摘要:目的:评价64层螺旋CT对冠心病的诊断价值。方法:对25例典型病例的CT图片进行分析、总结,观察64层螺旋CT对冠状动脉的管腔狭窄程度及冠脉内斑块性质的显示能力,并对桥血管和支架通畅性进行观察。结果:近端冠脉中度以上狭窄的敏感度、准确度、阳性预测值分别为93.5%,90.3%,88.5%,对左主干及前降支病变诊断价值较高;对冠状动脉内软斑块显示较佳;对桥血管及支架通畅和有无再狭窄显示良好。结论:MSCT冠状动脉成像在冠心病筛查及冠状动脉支架术后和搭桥术后的随访发挥重要作用。Abstract: Objective: To study the diagnose value of 64slice spiral CT for coronary heart disease. Methods:The CT pictures of 25 typical cases of coronary heart disease were analyzed so as to survey the displaying ability coronal arterial stenosis, its degree and the character plaques, the patency of bypass graft and stents by 64slice spiral CT. Results:The sensitivity, accuracy, positive predictive value for RCA1 narrow above moderate was 93.5%, 90.3%, 88.5% respectively. For LM and LAD, its diagnose value was high. The coronary soft or fibrous plaque, stent and bypass graft were displayed well. Conclusion:MSCT plays an important role in filtering coronary heart disease and reexamination after stents and bypass.
目的:通过对64排螺旋CT(MSCT)冠状动脉造影与选择性冠状动脉造影检测冠状动脉病变(冠状动脉狭窄≥50%)的对比分析,探讨64层螺旋CT评估冠状动脉病变诊断的准确性。方法:回顾性收集2007年12月~2008年10月于我院同期接受64层螺旋CT冠状动脉成像和常规经皮冠脉造影的112位冠心病患者的影像资料,以常规冠脉造影为参考标准,对2种检查方法的结果进行对比分析,评估64层螺旋CT冠脉造影对冠状动脉病变诊断的准确性。结果:按常规冠脉造影计算,112例患者共发现374处病变用于评价,MSCT造影检测冠脉病变总的准确性为906％,假阳性率和假阴性率分别为43％和51％;其中MSCT检测为假阴性均发生在左回旋支和右冠远段,假阳性均为冠状动脉伴有钙化。结论:64排螺CT冠状动脉造影检测冠状动脉病变诊断的准确性较高,但血管解剖和冠状动脉钙化可能会影响其对冠状动脉病变的评价和检测。
Coronary artery disease (CAD) is a cardiovascular disease mainly caused by atherosclerosis, which involves a variety of pathophysiological mechanisms such as lipid metabolism, inflammatory response, and endothelial dysfunction. Fetuin B is a glycoprotein secreted by the liver, which can participate in many processes such as cell inflammation, vascular calcification, and lipid metabolism, and is closely related to the pathogenesis of CAD. This article reviews the relationship between fetuin B and CAD and the mechanism of its occurrence and development, in order to provide new choices and methods for the prevention, diagnosis, and treatment of CAD.
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
ObjectiveTo investigate the impact of graft type on perioperative outcomes and long-term prognosis in patients undergoing surgical repair of post-myocardial infarction ventricular septal rupture (VSR) with concomitant coronary artery bypass grafting (CABG). MethodsA retrospective analysis was conducted on clinical data from patients who underwent VSR repair and simultaneous CABG at Fuwai Hospital between 2005 and 2022. Patients were divided into an arterial graft group and a saphenous vein graft (SVG)-only group based on the type of bypass grafts used. Clinical outcomes were compared between the two groups. ResultsA total of 92 patients were included, comprising 56 males and 36 females, with a mean age of (62.4±7.9) years. The arterial graft group consisted of 60 patients, and the SVG-only group consisted of 32 patients. There were no statistical differences between the two groups in baseline characteristics, time interval from myocardial infarction to surgery, or culprit vessel distribution (P>0.05). A higher proportion of patients in the SVG-only group received preoperative intra-aortic balloon pump (IABP) support (56.3% vs. 35.0%, P=0.049). However, cardiopulmonary bypass time, aortic cross-clamp time, and early mortality rates were similar between the two groups (P>0.05). Follow-up data revealed no statistically significant differences in cumulative 10-year survival (82.8% vs. 80.0%, P=0.940) or freedom from major adverse cardiovascular and cerebrovascular events (MACCE) (49.6% vs. 58.6%, P=0.491) between the SVG-only and arterial graft groups. Furthermore, graft type did not significantly affect long-term mortality in patients with a culprit vessel in the left anterior descending artery or those with multivessel disease. ConclusionIn patients undergoing delayed repair of VSR with concomitant CABG, the use of arterial or saphenous vein grafts did not significantly impact perioperative outcomes or long-term prognosis. Future research should further explore the benefits of different revascularization strategies to optimize treatment for this population.
Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in nonDR group and control group, the differences were statistically significant (chi;2=26.9,35.5;P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.
摘要:目的: 研究尿微量白蛋白与冠心病的相关性。 方法 : 按冠状动脉造影诊断标准将116例患者分为冠心病组(82人) 与非冠心病组(34人),测定晨尿白蛋白/ 肌酐浓度值(ACR),比较两组患者尿ACR 并分析ACR与冠脉病变程度的相关性。 结果 : 冠心病组ACR显著高于非冠心病组的; ACR与冠脉计分呈显著的直线正相关。 结论 :冠心病患者ACR水平升高,微量白蛋白尿与冠状动脉病变范围和程度密切相关, 且对冠状动脉狭窄程度具有独立预测价值。Abstract: Objective: To investigate the relationship between microalbuminuria and coronary artery disease(CAD). Methods : According to the diagnostic standard of coronary artery angiography,116 patients were divided into CAD group (82 patients) and nonCAD group (34 patients). The albumin and creatinine concentrationratio ratio(ACR) in morning urine samples from patients of both groups was estimated and compared. The correlation of ACR to the extent of coronary lesions was analyzed. Results : ACR in the CAD group was significantly higher than that in nonCAD group. A distinctly linear positive correlation existed between ACR and the score of the coronary lesions. Conclusion : ACR increase in patients with CHD.Micoalbuminuria was associated with the severity of coronary lesions in patients with CHD and is an independent predictor of CAD.
Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.
ObjectivesTo assess the accuracy of different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CNKI and CBM databases were searched to collect the studies on different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease from inception to May 15th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were synthesized by using MetaDisc 1.4, RevMan 5.3 and Stata 12.0 softwares. The pooled sensitivity (Sen), pooled specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (–LR), pooled diagnostic odds ratio (DOR) and the area under curve (AUC) of the summary receiver-operating characteristic curve (SROC) were used to assess the diagnostic value of different types and magnetic field intensity of cardiac magnetic resonance.ResultsTwenty diagnostic studies were included, which involved 1 357 patients. The results of meta-analysis showed that (1) based on patient: compared with the gold standard, the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.87, 95%CI 0.82 to 0.90), (0.88, 95%CI 0.82 to 0.92), (7.33, 95%CI 4.74 to 11.32), (0.15, 95%CI 0.11 to 0.20), (49.53, 95%CI 27.46 to 89.36), (0.93, 95%CI 0.91 to 0.95), 20.00% and 65.00%, respectively. (2) Based on blood vessels: the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.81, 95%CI 0.76 to 0.85), (0.87, 95%CI 0.81 to 0.91), (6.37, 95%CI 4.37 to 9.30), (0.22, 95%CI 0.17 to 0.27), (29.58, 95%CI 18.53 to 47.22), (0.89, 95%CI 0.86 to 0.92), 20.00% and 61.00%, respectively. (3) Subgroup analysis showed that there was no difference in AUROC of different types of cardiac magnetic resonance, but significant difference was found in AUROC of 1.5T and 3.0T magnetic field intensity.ConclusionsCurrent evidence shows that, compared with gold standard, cardiac magnetic resonance can be regarded as an effective and feasible method for preoperative staging of breast cancer.
Objective To systematically review the impact of cardiac shock waves on coronary artery disease. Methods The PubMed, Cochrane Library, Wed of Science, EMbase, ClinicalTrials.gov, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials and cohort studies related to the treatment of coronary artery disease with cardiac shock waves from inception to August 2022. After two evaluators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies, a meta-analysis was conducted by using RevMan 5.4.1 and Stata 15.0 software. Results A total of 11 studies with 519 patients were included. The meta-analysis results revealed that compared with the control group, cardiac shock wave therapy could reduce hospitalization rates (RR=0.38, 95%CI 0.25 to 0.57, P<0.01), increase exercise time (SMD=0.93, 95%CI 0.17 to 1.70, P=0.02), and improve the Canadian Cardiovascular Society (CCS) angina grading (MD=−0.62, 95%CI −0.73 to −0.51, P<0.01), the New York Heart Association (NYHA) cardiac function grading (MD=−0.60, 95%CI −0.85 to −0.35, P<0.01), left ventricular ejection fraction (MD=4.81,95%CI 3.17 to 6.46, P<0.01), total score of the Seattle angina questionnaire (SAQ) (MD=10.87, 95%CI 4.63 to 17.12, P<0.01), and 6-min walking test (MD=85.06, 95%CI 31.02 to 139.09, P<0.01). Conclusion Cardiac shock wave therapy can improve cardiac function as well as the prognosis and exercise ability. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.