冠状动脉瘤样扩张

本文介绍冠状动脉瘤样扩张的病因，诊断，临床意义和治疗方法。     

冠状动脉瘤样扩张的研究进展

冠状动脉瘤样扩张首次报道于 1983年[1,2 ] ,随着冠状动脉造影技术及冠脉介入治疗的推广普及 ,有关冠状动脉瘤样扩张的报道逐年增多 ,但是冠状动脉瘤样扩张发生的机制及其对人体的影响尚未清楚 ,本文就近年来冠状动脉瘤样扩张的病因、发病机理、治疗及预后等作一综述。1　冠状动脉瘤样扩张的定义冠状动脉瘤样扩张是指冠状动脉局部或弥漫性扩张。多数学者赞同冠状动脉瘤样扩张指冠状动脉局部管径扩大超过邻近正常段或其管径大于正常值上限的1.5倍[3 7] 。管径的测量有两种方法 ,即ＱＣＡ系统(Ｑｕａｎｔｉｔａｔｉｖｅｃｏｒｏｎａｒｙａｎ…     

冠状动脉瘤样扩张与缺血性心脏病的关系

目的　探讨冠状动脉瘤样扩张与缺血性心脏病的关系。方法　常规方法行选择性冠状动脉造影。缺血性心脏病的临床诊断按Ｗ ＨＯ 标准。结果　共发现３２ 例冠状动脉瘤样扩张,其中１７ 例为单纯冠状动脉扩张,１５ 例为冠状动脉扩张并狭窄。１１ 例并有心肌梗塞,１７ 例心绞痛,５ 例为非典型胸痛。结论　部分缺血性心脏病可能由冠状动脉瘤样扩张所致     

双源CT血管成像对冠状动脉瘤样扩张的诊断价值

<正>冠状动脉瘤样扩张(coronary artery aneurysmal ectasia,CAE)是指心外膜下冠状动脉的局限性或者弥漫性扩张,其管径扩张超过邻近正常冠状动脉管径的1.5~2倍~([1]),部分以心绞痛、ECG改变、心力衰竭及急性心肌梗死为主要临床表现,由于其存在瘤体破裂、心包填塞等风险,威胁着患者的生命,因此利用影像技术对冠状动脉瘤样扩张进行早期诊断,以及术前评估具有重要意义。本文通过对行双源CT冠状动     

冠状动脉瘤样扩张的临床特点

目的 探讨冠状动脉瘤样扩张的临床特点及治疗方法。方法 对冠状动脉造影发现的186例冠状动脉瘤样扩张患者询问胸痛病史，检查心电图、X线胸片、超声心动图、冠状动脉造影等，并对治疗方法与结果做回顾性总结分析。结果 冠状动脉瘤样扩张表现为心绞痛的病例有147例，占79．0％，心电图、X线胸片、超声心动图均无特异性，186例均由冠状动脉造影确诊。结论 心绞痛为冠状动脉瘤样扩张的主要临床表现，冠状动脉造影是确诊的主要方法。本病一旦确诊应积极、长期使用抗凝剂和血管扩张药物，防止冠状动脉痉挛与心肌梗死的发生。急性心肌梗死应积极溶栓，药物治疗不满意者，应行冠状动脉旁路移植术。     

冠状动脉-上腔静脉瘘合并瘤样扩张致心绞痛1例

<正>1病例资料患者,女,62岁,因"间断心前区疼痛8年,加重4个月"入院。8年前无明显诱因出现心前区疼痛,呈针扎样痛,无大汗、颈部紧缩感、肩背部及左上肢放射痛,此后上述症状间断发作,每次持续数秒钟后自行缓解,未行相关治疗。4个月以来心前区疼痛较前加重,持续时间延长,伴心悸、气促,遂至我院就诊。入院后体检:T 36.5℃,P 69次/min,R18次/min,BP 132/78 mmHg(1 mmHg=0.133     

