目的:通过冠脉造影探讨心电图对冠心病的诊断价值。方法:对226例可疑冠心病患者进行心电图与冠脉造影进行对比分析。结果:心电图诊断冠心病的灵敏度为 86.49％,特异度为 65.38％,假阳性率为3462％,假阴性率为 13.51％。心电图随着冠状动脉病变支数增加而检出冠心病的阳性率增高。结论:心电图是临床诊断冠心病最快捷、简便、经济而无创的有效方法,但仍存在一定的局限性。
睡眠呼吸障碍（sleep breathing disorders，SDB）是一种常见病、多发病，其主要类型是阻塞性睡眠呼吸暂停综合征（OSAS），特点是夜间睡眠过程中上气道完全或部分阻塞及呼吸中枢驱动降低导致呼吸暂停及低通气，产生慢性间歇性低氧、反复微觉醒、睡眠结构异常、自主神经功能紊乱等。OSAS近年已公认是一种全身性疾病，它可引起或加重许多疾病,美国心脏协会/美国心脏病学基金会（AHA/ACCF）联合发表了《睡眠呼吸暂停与心血管疾病的科学共识》。为了进一步认识两者之间的关系，提升OSAS及相关疾病防控水平，中华医学会呼吸病分会睡眠学组与心血管病学组就SDB与心血管疾病相关问题达成共识，为多学科联合防治SDB提供了科学依据。
摘要:目的:了解血肌酐清除率受损是否与冠心病患病率存在联系。方法:纳入2006年7月至2008年2月期间经冠状动脉造影证实的冠心病患者及年龄、性别匹配的对照组,按血肌酐清除率值将患者分为正常［≥90 mg/（mL·173 m2)］,轻度受损［≥60 mg/（mL·1.73 m2）,lt;90 mg/（mL·1.73 m2)］和明显受损［lt;60 mg/（mL·1.73 m2)］。比较冠心病组与对照组各组人群的比例有无差异。结果:研究期间共纳入冠心病组和对照组患者各116例。在冠心病组中,血肌酐清除率正常患者82例、轻度受损29例、重度受损5例,对照组中,正常患者98例、轻度受损13例、重度受损5例,〖JP3〗两组比较分布有统计学差异(χ2值7.517,P=0.023)。与对照组比较,冠心病组的血清肌酐值无明显差异（Pgt;005)，〖JP〗冠心病组（103.29±51.08） μmol/L,对照组（102.67±41.21）μmol/L。结论:血肌酐清除率降低是冠心病的危险因素。Abstract: Objective: To disclose the relation of the estimated glomerular filtration rate (eGFR) and coronary artery disease. Methods：We analyzed eGFR in the patients with coronary artery disease confirmed by coronary angiography and the control, and compared the proportion of patients with reduced renal function in the different groups. Results: A total 116 cases were included in each group. Among these patients, normal renal function, mildly and severe reduced renal function was documented in 82, 29 and 5 in coronary artery disease group, and in 98, 13 and 5 in the control group, respectively. In comparison to the control, more patients with reduced eGFR were found in coronary artery disease group (χ2 value 7.517,P=0.023), although no significant difference was observed between both groups（Pgt;0.05). Conclusion: Reduced eGFR, even if mildly, could be regarded as the risk factor of coronary artery disease.
Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.
Objective?To explore the glucometabolic state of angiographically documented inpatients with coronary artery disease (CAD) but without diagnosed diabetes mellitus (DM). Methods?The study recruited 449 patients, who were performed a coronary angiography as well as an oral glucose tolerance test (OGTT) when admitted in the cardiovascular medical ward in our hospital from January 2007 to May 2009. According to the results of coronary angiography, the patients were divided into a coronary artery disease (CAD) group and a non-coronary artery disease (non-CAD) group, and abnormal glucose metabolism (AGM) status was compared between the two groups. Results?The random plasma glucose (RPG) and fasting plasma glucose (FPG) had no significant differences (P values were 0.249 and 0.444, respectively) in the two groups, while the OGTT 2-hour plasma glucose (2hPG) was much higher in the CAD group, with a significant difference (Plt;0.001) compared with the non-CAD group. The CAD group had a prevalence of AGM up to 74.0%, of which 32.1% were newly diagnosed DM patients, and 39.0% were impaired glucose tolerance (IGT) patients, much higher than that in the non-CAD group, respectively, there being a significant difference (P=0.006). Logistic regression analyses revealed that the risk of IGT and newly diagnosed DM was 1.6 times (OR=1.603, 95% CI 1.023 to 2.512, P=0.04) and 2.3 times (OR=2.292, 95% CI 1.391 to 3.777, P=0.001) as much as that in non-CAD patients, respectively; when adjusted for the factors such as hypertension, dyslipidemia, BMI, hs-CRP, and other factors, CAD patients still had a higher risk of newly diagnosed DM (OR=1.852, 95%CI 1.064 to 3.223, P=0.029), compared with the non-CAD patients. Conclusion?AGM is common in the admitted patients with CAD but undiagnosed diabetes, most of whom need an OGTT to be diagnosed timely and accurately. OGTT should be considered to be a routine inspection item to diagnose AGM in the inpatients with CAD; if possible, all hospitalized patients with cardiovascular disease should be performed an OGTT routinely.
