The Virtual Coronary Angiography Method

This article is devoted to the development of a virtual coronary angiography method, a noninvasive method of evaluation of the state of the human coronary artery. Registration and processing of the signal of peripheral arterial blood pulsation against the background of a functional test with controlled respiration form the basis of the method. A mathematical model of the relationship between relative change in spectral evaluations of the variability of the cardiac rhythm and the degree of coronary-artery stenosis was developed. Clinical testing, which demonstrated the high efficiency of the proposed virtual coronary angiography method when examining patients with different states of coronary arteries, was conducted.     

Ergonovine-Provoked Esophageal Spasm During Coronary Angiography

In many patients with chest pain of esophageal origin, findings are normal on routine esophageal manometry and dysmotility develops only upon provocation with ergonovine maleate. Unfortunately, ergonovine may induce myocardial ischemia in patients in whom coronary artery spasm did not occur during previous provocative testing in a cardiac laboratory—limiting its clinical usefulness. We have recorded esophageal pressure simultaneously with ergonovine infusion during angiography in ten patients without significant arterial stenoses. In two patients their usual chest pain developed associated with esophageal spasm and without changes in coronary vessels. Simultaneous performance of angiography and manometry enhanced the diagnostic yield of provocative testing by showing esophageal motility changes. This method may detect significant changes in the esophageal motility, is easy to carry out and does not interfere with angiography. It maximizes the information gained from a single provocative test and avoids the risk of ergonovine infusion outside of a cardiac laboratory.     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的：探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法：收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影（DSA）检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果：70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论：相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

冠脉造影术后对比剂肾病的研究进展

随着人口老龄化以及饮食结构的改变,冠心病发病率逐年升高。冠状动脉造影技术在临床中广泛开展,导致对比剂肾病(contrast-induced nephropathy,CIN)的发病率不断上升。CIN的发生与患者本身的基础肾脏疾病及术前血糖水平等危险因素密切相关。对比剂会影响肾脏血流动力学,同时对肾小管有直接毒性作用,最新研究显示炎症反应参与了CIN的发生,但其具体发病机制尚未完全阐明。在CIN的早期诊断中,新的生化指标较血肌酐值可更早反应对比剂使用后肾功能的损害。除静脉水化疗法外,新型的药物在防治CIN中起到一定作用。CIN对患者的预后有重要影响,认识和熟悉CIN的高危因素、发病机制及早期诊断方法,对预防冠脉造影术后引发的肾脏损害尤为重要。该文就CIN的发病机制、高危因素、早期诊断、防治方法等方面的研究进展进行综述。     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的:探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法:收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影(DSA)检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果:70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论:相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

64层螺旋CT冠状动脉造影的护理

多层螺旋凹冠脉造影与导管法冠脉造影相比,具有无创、安全、经济快捷等优点,在临床上应用日见广泛。但影响其成像质量的因素较多,而检查前、检查中及检查后的护理是其很重要的环节,本文就与该项检查有关的护理问题进行探讨,提出相应的护理对策。     

Selective Coronary Angiography Using a Percutaneous Femoral Technique

Successful use, in 650 patients over a period of two years, of a percutaneous femoral technique of selective coronary angiography is described. This technique is carried out with the use of mouldable, manually preshaped polyethylene catheters. Preparation of the material and the different steps of the technique are discussed. Excellent flexibility and plastic memory of this catheter material allow easy, rapid and consistent percutaneous insertion and removal of catheters and intubation of the coronary arteries.     

256 层CT 冠状动脉造影低剂量技术联合应用的临床价值

目的:探讨前瞻性心电门控扫描、低管电压结合迭代重建算法在256层螺旋CT冠脉造影中的应用价值。方法:回顾性分析行256层螺旋CT冠状动脉成像(CCTA)、体质量指数正常的受检者130例。常规剂量组(A组)50例:应用回顾性心电门控扫描模式,管电压120 kv;低剂量组(B组)80例,心率70次/分者50例,心率≧70次/分者30例:应用前瞻性心电门控扫描模式,管电压100 kv。B组患者原始数据分别应用迭代算法(Idose3)重建及标准滤波反投影法(FBP)重建。比较A、B两组的有效辐射剂量,对各组客观图像质量及主观图像质量进行统计学分析。结果:A、B两组平均有效辐射剂量分别为(15.34±3.89)、(1.43±0.12)m Sv。B组患者应用迭代重建图像噪声降低,差异有统计学意义(P0.05)。应用FBP重建,B组图像噪声高于A组,两者比较差异有统计学意义(P0.05)。各组主观图像质量评分差异无统计学意义(P0.05)。结论:前瞻性心电门控低千伏扫描模式联合迭代重建算法在提供满足诊断的冠状动脉CTA图像的同时,辐射剂量降幅高达90.6%。心率70次/分-85次/分的患者也可行256层CT前门控扫描,降低管电压造成的图像噪声增加可以通过迭代重建弥补。     

Positive Association of Coronary Calcium Detected by Computed Tomography Coronary Angiography with Periprocedural Myocardial Infarction

Background

Periprocedural myocardial infarction (PMI) may occur in approximately 5% to 30% of patients undergoing percutaneous coronary intervention. Whether the morphology of coronary plaque calcium affects the occurrence of PMI is unknown.

