊断闭塞1例,与DSA结果符合率为88.27%(60/68),Kappa指数为0.827,一致性较好(95%CI:0.811-1.113,χ²=189.722,P<0.001),两种诊断方式检测的最小管腔直径、平均血管直径、最小管腔面积、斑块长度、斑块负荷以及斑块体积均无显著差异(P>0.05),CT血管成像诊断轻度狭窄的敏感性可达91.30%,特异性为91.78%;...     

急性冠状动脉综合征与稳定型心绞痛患者冠状动脉病变的血管内超声比较研究

目的　探讨急性冠状动脉综合征与稳定型心绞痛患者的冠状动脉 (冠脉 )病变血管内超声特征。方法　 5 2例急性冠脉综合征患者与 79例稳定型心绞痛患者进行冠脉造影及血管内超声检查 ,根据超声检查结果 ,冠脉病变分为钙化斑块、硬斑块及软斑块。钙化斑块为斑块的回声比血管壁外膜回声强并伴有声影 ,其范围大于 90° ;硬斑块为斑块的回声与血管壁外膜回声大致相同 ,但后方无声影 ;软斑块为斑块的回声比血管壁外膜回声弱。不稳定斑块为纤维帽较薄、有脂质池的斑块或并有斑块破裂。稳定型斑块为钙化斑块及硬斑块。结果　稳定型心绞痛的冠脉病变特点以稳定型斑块为主 ,急性冠脉综合征冠脉病变特点以不稳定型斑块为主。 61.5 %急性冠脉综合征及 3 8.0 %稳定型心绞痛患者为软斑块 ( P <0 .0 1) ,2 8.9%急性冠脉综合征及 6.3 %稳定型心绞痛患者有脂质池 (P <0 .0 1) ,并且急性冠脉综合征患者冠脉斑块多伴有斑块破裂。结论　急性冠脉综合征及稳定型心绞痛的冠脉病变各有自己的特征 ,血管内超声对其有一定的诊断价值。     

双源CT冠状动脉血管成像对冠状动脉狭窄的诊断价值分析

目的:探讨应用双源CT冠状动脉血管成像(DSCT-CA)的检查方式对诊断冠状动脉狭窄的价值.方法:选取2019年1月—2020年5月期间我院65例疑似冠状动脉狭窄的患者,均接受冠脉造影(CAG)与DSCT-CA检查,以CAG检查为金标准,评价DSCT-CA对狭窄情况的诊断价值,并且以冠状动脉狭窄50％为界限,分析DSC...     

冠状动脉CT血管造影在冠心病患者斑块定量评估及预后评估中的应用价值

目的研究冠状动脉CT血管造影(CTA)在冠心病患者斑块定量及预后评估中的应用价值。方法收集本院接诊的60例临床疑似冠状动脉病变患者的临床资料。以CAG结果为参照,评价CTA管腔狭窄程度诊断的准确性;以冠状动脉造影(CAG)为金标准,评价CTA的诊断效能。结果冠状动脉CTA检测所得的轻中重度患者的病理参数与CGA检查结果相比,差异无统计学意义(P 0. 05)。CTA在诊断轻中重度狭窄的灵敏度分别为73. 69%、80. 42%、87. 77%,特异性为95. 63%、96. 82%、97. 14%。心肌缺血组钙化积分、斑块负荷、狭窄程度以及重建指数均显著优于无心肌缺血组(P 0. 05)。心肌缺血组钙斑块体积与无心肌缺血组差异无统计学意义(P 0. 05)。结论冠状动脉CTA在冠心病患者斑块定量评估及预后评估中的有较高的应用价值。     

慢性肾脏病冠状动脉钙化发生率及预后评估

目的探讨慢性肾脏病（CKD）冠状动脉钙化发生率及其在预后评估中的应用。方法测定136例CKD患者及50例同期健康体检者血钙（Ca）、血磷（P）水平,并采用多层螺旋CT（MSCT）检测所有观察对象冠状动脉钙化积分情况。比较不同组间患者的冠状动脉钙化及主要心脏不良事件（MACE）发生情况。结果与对照组比较,三组不同CKD分期患者的冠状动脉钙化率、重度钙化率、血磷及钙磷乘积均明显升高（P〈0．05）;且随着CKD病情程度的增加,患者冠状动脉钙化率、重度钙化率、钙磷乘积均依次增加（P〈0．05）;随着透析治疗时间的延长,冠状动脉钙化率、重度钙化率均呈上升趋势（P〈0．05）;随访1年,钙化组MACE发生率为16．9％,显著高于非钙化组为5．6％（P〈0．05）。结论CKD患者冠状动脉钙化发生率较高,尤其是长期维持性透析患者,且冠状动脉钙化程度与CKD患者的预后有关。     

