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.
ObjectiveTo investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. MethodsWe retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. ResultsA total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events. ConclusionMulti-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.
Objective To provide evidence for timely diagnosis and treatment of Kawasaki disease through assessing the relationship between the duration of fever and the incidence of coronary artery lesion in patients with Kawasaki disease. Methods To retrospectively analyze the clinical information of 352 inpatients with Kawasaki disease (including typical Kawasaki disease, incomplete Kawasaki disease, and non-responsive to intravenous immunoglobulin treatment Kawasaki disease ) from January 1997 to December 2007. The relationship between the duration of fever and the incidence of coronary artery lesion was presented by a linear trend plot, using Cochran-Armitage trend test. A value of P lt; 0.05 was considered statistically significant. Results Among 352 patients with Kawasaki disease, 88 had coronary artery lesions. Sixty-eight out of 294 patients with typical Kawasaki disease, 20 out of 58 patients with incomplete Kawasaki disease, and 18 out of 44 patients with non-responsive Kawasaki disease had coronary artery lesions. Linear trend analysis showed that the duration of fever in all 352 patients with Kawasaki disease and 294 cases with typical Kawasaki disease was positively correlated with the incidence of coronary artery lesion (Plt;0.05). However, in patients with incomplete Kawasaki disease and non-responsive Kawasaki disease, the relationship between the duration of fever and the incidence of coronary artery lesion was not significant (Pgt; 0.05). Conclusion The longer the duration of fever was in patients with Kawasaki disease, higher the risk of coronary artery lesion.
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.
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.
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.
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.
Abstract： Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenosesusing 64-multislice spiral computed tomography （64-MSCT） scanner compared with selective coronary angiography（SCA）. Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of （58.2±8.5） years in West China Hospital between April 2004 and December 2010. The cardiacrhythm of all the patients was stably sinus. Patients with initial heart rates≥90 time/min were received treatments of β-blockers. All available coronary segments（internal diameter ≥ 2.0 mm）were included in the evaluation. Lesions with ≥ 50％ luminalnarrowing were considered as significant stenosis. According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ ,with rank Ⅰ to Ⅲ meeting demands of image evaluation. Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery. Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA. All of the coronary segments involved （n=1 238） met the quality demands of being evaluated as rankⅠ to Ⅲ. Considering SCA as the golden standard， overall sensitivity for classifying stenosis using 64-MSCT scannerwas 88.8%（427/481）， specificity was 91.7%（694/757）， positive predictive value was 87.1%（427/490），and negative predictive value was 92.8%（ 694/748）.While the stenosis diagnostic accuracy of proximal left circumflexbranch and the first obtuse marginal branch of left coronay artery is lower than other branches： the sensitivity of the proximal left circumflex branch was 68.3%（41/60），specificity was 60.6%（20/33），positive predictive value was 75.9%（41/54），negative predictive value was 51.3%（20/39）；the sensitivity of the first obtuse marginalbranch was 58.8%（10/17），specificity was 93.5%（58/62），positive predictive value was 71.4%（10/14），negative predictive value was 89.2%（58/65）. Arterial wall calcification and false image of cardiac movements were the maininfluence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner. Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery. The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy. Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronarysegments.
Objective To compare the clinical effects of coronary artery bypass grafting (CABG) via the left anterior small thoracotomy (LAST) versus lower-end sternal splitting (LESS) approach in the treatment of coronary heart disease. Methods The patients who underwent LAST CABG in Tianjin Chest Hospital from October 2015 to December 2020 were allocated to an observation group (LAST group), and the patients who underwent LESS CABG at the same period were allocated to a LESS group. Propensity score matching method was applied with a ratio of 1∶1. The baseline data, perioperative data and grafts data were compared between the two groups after matching. Results Before matching, there were 110 patients in the LAST group, and 206 patients in the LESS group. After matching, there were 110 patients in each group. In the LAST group, there were 83 males and 27 females with an average age of 60.6±8.3 years. In the LESS group, there were 80 males and 30 females with an average age of 61.0±9.6 years. There was no statistical difference in baseline data between the two groups after matching (P>0.05). The hospital stay time (t=2.255, P=0.025) and ventilator using time (t=−2.229, P=0.027) in the LAST group were significantly shorter than those in the LESS group. There were no statistical differences between the two groups in the postoperative hospital stay time, ICU stay time, postoperative left ventricular ejection fraction, postoperative left ventricular end-diastolic diameter, average number of grafts, secondary intubation, secondary thoracotomy, postoperative wound infection, sternal complications, postoperative atrial fibrillation, postoperative pulmonary infection or main adverse cardiovascular and cerebrovascular events (P>0.05). There was no statistical difference in the distribution of target vessels in the anterior descending branch, diagonal branch or posterior descending branch between the two groups (P>0.05). The grafts of the LAST group were significantly more than those of the LESS group in the area of obtuse marginal branch and posterior ventricular branch, and the grafts of the LESS group were significantly more than those of the LAST group in the area of right coronary artery (P<0.05). Postoperative computerized tomography angiography indicated that 1 patient in the LAST group had obtuse marginal branch vein bridge vessel occlusion, and the bridge vessels in the other patients were unobstructed. Conclusion Minimally invasive CABG via both LAST and LESS approaches is safe and effective. LAST approach can achieve complete revascularization for multi-vessel lesions, and it is safe and reliable, with the advantages of less trauma and aesthetic appearance. However, it requires a certain learning curve of surgical techniques and certain surgical indications.
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.