Materials and Methods

A total of 616 subjects with stable angina and normal baseline cardiac troponin I levels who had undergone computed tomography angiography (CTA) were referred to elective percutaneous coronary intervention. The morphology of coronary calcium was determined by CTA analysis. PMI was defined as an elevation in 24-h post-procedural cardiac troponin I levels of > 5 times the upper limit of normal with either symptoms of myocardial ischemia, new ischemic electrocardiographic changes, or documented complications during the procedure. Logistic regression was performed to identify the effect of the morphology of coronary calcium on the occurrence of PMI.

Results

According to the presence or morphology of coronary calcium as shown by CTA, 210 subjects were grouped in the heavy calcification group, 258 in the mild calcification group, 40 in the spotty calcification group and 108 in the control group. The dissection rate was significantly higher in the heavy calcification group than in the control group (7.1 % vs. 1.9%, p = 0.03). The occurrence of PMI in the heavy calcification group was significantly higher than that in the control group (OR 4.38, 95% CI 1.80–10.65, p = 0.001). After multivariate adjustment, the risk of PMI still remained significantly higher in the heavy calcification group than in the control group (OR 4.04, 95% CI 1.50–10.89, p = 0.003).

Conclusions

The morphology of coronary calcium determined by CTA may help to predict the subsequent occurrence of PMI. A large amount of coronary calcium may be predictive of PMI.     

Validation of a Novel Clinical Prediction Score for Severe Coronary Artery Diseases before Elective Coronary Angiography

Objectives

Coronary artery disease (CAD) severity is associated with patient prognosis. However, few efficient scoring systems have been developed to screen severe CAD in patients with stable angina and suspected CAD before coronary angiography. Here, we present a novel scoring system for CAD severity before elective coronary angiography.

Methods

Five hundred fifty-one patients with stable angina who were admitted for coronary angiography were enrolled in this study. Patients were divided into training (n = 347) and validation (n = 204) cohorts. Severe CAD was defined as having a Gensini score of 20 or more. All patients underwent echocardiography (ECG) to detect ejection fraction and aortic valve calcification (AVC). Multivariable analysis was applied to determine independent risk factors and develop the scoring system.

Results

In the training cohort, age, male sex, AVC, abnormal ECG, diabetes, hyperlipidemia, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were identified as independent factors for severe CAD by multivariable analysis, and the Severe Prediction Scoring (SPS) system was developed. C-indices of receiver operating characteristic (ROC) curves for severe CAD were 0.744 and 0.710 in the training and validation groups, respectively. The SPS system also performed well during calibration, as demonstrated by Hosmer-Lemeshow analysis in the validation group. Compared with the Diamond-Forrester score, the SPS system performed better for severe CAD prediction before elective coronary angiography.

Conclusions

Severe CAD prediction was achieved by analyzing age, sex, AVC, ECG, diabetes status, and lipid levels. Angina patients who achieve high scores using this predicting system should undergo early coronary angiography.     

320排CT冠脉造影检查对冠状动脉斑块成分分析可行性初探

目的:研究320排CT冠脉造影对分析冠状动脉轻度及重度狭窄患者斑块成分的价值。方法:2011年4月-2012年5月间我院1132例(62±12岁,42%女性)冠心病患者行320排CT冠状动脉造影检查,依据美国心脏协会16分段标准,分析每一例患者每一节段血管狭窄程度及斑块性质,CT斑块分型如下:Ⅰ型为钙化斑块,Ⅱ型为钙化为主的混合斑块,Ⅲ型为非钙化为主的混合斑块,Ⅳ型为非钙化斑块。比较不同狭窄程度组斑块类型差别。结果:共363例为冠脉血管正常人群,冠状动脉狭窄患者共769例,其中管腔狭窄程度<50%的轻度人群为367例,重度狭窄组(≥50%)为402例。重度狭窄患者组冠脉血管混合斑块数量较多,而非钙化斑块相对较少(Ⅰ～Ⅳ型斑块所占比例分别为22%,,39%,21%,18%),轻度狭窄患者组各斑块所占比例分别为29%,29%,26%,16%(p=0.006)。结论:随着冠状动脉狭窄程度的不同,冠状动脉粥样硬化斑块的类型也不尽相同,重度狭窄人群组中混合斑块较多而非钙化斑块较少。320排CT冠脉造影可对冠状动脉斑块成分进行分析。     

Relation between Mild to Moderate Chronic Kidney Disease and Coronary Artery Disease Determined with Coronary CT Angiography

Background

Both end-stage and milder stages of chronic kidney disease (CKD) are associated with an increased risk of adverse cardiovascular events. Several studies found an association between decreasing renal function and increasing coronary artery calcification, but it remains unclear if this association is independent from traditional cardiovascular risk factors. Therefore, the aim of this study was to investigate whether mild to moderate CKD is independently associated with coronary plaque burden beyond traditional cardiovascular risk factors.

