踝臂指数对冠状动脉病变狭窄程度的预测价值

目的探讨踝臂指数(ABI)对冠状动脉病变严重程度的预测价值。方法对243例行冠状动脉造影的患者纳入研究,对所有患者进行测量ABI及常规化验检查,主要观察ABI与冠状动脉造影结果的相关性。结果按照冠状动脉病变严重程度分组冠状动脉病变程度间ABI有显著性差异(P0.05);冠状动脉造影多支病变组与冠造正常组、单支病变组、双支病变组ABI比较,有显著性差异(P0.05);回归分析提示ABI≤0.90是预测冠状动脉严重病变的可靠指标。结论ABI≤0.9对冠状动脉动脉病变的严重程度有预测价值;ABI与冠状动脉病变严重程度呈显著相关性,可作为对冠心病患者危险分层评估的一项可靠指标。     

踝臂指数对冠状动脉病变狭窄程度的预测价值

目的探讨踝臂指数（ABI）对冠状动脉病变严重程度的预测价值。方法对243例行冠状动脉造影的患者纳入研究,对所有患者进行测量ABI及常规化验检查,主要观察ABI与冠状动脉造影结果的相关性。结果按照冠状动脉病变严重程度分组冠状动脉病变程度间ABI有显著性差异（P〈0.05）;冠状动脉造影多支病变组与冠造正常组、单支病变组、双支病变组ABI比较,有显著性差异（P〈0.05）;回归分析提示ABI≤0.90是预测冠状动脉严重病变的可靠指标。结论ABI≤0.9对冠状动脉动脉病变的严重程度有预测价值;ABI与冠状动脉病变严重程度呈显著相关性,可作为对冠心病患者危险分层评估的一项可靠指标。     

踝臂指数对老年人冠状动脉狭窄程度的预测价值

目的观察老年患者踝臂指数(ABI)与冠状动脉狭窄程度的相关性,评价ABI对冠状动脉狭窄程度的预测价值。方法对118例连续入选冠状动脉造影患者进行ABI测量、病史采集及血液化验检查。结果ABI与Gensini评分呈显著负相关;冠状动脉三支或左主干病变患者ABI显著降低(P<0.001),而造影正常、单支病变或二支病变患者的ABI无显著性差异;评价ABI对三支或左主干病变预测价值的操作者工作特征曲线(ROC)下面积为0.75±0.045(95%CI=0.67~0.84,P<0.001);ABI≤0.9作为截断值预测三支或左主干病变具有相对高的特异度(89.1%)和敏感度(55.6%)。结论老年患者ABI与冠状动脉狭窄严重程度显著负相关,ABI≤0.90对预测冠状动脉三支和左主干病变具有较高的特异度和敏感度。     

踝臂指数对早发冠心病三支病变的预测价值

目的评价踝臂指数(ABI)对早发冠心病冠状动脉三支病变的预测价值。方法选取我院心脏科住院的早发冠心病患者194例,入院患者均已行ABI及冠状动脉造影检查。根据冠状动脉造影结果分为单支病变组(57例)、双支病变组(55例)、三支病变组(82例),并将单支病变组与双支病变组合并为非严重病变组。比较非严重病变组与三支病变组ABI异常率,并以多元logistic回归方法分析早发冠心病冠状动脉三支病变的独立危险因素。结果三支病变组ABI异常率明显高于非严重病变组,19.5%(16/82)vs 2.7%(3/112),差异有统计学意义(P<0.01);多元logistic回归分析提示,ABI≤0.9是早发冠心病冠状动脉三支病变的独立危险因素(OR=5.529,95%CI=1.333～22.930)。结论 ABI≤0.9对早发冠心病冠状动脉三支病变有一定的预测价值。     

踝臂指数与冠心病的相关性研究

目的 研究踝臂指数(ABI)与冠心病的相关性.方法 选择132例经冠状动脉造影的患者,采用日本Colin公司生产的VP1000全自动动脉硬化测定仪测定ABI,分析ABI与冠状动脉病变Gensini评分、病变支数的相关性.结果 冠心病组与非冠心病组比较,ABI差异有统计学意义(P<0.05),且ABI值无病变组高于单支病变组(P<0.05),单支病变组高于双支病变组(P<0.05)、双支病变组又高于3支病变组.用stepwise多元回归分析显示,入选患者的ABI是影响 Gensini评分独立因素,表明ABI是冠状动脉病变及其严重程度的预测因子.结论 踝臂指数与冠心病关系密切,有助于评价、预测冠状动脉病变严重程度.     