目的 探讨冠状动脉钙化检测联合动态心电图对冠心病的诊断价值及临床应用。 方法 对2010年5月－2011年8月住院的108例拟诊冠心病的患者同期进行128排螺旋CT冠状动脉钙化积分检测、动态心电图和冠状动脉造影，对比研究冠状动脉钙化检测联合动态心电图预测冠心病的价值。 结果 冠状动脉钙化阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为75.6%、81.0%、73.9%、82.3%；动态心电图阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为73.3%、76.2%、68.8%、80.0%；冠状动脉钙化检测联合动态心电图的系列实验的特异度和阳性预测值分别达到96.8%和92.9%，平行试验的灵敏度和阴性预测值分别达到93.3%和92.7%，均显著高于单项试验的相应指标（P＜0.05）。 结论 高分辨率螺旋CT冠状动脉钙化检测联合动态心电图显著提高冠心病的诊断价值，可作为老年患者及基层医院冠心病首选的筛选检查。
【摘要】目的 探讨胸部X线片检查发现的主动脉弓钙化与冠心病的不同临床表现类型的相关性。方法 回顾分析2006年7月-2008年2月期间经冠状动脉造影证实的冠心病患者的临床资料,对比分析胸部平片所见的主动脉弓钙化情况与冠心病不同临床类型的相互关系。结果 116例经冠状动脉造影证实的冠心病患者纳入研究。其中,稳定型心绞痛40例,急性冠脉综合征76例(不稳定型心绞痛21例、非ST段抬高心肌梗死38例、ST段抬高心肌梗死17例)。40例稳定型心绞痛患者中,有主动脉弓钙化者21例,占52.5%;76例急性冠脉综合征患者中,有主动脉弓钙化者22例,占28.9%。与急性冠脉综合征相比,更多的稳定型心绞痛患者合并有主动脉弓钙化(χ2=6232,P=0013)。结论 在不同的冠心病临床类型,主动脉弓钙化更易在稳定型心绞痛患者中发现。【Abstract】 Objective To investigate the relationships between calcification of aortic arch and different clinical classification of coronary artery disease. Methods The clinical data of patients with coronary artery diease who diagnosed by arteriography from July 2006 to February 2008, were retrospectively analyzed. The Xray data on calcification of aortic arch and clinical characteristics of patients with coronary artery disease confirmed by coronary angiography were analyzed. The relationship between coronary calcification of aortic arch which showed by Xray and different clinical classification of coronary artery disease were comparatively analyzed. Results Among the total of 116 patients, 40 stable angina and 76 acute coronary syndrome were included, and 21 (52.5%) and 22 (28.9%) patients with calcification of aortic arch were observed respectively. In comparison to patients with acute coronary syndrome, more stable angina patients were complicated with calcification of aortic arch (χ2 =6232,P=0013). Conclusion It is more likely to document calcification of aortic arch in patients with stable angina.
ObjectiveTo explore the incidence of total occlusion of right coronary artery (RCA)and its treatment strategy during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January 1, 2005 to December 31, 2012. There were 889 male (77.1%)and 264 female (22.9%)patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. ResultsAmong 6 206 OPCAB patients, 1 153 patients (18.6%)had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients (1.1%)died postoperatively. Thirty-four patients (2.9%)had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients (97.4%)were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. ConclusionThe incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.
To declare the clinical value of lowing serum LDL-C level in coronary heart disease by reviewing the history of its clinical trials in the last 4 decades.