128层螺旋CT冠状动脉CT血管成像(CTA)检查诊断冠状动脉斑块及狭窄的意义分析

目的:分析128层螺旋CT冠状动脉CT血管成像(CTA)检查诊断冠状动脉斑块及狭窄的意义。方法:选取我院2018年1月-2019年1月收治的150例疑似冠状动脉斑块及狭窄患者,借助128层螺旋CT冠状动脉CT血管成像(CTA)技术进行检查和诊断,设为观察组,以患者后续治疗资料为金标准,分析冠状动脉斑块及狭窄的检出率和诊断正确率。结果:观察组冠状动脉斑块及狭窄检出率为96.67%(145/150),较金标准差异无统计学意义(P>0.05,χ^2=0.215),观察组混合斑、软斑、硬斑检出42例、49例、52例,正确率为98.62%(143/145),较金标准差异无统计学意义(P>0.05,χ^2=0.193)。结论:128层螺旋CT冠状动脉CT血管成像(CTA)技术可敏锐完成冠状动脉斑块及狭窄检查、诊断,检出率和诊断正确率均较高。     

基于冠状动脉CT血管成像的冠状动脉斑块风险分层的研究进展

<正>冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)是危害人类健康的主要疾病之一。动脉粥样硬化斑块在CAD相关患者的死亡中起着重要作用,斑块的破裂、糜烂及血栓形成容易导致主要心血管不良事件(major adverse cardiovascular event,MACE)的发生,在急性冠状动脉综合征(acute coronary syndrome,ACS)的发生和发展中起着至关重要的作用^[1]。同时血管壁的炎症也可以促进管壁斑块的进展及破裂,从而导致ACS的发生^[2]。因此,冠状动脉粥样硬化斑块的精准评估对于CAD的早期预防和干预具有重要的临床意义。     

冠状动脉重构对心绞痛患者介入治疗预后影响的研究

目的　研究不同血管重构类型对单纯球囊扩张的影响。方法　采用冠状动脉内超声对 76例心绞痛患者 (不稳定型 3 7例 ,稳定型 3 9例 )在球囊扩张前、扩张后即刻及术后 3个月时连续观察。对发生再狭窄的患者进行切割球囊成形术和血管内放射治疗。结果　 76例患者中具有典型血管正向重构(VPR)的患者 3 7例 ,非正向重构 (NPR)的患者 3 9例 ,两组年龄及性别等参数之间的差异无显著性意义( P >0 .0 5 )。VPR患者的重构指数 (PR) [1.40± 0 .13 )mm2 ]大于NPR组 [( 0 .79± 0 .11)mm2 ] ;VPR的总发生率为 49% ,这一部分患者中冠状动脉内超声下不稳定斑块的检出率为 70 % ( 2 6/ 3 7) ,后者中脂肪核的检出率为 46% ( 12 / 2 6) ,尤其以近 2 4h内具有静息心绞痛 ( 14例 )的患者多见 ( 9/ 14 ,64 % ) ;VPR组术后 3个月时血管外弹力膜面积增加值 [( -0 .2 5± 1.13 )mm2 ]明显小于NPR组 [( 0 .40± 1.2 3 )mm2 ] ,而血管腔截面积丢失值 [( -1.5 7± 0 .14 )mm2 ]明显大于NPR组 [( -0 .88± 0 .12 )mm2 ] ,再狭窄率高于NPR组。两组再狭窄病变在血管内照射时痉挛的发生率较高 ,且以VPR组最明显 ( 70 % )。再狭窄主要见于病变的近端边缘处。结论　冠状动脉超声下VPR组轻中度狭窄患者斑块多为不稳定型 ,VPR组单纯球囊扩     