踝臂指数对冠心病的预测价值

目的:评价踝臂指数(ABI)对冠心病的预测价值.方法:对100例冠状动脉造影(CAG)患者行ABI测量、病史采集及常规化验检查,评价ABI对冠心病的预测价值.结果:冠心痛组与非冠心病组之间ABI有明显差异(P<0.05).多变量Logistic回归分析显示糖尿病史、LDL、TC、年龄、吸烟、ABI≤0.9是冠状动脉病变的预测因子.结论:ABI与冠状动脉病变关系密切,有助于预测冠状动脉病变,ABI降低是冠心病的危险因子.     

踝臂指数与冠状动脉粥样硬化的相关性

目的:探讨踝臂指数(ABI)和冠状动脉粥样硬化及其病变程度的相关性.方法:选择102例冠状动脉造影的惠者,依据冠脉造影的结果分为冠心病(CHD)组和对照组,CHD组根据冠脉病变的程度分为单支、双支、严重病变组.所有惠者在冠脉造影前应用全自动动脉硬化测定仪测定ABI.结果:CHD组ABI明显低于对照组(1.03±0.11 vs 1.11±0.10,P＜0.05).冠状动脉病变程度分析中ABI在严重病变组(1.01±0.13)和双支病变组(1.03±0.09)明显低于对照组(1.11±0.10),组间比较差异有统计学意义(P＜0.05).但是ABI在严重病变组、双支病变组和单支病变组(1.06±0.08)之间,单支病变组和对照组之间差异无显著性(P＞0.05).冠状动脉造影入选患者的Gensini评分与ABI呈负相关(r=-0.355 7,P＜0.001).在控制了吸烟、高血压病史、糖尿病史等多种动脉粥样硬化危险因素后,这种负相关性仍然存在(r=-0.324 8,P＜0.01).结论:ABI与冠状动脉粥样硬化密切相关,在一定程度上可以反映冠脉病变的严重程度.     

踝臂指数与冠状动脉病变程度的研究

[目的]探讨踝臂指数(ABI)与冠状动脉病变之间的关系.[方法]根据冠状动脉造影结果对151例患者进行分组,将各组患者的ABI进行对比研究,并将病变冠状动脉积分、冠状动脉病变积分与患者的ABI进行线性相关分析.[结果]正常组ABI与冠心病组、多支病变组、三支病变组、严重病变组比较均有显著差异(均P＜0.05).患者病变冠状动脉积分、冠状动脉病变积分均与ABI呈显著负相关(r值为-0.92,-0.91,均P＜0.05).[结论]踝臂指数有助于预测冠状动脉病变程度.     

踝臂指数与冠状动脉病变严重程度的相关性研究

目的评价踝臂指数(ABI)与冠状动脉病变严重程度的相关性。方法选择162例冠状动脉造影术或介入治疗的患者,采用全自动动脉硬化测定仪测定ABI,重点观察ABI与冠状动脉病变Gensini评分的相关性及对严重冠状动脉病变的预测价值。结果冠心病组与非冠心病组相比较ABI差异具有统计学意义(0.97±0.22 vs 1.09±0.11,P<0.001),比较无病变组、轻度病变组、严重病变组的SBP[(137±17),(147±17)和(159±21)]、PP[(57±12),(67±12)和(81±17)]、HDL-C[(1.28±0.21),(1.22±0.31)和(1.14±0.33)]、ABI值[(1.12±0.16),(1.01±0.18)和(0.85±0.21)],差异有统计学意义(P<0.05),观察SBP、PP值,严重病变组高于轻度病变组(P<0.05),轻度病变组高于无病变组(P<0.05)。观察ABI值则是无病变组高于轻度病变组(P<0.05),轻度病变组高于严重病变组(P<0.05)。冠状动脉入选患者的Gensini评分与ABI呈显著负相关(r=-0.522,P<0.001)。多变量logistic回归分析显示糖尿病史、HDL-C、SBP、ABI≤0.9是严重冠状动脉病变的预测因子。结论踝臂指数与冠状动脉病变程度关系密切,有助于预测冠状动脉病变严重程度。     