Methods

A total of 2,038 patients with symptoms of chest discomfort suspected for coronary artery disease underwent coronary CT-angiography. We assessed traditional risk factors, coronary calcium score and coronary plaque characteristics (morphology and degree of luminal stenosis). Patients were subdivided in three groups, based on their estimated glomerular filtration rate (eGFR) Normal renal function (eGFR ≥90 mL/min/1.73 m²); mild CKD (eGFR 60–89 mL/min/1.73 m²); and moderate CKD (eGFR 30–59 mL/min/1.73 m²).

Results

Coronary calcium score increased significantly with decreasing renal function (P<0.001). Coronary plaque prevalence was higher in patients with mild CKD (OR 1.83, 95%CI 1.52–2.21) and moderate CKD (OR 2.46, 95%CI 1.69–3.59), compared to patients with normal renal function (both P<0.001). Coronary plaques with >70% luminal stenosis were found significantly more often in patients with mild CKD (OR 1.67 (95%CI 1.16–2.40) and moderate CKD (OR2.36, 95%CI 1.35–4.13), compared to patients with normal renal function (both P<0.01). After adjustment for traditional cardiovascular risk factors, the association between renal function and the presence of any coronary plaque as well as the association between renal function and the presence of coronary plaques with >70% luminal stenosis becomes weaker and were no longer statistically significant.

Conclusion

Although decreasing renal function is associated with increasing extent and severity of coronary artery disease, mild to moderately CKD is not independently associated with coronary plaque burden after adjustment for traditional cardiovascular risk factors.     

The Association of Brachial-Ankle Pulse Wave Velocity with Coronary Artery Disease Evaluated by Coronary Computed Tomography Angiography

The aim of this study was to investigate whether brachial-ankle pulse wave velocity (baPWV) is associated with the severity of coronary artery disease (CAD) assessed by coronary computed tomography angiography (CCTA), and to evaluate baPWV as a predictor of obstructive CAD on CCTA. A total of 470 patients who underwent both baPWV and CCTA were included. We evaluated stenosis degree and plaque characteristics on CCTA. To estimate the severity of CAD, we calculated the number of segment with plaque (segment involvement score; SIS), stenosis degree-weighted plaque score (segment stenosis score; SSS), and coronary artery calcium score (CACS). The mean baPWV was 1,485 ± 315 cm/s (range, 935-3,175 cm/s). Non-obstructive (stenosis < 50%) and obstructive (stenosis ≥ 50%) CAD was found in 129 patients (27.4%) and 144 (30.6%), respectively. baPWV in patients with obstructive CAD was higher than that of patients with non-obstructive (1,680 ± 396 cm/s versus 1,477 ± 244 cm/s, P < 0.001) or no CAD (1,680 ± 396 cm/s versus ± 196 1,389 cm/s, P < 0.001). baPWV showed significant correlation with SSS (r = 0.429, P < 0.001), SIS (r = 0.395, P < 0.001), CACS (r 0.346, P < 0.001), and the number of segment with non-calcified plaque (r 0.092, P = 0.047), mixed plaque (r = 0.267, P < 0.001), and calcified plaque (r = 0.348, P < 0.001), respectively. The optimal baPWV cut-off value for the detection of obstructive CAD was 1,547 cm/s. baPWV ≥ 1,547 cm/s was independent predictor for the obstructive CAD. In conclusion, baPWV is well correlated with the severity of CAD evaluated by CCTA. baPWV has the potential to predict severity of coronary artery atherosclerosis.     