冠状动脉瘤样扩张的研究进展

随着冠状动脉CT血管成像、核磁共振成像及介入术治疗的推广,有关冠状动脉瘤样扩张的报道逐渐增多。常见病因有动脉粥样硬化、川崎病等,但其发病机制尚不完全清楚,选择优化的治疗方案仍具有争议。现介绍冠状动脉瘤样扩张的流行病学、病因、发病机制、临床表现与诊断及治疗方案。     

支架置入术后冠状动脉瘤样扩张的临床研究

目的分析冠脉支架置人术后冠状动脉瘤样扩张的临床特点。方法支架置人术后半年至2年复查冠脉造影的患者,筛选支架处动脉瘤样扩张患者,分析易患因素,并对患者进行随访。结果1209例患者于支架术后复查冠脉造影,有11例发现发生了支架相关冠状动脉瘤样扩张。其中8例为男性（8／1209）,9例为药物支架（9／1209）,发生在前降支者6例（6／1209）,右冠脉者5例（5／1209）。对发生动脉瘤患者进行随访,在平均18个月（9～25个月）的随访中,发生1例因心绞痛住院,1例冠状动脉瘤样扩张患者在16个月后再次复查造影,动脉瘤样扩张消失。结论支架置入术后冠状动脉瘤样扩张总体发生率低,远期预后良好。     

冠状动脉瘤样扩张与电子束CT检测的冠状动脉钙化

为探讨冠状动脉瘤样扩张患者电子束CT检测的冠状动脉钙化的特点及其临床和病理意义 ,将 2 7例经选择性冠状动脉造影确诊的冠状动脉瘤样扩张患者行电子束CT检查以计算钙化积分 ,并与 2 7例年龄和性别匹配的冠状动脉造影正常者进行比较。结果发现 ,冠状动脉瘤样扩张组钙化阳性率、钙化积分中位数及钙化积分的自然对数转换值均显著高于正常对照组 (P <0 .0 1或 0 .0 0 1)。冠状动脉瘤样扩张组中 2 1例粥样硬化性瘤样扩张患者钙化阳性率为 81.0 % ;弥漫性扩张动脉的钙化积分对数转换值显著低于局限性扩张动脉 (1.2 2± 1.79比 2 .86± 1.85 ,P <0 .0 5 )。结果提示 ,粥样硬化性冠状动脉瘤样扩张患者多数存在较为广泛的冠状动脉钙化 ,且钙化程度与病变类型有关。     

药物洗脱支架术后冠状动脉瘤样扩张一例

<正>1病例介绍患者,男,65岁。因活动后胸闷心悸2年,加重1周于2015-06-18入住上海市普陀区中心医院心内科。患者否认既往高血压、糖尿病、慢性肾脏病等慢性病史。门诊查心电图示窦性心律、室性早搏;心超提示心脏多节段收缩活动异常,左室射血分数(LVEF)0. 40。入院查体无明显异常。实验室检查:血常规、尿常规、粪便常规、肝肾功能、凝血功能、血糖、血脂、肌钙蛋白等化验指标均正常。入院诊断:冠状动脉     