ABI对冠心病患者危险分层预测价值的研究

目的通过与冠状动脉造影结果的相关性分析,评价ABI指数对临床冠心病患者危险程度预测价值的意义。方法经冠状动脉造影明确冠脉狭窄程度的患者106例,采用Gemini积分系统,将各组患者冠状动脉病变程度进行评分。并对其进行ABI测量,分析ABI与冠状动脉病变严重程度的相关性。结果三支病变组ABI（0．81±0．18）与正常组ABI（1．07±0．16,P〈0．01）及单支病变组ABI（O．98±0．12,P〈0．05）之间差异有显著性,两支病变组ABI（0．87±0．20）明显低于正常组ABI（1．07±0．16）,差异有显著性,P〈0．05。患者ABI与Gemini评分呈显著负相关。结论ABI是一种无创、简单易行的检查方法,对冠心病患者的危险分层有较好的预测价值。     

Successful implantation of a coronary sinus lead after stenting of a coronary vein stenosis

Dislodgment of the coronary sinus lead was observed in a 79-year-old patient 8 months after implantation of a biventricular pacing system. A severe stenosis in the posterolateral branch, in which the lead was previously positioned, prohibited reinsertion of the lead. Because no other branches with adequate anatomy for lead insertion were available in the targeted area, the stenosis was dilated and stented. Subsequently, the left ventricular lead could be reimplanted in the same vessel.     

Echocardiographic Diagnosis of a Right Coronary Artery-Coronary Sinus Fistula

In this case report, we describe a 67-year-old woman with right coronary artery-coronary sinus fistula. This woman had complaints of chest pain. Ischemic ECG changes and a ventricular tachycardia were detected on her electrocardiogram. Transthoracic echocardiography showed a large right coronary artery and a dilated coronary sinus. Drainage of the coronary artery to the coronary sinus was detected by colour flow mapping during transesophageal echocardiographic examination, and a 94 mmHg peak gradient was recorded by continuous wave Doppler at the drainage site. These findings were confirmed by cardiac catheterization. Transthoracic and transesophageal echocardiography can provide definitive confirmation of the right coronary artery-coronary sinus fistula, and can be the diagnostic procedure of choice when this anomaly is suspected.     

冠状动脉介入治疗后痉挛的原因分析及护理对策

回顾分析了2003年1月-2005年1月行冠状动脉支架植入术后4例发生冠状动脉痉挛的原因,认为可能与血管的狭窄、术中造影剂或机械刺激、精神紧张等因素有关。针对冠状动脉支架植入术后发生冠状动脉痉挛的时间和规律,认真做好术前评估,尤其是高危患健康教育和心理护理,术后严格床头交接班,了解介入治疗血管及未治疗血管狭窄的情况．并对患发作冠状动脉痉挛时的心电图变化进行分析,加强围手术期的病情观察。     

老年冠心病及血运重建对QT离散度的影响

目的 观察老年冠心病患者经皮冠状动脉介入治疗(PCI)术前后QT离散度(QTd)的变化特点与趋势,并与正常对照组进行对比,探讨QTd与冠状动脉狭窄程度和范围的关系及经皮冠状动脉腔内成形术和PCI对其的影响,以期为临床寻找一种评价PCI术预后的有效无创方法.方法 已行冠状动脉造影术的≥60岁冠心病患者679例,分为冠心病组(经冠状动脉造影证实有单支或多支病变,狭窄程度≥50％)536例.对照组(同期住院冠状动脉造影狭窄程度＜50％)143例.术前分别描记两组的常规12导联心电图,测量QTd、校正QT离散度(QTcd).经冠状动脉造影证实狭窄程度≥75％的393例冠心病患者行PCI术,并再分为3个亚组:单支病变组176例,双支病变组118例,3支病变组99例.对照组:同期住院冠状动脉造影狭窄程度＜50％患者143例.PCI各组术前、术后1天、7天,分别检测QTd、QTcd,进行比较.结果 冠心病组胆红素明显低于对照组(P＜0.01).冠心病组的总胆固醇 (TC)、低密度脂蛋白胆固醇(LDL-C)和血尿酸明显高于对照组(P＜0.01),QTd和QTcd明显比对照组延长(P＜0.01),冠心病3个亚组的QTd和QTcd在术前、术后1天和术后7天均呈逐渐下降趋势,3个亚组在组间、不同时点以及组间和不同时点的交互作用中差异均有统计学意义.单支病变组术前QTd(48.52±12.35)ms,术后1天(41.23±13.35) ms,术后7天(41.12±12.61) ms,术前QTcd(55.34±15.81)ms,术后1天(48.62±14.93) ms,术后7天(48.23±13.65) ms;双支病变组术前QTd(53.26±16.95) ms,术后1天(44.54±14.63)ms,术后7天(43.96±15.32) ms,术前QTcd(59.41±16.72)ms,术后1天(50.35±15.43) ms,术后7天(49.94±15.35)ms;3支病变组术前QTd(58.43±13.72) ms,术后1天(52.82±13.66)ms,术后7天(52.76±13.32)ms,术前QTcd(65.91±18.53)ms,术后1天(60.21±16.38) ms,术后7天(60.19±15.74) ms.结论 QTd、QTcd在冠心病患者明显升高,PCI术后明显降低,并与冠状动脉狭窄的程度和范围有关.说明QTd、QTcd可以作为临床上预测心肌缺血,评估PCI术后预后的有效无创指标.     