64层螺旋CT冠状动脉成像评价可疑冠心病患者预后

目的 探讨64层螺旋CT冠状动脉成像(64-CTCA)判断可疑冠心病患者预后的价值。 方法 收集1092例接受64-CTCA检查的患者,分析其CTA结果,评估影响患者预后的危险因素。随访终点事件包括心源性死亡、心肌梗死、不稳定型心绞痛以及住院接受经皮冠状动脉介入治疗(PCI)、冠状动脉搭桥术(CABG)、溶栓治疗。 结果 39例患者失访,14例患者因图像质量较差、不能用于评价而被排除。平均随访(22.74±7.27)个月。764例检查正常者中,1例死亡,4例发生心脏事件;174例冠状动脉狭窄<50%患者中,7例发生心脏事件;101例冠状动脉狭窄≥50%患者中,4例死亡,62例发生心脏事件;三者年事件发生率分别为0.65%,4.02%和65.35%。冠状动脉狭窄程度、狭窄位置及斑块类型均为影响预后的危险因素(HR=14.586,95%CI=8.751~24.313;HR=2.624, 95%CI=2.275~3.027;HR=1.648,95%CI= 1.204~2.257;P均<0.001)。 结论 64-CTCA能够为可疑冠心病患者提供预后参考信息,64-CTCA检查正常者预后较好。     

地尔硫(艹卓)治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的 探讨地尔硫[艹卓]治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法 对106例围手术期心绞痛患者静脉应用地尔硫[艹卓]，观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化，判断疗效。结果 82例（77．4％）用药期间未再发作，另有24例（22．6％）仍有心绞痛发作，但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降（均P〈0．05）。无一例因严重不良反应而停药。结论 静脉应用地尔硫[艹卓]治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。     

地尔硫治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的探讨地尔硫治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法对106例围手术期心绞痛患者静脉应用地尔硫,观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化,判断疗效。结果82例(77.4%)用药期间未再发作,另有24例(22.6%)仍有心绞痛发作,但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降(均P<0.05)。无一例因严重不良反应而停药。结论静脉应用地尔硫卓治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。     

Prognostic value of coronary artery calcium score and coronary CT angiography in patients with intermediate risk of coronary artery disease

The aim of this study was to compare the prognostic value of coronary calcium scoring and coronary computed tomography (CT) angiography in assessing the cardiac risk and its temporal characteristics in patients at intermediate pre-test likelihood of coronary artery disease (CAD). Cardiac CT was performed in 326 patients at intermediate (15–85%) pre-test likelihood of CAD to evaluate calcium score and presence and severity of the disease. Patients were followed-up for the occurrence of major cardiac events (cardiac death, myocardial infarction, and unstable angina requiring revascularization). During follow-up (26 ± 12 months) 34 events occurred. Calcium score, extent of CAD, and plaque extent and distribution were higher (all P < 0.001) in patients with events than in those without. No patients with calcium score of 0 had events at follow-up. Calcium score (P < 0.001), number of segments with non-calcified or mixed plaque (P < 0.05), and segments-at-risk-score (P < 0.005) were independent predictors of events. Cardiac risk was greater for all time intervals and accelerated more over time with worsening of calcium score. In presence of coronary calcium, significant CAD further increased the probability of failure for all time intervals. Therefore, patients at intermediate CAD risk without coronary calcium do not need further evaluation with longer and higher-radiation-dose protocols, while in the presence of coronary calcium CT angiography is useful to further stratify patients.     

Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography

Aims

To evaluate whether the corrected thrombolysis in myocardial infarction frame count (CTFC), an index of resting coronary blood flow, is associated with the risk of major adverse cardiovascular events (MACE) in patients with suspected stable angina pectoris (SAP) but no obstructive coronary artery disease (CAD) at angiography.