Clinical features of coronary artery ectasia

OBJECTIVES: To investigate the clinical significance of coronary artery ectasia in Japanese patients. METHODS: Coronary artery ectasia was found in 54 of 3,778 (1.4%) consecutive patients who underwent coronary angiography. The clinical characteristics and the coronary angiographic findings of these patients were studied. Follow-up data were obtained for 49 patients, who were separated into two groups: Group A subsequently suffered a follow-up major cardiac event, and Group B did not develop such an event. RESULTS: Among the coronary artery ectasia patients, 65% had myocardial infarction, 91% had coronary artery disease, and 48% had single-vessel disease. Seventy-six percent had single-vessel involvement with coronary artery ectasia. Eighteen patients (37%) suffered 22 follow-up major events. Seventy-two percent of the first follow-up event cases occurred within 4 years after the first cardiac event. The follow-up event in 78% of cases was acute coronary syndrome. There were no significant differences in age and prevalence of each coronary artery risk factor between Groups A and B. There were no significant differences in the incidence of follow-up event between the patients with single-vessel disease and the patients with multi-vessel disease, nor between the patients with single-vessel involvement with coronary artery ectasia and the patients with multi-vessel involvement with coronary artery ectasia. There was no significant difference in the percentage of patients in whom the culprit vessel of the cardiac event was the same as the ectatic vessel between the first cardiac event and follow-up cardiac events (41% vs 62%). CONCLUSIONS: Coronary artery ectasia is not benign and must be carefully monitored. Coronary atherosclerosis may contribute to the occurrence of subsequent cardiac events.     

Adiponectin levels in coronary artery ectasia

Etiopathogenesis of coronary artery ectasia (CAE), which is defi ned as abnormal dilatation of a segment of the coronary artery to 1.5 times of an adjacent normal coronary artery segment, is unclear. However, it is speculated that CAE develops in the atherosclerosis process through degeneration of coronary artery media layer. Our objective in this study is to compare levels of adiponectin between cases with CAE and normal coronary anatomy, and to examine whether adiponectin plays a role in CAE etiopathogenesis. The study registered a total of 66 cases, consisting of CAE cases (group 1, n = 36) and cases with normal coronary anatomy (group 2, n = 30). Taking coronary artery diameters of the control group cases as the reference, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. Serum adiponectin levels were 4.31 ± 2.02 μg/ml in group 1 and 6.73 ± 4.0 μg/ml in group 2 (P = 0.02). High-sensitivity Creactive protein was 4.8 ± 3.8 mg/l in group 1 and 3.6 ± 3.4 mg/l in group 2 (P > 0.05). There was a negative correlation between ectatic coronary artery diameter and plasma adiponectin level (P = 0.03; r = −0.339). It was known that adiponectin levels dropped in atherosclerotic heart disease. In this study we found low plasma adiponectin levels in acquired CAE, attributed to atherosclerosis. Therefore, we think that adiponectin might be playing a role in etiopathogenesis and progression of CAE. This in turn may indicate that hypo-adiponectinemia may be useful in revealing a realized risk in CAE. However, larger, randomized, multicenter studies are required to examine the role of adiponectin in the development of CAE.     

Altered coronary flow properties in diffuse coronary artery ectasia

Objectives The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia.Methods Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary artery segment or the diameter of the corresponding coronary artery of the control group when there was no normal segment. The age- and sex-matched control group (n = 20) comprised patients with normal epicardial coronary arteries. Coronary blood flow velocities were obtained invasively by use of Doppler scanning flow wire. Coronary flow reserve (CFR) was measured by administration of intracoronary papaverine as the hyperemic stimulus. Volumetric coronary blood flow was estimated by multiplying the velocity time integral of coronary blood flow with the cross-sectional area of the coronary artery and the heart rate.Results Fifteen patients with CAE, but none of the patients in the control group, had electrocardiographic signs of myocardial ischemia at peak exercise on ergometry. Baseline average peak velocities (APVs) of coronary blood flow were similar in the 2 groups. Peak hyperemic APVs of coronary blood flow were lower in the CAE group than in the control group (17.5 ± 7.4 cm/s vs 41.5 ± 12.6 cm/s, respectively, P < .001). Volumetric coronary blood flow was significantly higher in the CAE group than in the control group, both at rest and at hyperemia (146.3 ± 71.2 cm³/min vs 45.1 ± 16.1 cm³/min, respectively, P < .001, and 202 ± 87.3 cm³/min vs 104.1 ± 37.6 cm³/min, respectively, P < .003). The mean CFR of the CAE group was significantly reduced compared with that of the control group (1.51 ± 0.31 vs 2.67 ± 0.52, respectively, P < .001).Conclusions The CFR is significantly reduced in patients with diffuse CAE compared to a matched control group. Although volumetric coronary blood flow is significantly higher in CAE, microcirculatory dysfunction that is reflected as depressed CFR may be the underlying cause of exercise-induced myocardial ischemia. (Am Heart J 2003;145:66-72.)     