Whole blood versus plasma measurements of glutamate and alanine across the human myocardium

Comparisons of whole blood and plasma aorto-coronary sinus concentration differences of glutamate and alanine were made before, during and after coronary sinus pacing in seven patients with normal and six patients with stenotic coronary arteries. Mean differences between duplicate analyses were greater in whole blood than plasma both of glutamate (7.5±5.8 vs. 3.3±3.0 μmol/l, p<0.001) and of alanine (7.9±7.0 vs. 3.8±3.4 μmol/l, p<0.001). Concentrations of glutamate were 3.4 and of alanine 1.4 times higher in whole blood than in plasma. Blood cells were calculated to be responsible for about 20% of glutamate and alanine blood exchanges across the heart. Plasma and whole blood fluxes were closely positively correlated (glutamate:r=0.81, alanine:r=0.88) and had always the same direction. Differences in myocardial exchanges of amino acids between the patients with and without coronary artery disease, as well as rapid changes during pacing, could be demonstrated in plasma analyses but were not significantly reflected in whole blood glutamate determinations. This seemed to be due to the greater variations in whole blood analysis. In conclusion, differences in aorto-coronary sinus plasma concentrations reflected, although underestimated, whole blood fluxes. Because of considerable gains in precision of analysis, plasma should be preferred to whole blood for evaluations of glutamate and alanine exchanges across the human heart.     

血清对氧磷酶1活性与冠心病及其病变程度的关系

目的观察和探讨中国人血清对氧磷酶1(PON-1)活性与冠状动脉粥样硬化性心脏病及其病变程度的关系。方法分光光度法测定入选研究对象(包括非冠心病61例,冠心病151例)的血清PON-1活性;以冠状动脉造影结果作为分组依据,并分析PON-1活性与冠状动脉病变支数、Gensini评分的关系,并对影响冠心病Gensini评分的影响因子进行多因素分析。结果冠心病组血清PON-1活性明显低于对照组,(1.95±0.12)vs(2.28±0.13)(t=17.25,P<0.01);血清PON-1活性单支病变组明显高于双支、三支病变组(2.02±0.15)vs(1.95±0.11)vs(1.91±0.11)(F=9.356,P<0.05);而双支和三支病变组比较差异无统计学意义(P=0.13);血清PON-1活性与Gensini评分间呈负相关(rs=-0.315,P<0.01);PON-1活性、年龄、体质量指数(BMI)、性别、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)与冠状动脉病变的程度相关(P<0.05)。结论冠心病患者血清PON-1活性水平明显降低,随着病变程度加重,血清PON-1活性水平降低,二者呈负相关关系。     

腔内CT密度值用于评估冠状动脉钙化及狭窄程度

目的观察冠状动脉CT成像(CCTA)中,根据冠状动脉钙化(CAC)近端与远端冠状动脉管腔CT值及校正后冠状动脉强化值(CCO)差值评估钙化部位管腔狭窄的准确度。方法对CCTA显示钙化的233支主要冠状动脉(左前降支、左回旋支和右冠状动脉),根据狭窄程度分为轻度狭窄组、中度狭窄组、重度狭窄组和完全闭塞组,比较各组CCO差值,分析以钙化近远端CCO差值评估冠状动脉狭窄的准确度。结果完全闭塞组CCO差值高于轻度狭窄组、中度狭窄组和重度狭窄组(P<0.001);重度狭窄组与中度狭窄组CCO差值差异无统计学意义(P>0.05);中度狭窄组和重度狭窄组CCO差值高于轻度狭窄组(P<0.001)。以钙化近远侧CCO差值0.0869作为诊断界点,其诊断冠状动脉≥50%狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为76.67%、75.47%、91.39%和48.78%;以0.2070作为诊断界点时,其诊断冠状动脉闭塞的敏感度、特异度、阳性预测值和阴性预测值分别为91.84%、79.89%、54.88%和97.35%。结论冠状动脉钙化近远端管腔CCO差值随狭窄程度加重而升高,以之作为评价指标,可明显提高评估冠状动脉钙化及狭窄程度的准确性。     