Methods and results

In this case–control study, CTFC at baseline in 127 patients (50 % women) who subsequently experienced a myocardial infarction, non-hemorrhagic stroke or cardiovascular death during 2001–2011 was compared with CTFC in 254 event-free matched controls. All patients had suspected SAP but no obstructive (≥50 % stenosis) CAD at baseline angiography. Mean CTFC in controls was 23.4 (95 % confidence interval 20.9–25.9) frames and mean CTFC in cases did not differ significantly with a difference of ?1.0 (?3.1 to 1.1) frames (P = 0.35) and no sex-specific interaction (P = 0.18). In a conditional logistic regression model, we found no dose–response relationship between CTFC and the risk of MACE, i.e., compared to the risk in the lowest CTFC quintile, the odds ratios for MACE were 1.3 (0.7–2.6), 0.7 (0.3–1.3), 0.7 (0.4–1.5) and 1.0 (0.5–2.1) in the second, third, fourth and fifth CTFC quintiles, respectively. Adjustment for cardiac risk factors including diabetes, active smoking, body mass index, and use of lipid-lowering and antihypertensive medication did not significantly change the results.

Conclusions

In patients with SAP symptoms without obstructive CAD at angiography, CTFC is not associated with the risk of MACE.     

Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48 - 72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.     

Deriving coronary artery calcium scores from CT coronary angiography: a proposed algorithm for evaluating stable chest pain

We validate a method of calcium scoring on CT coronary angiography (CTCA) and propose an algorithm for the assessment of patients with stable chest pain. 503 consecutive patients undergoing coronary artery calcium score (CACS) and CTCA were included. A 0.1 cm² region of interest was used to determine the mean contrast density on CTCA images either in the left main stem (LM) or right coronary artery. Axial 3 mm CTCA images were scored for calcium using conventional software with a modified threshold: mean LM contrast density (HU) + 2SD. A conversion factor (CF) for predicting CACS from raw CTCA scores (rCTCAS) was determined using a multivariable regression model adjusted for model over-optimism (1,000 bootstrap samples). Accuracy of this method was determined using weighted kappa for NICE recommended CACS groupings (0, 1–400, >400) and Bland–Altman analysis for absolute score. With the CF applied: CACS = (1.183 × rCTCAS) + (0.002 × rCTCAS × threshold), there was excellent agreement between methods for absolute score (mean difference 5.44 [95 % limits of agreement ?207.0 to 217.8]). The method discriminated between high (>400) and low risk (<400) calcium scores with a sensitivity and specificity of 85 and 99 %, and a PPV and NPV of 92 and 98 %, respectively, and led to a significant reduction in radiation exposure (6.9 [5.1–10.2] vs. 5.2 [6.3–8.7] mSv; p < 0.0001). Our proposed method allows a comprehensive assessment of coronary artery pathology through the use of an individualised, semi-automated approach. If incorporated into stable chest pain guidelines the need for further functional testing or invasive angiography could be determined from CTCA alone, supporting a change to the current guidelines.     

冠状动脉钙化对320排容积CT冠状动脉血管成像的影响

目的 探讨320排容积CT（DVCT）冠状动脉钙化（CAC）对冠状动脉图像质量及诊断准确性的影响.方法 回顾性分析济南军区总医院2011年12月至2012年3月行DVCT扫描及常规冠状动脉造影检查（ICA）的患者60例,计算每例患者总的钙化积分（CS）及四大分支的CS,以图像质量4级（优）至1级（差）对每支血管图像质量进行评价,分析患者每支血管的CS与图像质量的相关性.对患者及每支冠状动脉血管的明显狭窄（狭窄≥50%）进行判断,以ICA为金标准,作出该60例患者冠状动脉狭窄≥50%的ROC曲线,获得患者总CS的最佳截断点.以最佳截断点为界,将60例患者分为高CS组和低CS组,以每支冠状动脉为研究对象,不可评价的血管作为假阳性处理,对高、低CS组的诊断准确性进行比较,同时比较两组DVCT冠状动脉成像结果 与ICA结果 的差异性,分析CS对冠心病诊断准确性的影响.结果 冠状动脉钙化积分（CACS）与图像质量呈负相关,CS越高,图像质量越差.该60例患者的冠状动脉狭窄≥50%的ROC曲线的CS最佳截断点为381.5分（灵敏度为81.5%,特异度为78.8%）.高CS组的诊断准确性低于低CS组（P=0.009）,而两组DVCT结果 与ICA结果 的差异均无统计学意义（P=0.134,0.607）.结论 CAC仍是320排容积CT图像质量及诊断准确性下降的重要原因.