Relation of coronary artery ectasia to diabetes mellitus

An increased prevalence of coronary artery ectasia (CAE) and a low frequency of diabetes mellitus have been reported in patients with abdominal aortic aneurysm (AAA). The prevalence of diabetes was studied in 190 patients with CAE in comparison with 341 age- and gender-matched patients with coronary artery disease alone. Diabetes mellitus was found to be independently but inversely associated with CAE (relative risk 0.603, 95% confidence interval 0.375 to 0.960, p = 0.037), thus resembling the relation between diabetes and AAA.     

Extracellular matrix turnover in coronary artery ectasia patients

Dysregulation of the metabolism of the extracellular matrix (ECM) may contribute to coronary artery ectasia (CAE). This study evaluated the turnover of main ECM components and related proteolytic enzymes activities. In this study, thirty patients with CAE, 30 patients with coronary artery disease (CAD) and 30 subjects with normal coronary arteries (Control) were selected. The following circulating ECM metabolism markers were measured: soluble elastin (sElastin), collagen type I cross-linked telopeptides (ICTP), procollagen type I carboxy terminal peptide (PICP), protocollagen III N-terminal propeptide (PIIINP), and procollagen a1(III) C-terminal propeptide (PIIICP). Serum total elastase activity and total matrix metalloproteinase (MMP) activity were also determined. The level of sElastin was higher in the CAE group than in the CAD and Control groups (P1 = 0.009, P2 = 0.000). There was no difference in ICTP (P = 0.168) or PIIICP (P = 0.079) among the three groups. PICP was significantly elevated in CAE (P1 = 0.001, P2 = 0.002). PIIINP was also significantly increased in CAE (P1 = 0.002, P2 = 0.007). Total elastase activity was higher in the CAE group than in the other two groups (P1 = 0.006, P2 = 0.022). Total MMP activity was significantly higher in the CAE group than the Control group (P2 = 0.013) but not higher than the CAD group (P1 = 0.477). In conclusion, within CAE patients the main changes in ECM metabolism were increased degradation of elastin fibres and the transition of collagen from type III to type I. Elastase and MMPs appear to be associated with this kind of ECM turnover.     

Relationship between coronary artery ectasia,cocaine abuse and acute coronary syndromes

Coronary artery ectasia(CAE)often represents a coronary angiography finding casually detected or following the occurrence of an acute coronary syndrome.The pathogenetic role of cocaine abuse in the genesis of CAE is still little known and very few data are available in literature.We describe a case of a 31-year-old male cocaine user admitted to our department for typical acute chest pain.Coronary angiography showed diffuse coronary ectasia with slow flows and without hemodynamically significant stenosis.An increasing of matrix metalloproteinases values and a reduction of their tissue inhibitors was showed both during hospitalization and at one month after discharge.This case report emphasizes the close relationship between cocaine abuse,CAE and acute coronary syndromes in patients without hemodynamically significant coronary stenosis.As reported by Satran et al,cocaine abuse should be considered an important risk factor for CAE and these patients appear to be at increased risk of angina and acute myocardial infarct.Further studies that can strengthen this hypothesis would be useful to deepen and better analyze this interesting association.     

A case of acute coronary thrombosis in diffuse coronary artery ectasia

A 75-year-old Afro-Caribbean male presented with a non-ST-elevation myocardial infarction. Coronary angiography showed generally grossly dilated coronary arteries with a large lobular thrombus in the distal right coronary artery. We briefly review this case and discuss the definition, pathophysiology and treatment for coronary artery ectasia.