25-(OH)D3与冠心病患者冠状动脉狭窄程度的相关性

目的 研究25-(OH)D₃与冠心病患者冠状动脉狭窄程度之间是否具有相关性。方法 接受了冠状动脉造影术(CAG)的216例患者,根据是否达到冠心病诊断标准与Gensini积分高低分为4组:对照组(43例)、轻度狭窄组(73例)、中度狭窄组(53例)、重度狭窄组(47例)。分别检测25-(OH)D₃、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、肌酐(Cr)等指标。结果 4组在25-(OH)D₃、男性、HDL-C、LDL-C、TC、TG的差异有统计学意义(P<0.05); 25-(OH)D₃与Gensini积分存在负相关关系(r=-0.355, P<0.001);多元logistic回归提示:高水平的25-(OH)D₃对于冠状动脉狭窄具有保护意义(B=-0.084, P<0.001);ROC曲线表明25-(OH)D₃对于冠心病发生及冠状动脉严重狭窄具有较强的预测价值,前者曲线下面积(AUC)为0.74(95%CI:0.663~0.817), 最佳临界值为17.57 ng/ml, 敏感度为74.4%,特异度为72.3%;后者AUC为0.72(95%CI:0.636~0.804), 最佳临界值为11.42 ng/ml, 敏感度为63.8%,特异度为74.6%。结论 25-(OH)D₃与冠状动脉狭窄程度之间呈负相关,较高水平的25-(OH)D₃对冠状动脉狭窄具有一定的保护作用,对于重度狭窄的诊断能力明显强于轻度及中度狭窄。     

Changes in the way diagnostic coronary arteriography is performed due to the interventional prospect: the clinical impact

Our study was aimed at assessing whether diagnostic coronary angiography has changed in the interventional era. We have studied consecutive 1073 patients with coronary artery disease that was detected by a first angiographic study 2 years prior to (group 1: 545 patients) and after (group 2: 528 patients) the start of an interventional cardiology program in our catheterization laboratory. Radiological data and the use of intracoronary nitrates were recorded as well as demographic data and angiographic results. Pre- and post-interventional era comparison demonstrated: a significant increase in cranial, caudal and left anterior oblique angles, 19.3 degrees +/- 14.8 degrees vs. 24.3 degrees +/- 15.4 degrees, -18.4 degrees +/- 17.4 degrees vs. -23.3 degrees +/- 13.9 degrees, and 29.0 degrees +/- 23.3 degrees vs. 36.2 degrees +/- 25.4 degrees, respectively; a decrease in mean number of angiographic views and mean fluoroscopy time, 9.5 degrees +/- 1.6 degrees vs. 8.9 degrees +/- 1.8 degrees (p = 0.04) and 4.1 +/- 4.2 vs. 3.6 +/- 3.2 min (p = 0.008), respectively. The percentage of patients with normal coronary arteries on coronary arteriography decreased from 9.78 to 8.07% in the pre- and post-interventional era comparison. The way coronary arteriography is performed has changed, thanks to the new interventional attitude of invasive cardiologists. Trainees and young fellows should be trained right from the start of their fellowship to assess coronary artery disease from an interventional point of view.     

20例经皮冠状动脉腔内成形术

目的：总结经皮冠状动脉腔内成形术（ＰＴＣＡ）的经验以求改善ＰＴＣＡ技术，提高临床ＰＴＣＡ的成功率。方法：ＰＴＣＡ按Ｇｒｕｎｔｚｉｇ方法进行。结果：对２０例严重冠状动脉硬化性心脏病患者进行ＰＴ－ＣＡ，共计３０支３９处血管病变中的２６支３５处病变进行了有效扩张，平均扩张次数３．５±２．６次／处，扩张时间６５±２１秒／次，扩张压力每次７．５±２．３ａｔｍ。平均狭窄程度由８７％减轻至１５％，狭窄完全消失的病变有２８处。１例术中发生急性冠状动脉闭塞，经植入支架后恢复正常，未发生其它严重并发症。总成功率１００％。术后心绞痛、心电图缺血性ＳＴＴ改变消失或减轻。结论：ＰＴＣＡ具有创伤小、疗效确切和较安全等优点；植入冠状动脉内支架是处理ＰＴＣＡ所致急性冠状动脉闭塞的有效方法；对于有指征的陈旧性心肌梗塞患者也宜积极采取ＰＴＣＡ的治疗，有助于提高生活质量，改善预后