Prevalence of Coronary Artery Disease Evaluated by Coronary CT Angiography in Women with Mammographically Detected Breast Arterial Calcifications

To assess the correlation between breast arterial calcifications (BAC) on digital mammography and the extent of coronary artery disease (CAD) diagnosed with dual source coronary computed tomography angiography (CTA) in a population of women both symptomatic and asymptomatic for coronary artery disease. 100 consecutive women (aged 34 – 86 years) who underwent both coronary CTA and digital mammography were included in the study. Health records were reviewed to determine the presence of cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus, and smoking. Digital mammograms were reviewed for the presence and degree of BAC, graded in terms of severity and extent. Coronary CTAs were reviewed for CAD, graded based on the extent of calcified and non-calcified plaque, and the degree of major vessel stenosis. A four point grading scale was used for both coronary CTA and mammography. The overall prevalence of positive BAC and CAD in the studied population were 12% and 29%, respectively. Ten of the 12 patients with moderate or advanced BAC on mammography demonstrated moderate to severe CAD as determined by coronary CTA. For all women, the positive predictive value of BAC for CAD was 0.83 and the negative predictive value was 0.78. The presence of BAC on mammography appears to correlate with CAD as determined by coronary CTA (Spearman’s rank correlation coefficient = 0.48, p<.000001). Using logistic regression, the inclusion of BAC as a feature in CAD predication significantly increased classification results (p=0.04).     

冠状动脉解剖变异的CTA影像特征分析

目的:分析冠状动脉解剖变异的CT血管造影(computed tomography angiography,CTA)影像特征。方法:回顾分析2010年6月到2014年4月间PACS存储的12326例心脏CTA图像资料,记录解剖变异冠状动脉的名称、开口起源位置、数目、行程状态及终止部位表现及其与毗邻结构的关系。结果:共有700例心脏有冠状动脉解剖变异,以冠状动脉开口起源异常最多见,共622例(622/12326,5.05%),其中左和右冠状动脉开口高位350例(350/12326,2.84%),左和右冠状动脉开口于对侧窦166例(166/12326,1.35%),冠状动脉双开口70例(70/12326,0.57%),左和右冠状动脉开口于窦间36例(36/12326,0.29%);其次为数目异常29例(29/12326,0.24%),包括左、右单支冠状动脉19例(19/12326,0.15%)和冠状动脉分支(LCx)缺如10例(10/12326,0.08%);冠状动脉终止异常(冠脉动脉-动脉圆锥和/或肺动脉瘘)29例(29/12326,0.24%)。VR是显示冠状动脉解剖变异最重要的后处理方法。结论:冠状动脉解剖变异CTA表现复杂多样,心脏CTA能够准确显示冠状动脉解剖变异种类及其毗邻关系。     

冠状动脉造影正常的胸痛患者病因分析

目的:探讨冠状动脉造影正常的胸痛患者的病因及其临床特征.方法:对49例临床拟诊冠心病而冠状动脉造影正常的胸痛患者的临床特征进行回顾性分析,为胸痛的临床诊断提供思路.结果:最后诊断:急性心梗死1例(2.04%);冠心病心绞痛10例(20.45%);高血压病12例(24.49%);心律失常8例(16.33%);糖尿病6例(12.24%);X综合症7例(14.29%);急性胆囊炎2例(4.08%);急性胰腺炎2例(4.08%);反流性食管炎1例(2.04%);颈椎病2例(4.08%).结论:冠状动脉造影正常的胸痛患者并不能完全排除冠心痛,要考虑心外病变、非冠心病性器质性心脏病和X综合症等众多的影响因素.     

不同粘度对比剂对冠状动脉造影患者肾功能的影响

目的：对比剂肾病（CIN）是介入治疗中常见并发症之一。由于对比剂肾病发病机制复杂,其确切的机制尚不明确,有研究认为应用渗透压相似的对比剂,高粘度组对比剂引起CIN的几率明显高于低粘度组。本研究探讨接受不同粘度对比剂冠状动脉造影检查的患者术后引起肾功能损害的差异及其可能的机制。方法：80例接受冠状动脉造影检查的患者随机分为两组。分别为20℃碘海醇组、37℃碘海醇组,每组各40例。分别于冠脉造影前8h、冠脉造影后48h采集同一患者肘正中静脉血进行血清肌酐（Scr）、血清胱抑素C（CysC）检测,并对数据进行统计学分析。结果：两组患者组间比较基本资料无明显差异,两组患者术后Ser、CysC较术前均升高,差异均有统计学意义（P〈0．05）;20℃碘海醇组术后Scr较37℃碘海醇组升高不明显,差异无统计学意义（P〉0．05）;20℃碘海醇组术后CysC较37℃碘海醇组升高明显,差异有统计学意义（P〈0．05）。结论：冠脉造影检查时．对比剂对患者的肾功能有损害;选择低粘度对比剂可能减少其对冠状动脉造影患者的肾功能的不良影响;其作用机制可能与对比剂改变血液粘滞性,从而影响肾血流有关。     

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients,Despite High Average Calcium Scores

Purpose

Significant obstructive coronary artery disease (CAD) is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group.

Methods

For this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861), with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1–3, 5–8, 11 and 13) by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable.

Results

A total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70%) were included. The median calcium score was 623 [79, 1619].Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01).

Conclusion

Despite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.