Predictive value of apolipoprotein for coronary atherosclerosis in asymptomatic non-diabetic population / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the potential correlation between apolipoprotein (Apo) levels and coronary atherosclerosis and investigate its predictive value for coronary artery lesions in asymptomatic population without diabetes.</p><p><b>METHODS</b>We performed a retrospective analysis of data collected from 401 asymptomatic patients who took health check-ups. They were divided into atherosclerosis group (n=224)and control group (n=177) based on the outcome of CT angiography and blood biochemical findings. The risk factors, lipid profiles, and Apo levels were compared between these two groups. The best biochemical indicators for predicting the coronary atherosclerosis were explored.</p><p><b>RESULTS</b>The levels of ApoB, ApoC2,ApoC3,and ApoE and ApoB/ApoA1 ratio were significantly higher in the atherosclerosis group than in the control group (all P<0.01), whereas the ApoA1,ApoA2, and lipoprotein a levels showed no such significant difference (all P>0.05). Logistic regression analysis revealed that age, male, hypertension,ApoC3(OR=1.572,95%CI 1.200-2.061) and ApoB/ApoA1 ratio (OR=1.767,95% CI 1.335-2.338) were independently correlated with coronary atherosclerosis (all P<0.01). In the prediction of the presence of plaque, ApoB had the largest area under curves, and the optimal cutoff point was 1.005 g/L.</p><p><b>CONCLUSIONS</b>ApoC3 is closely associated with subclinical coronary atherosclerosis,while the decrease of ApoA1 level is not obvious during this period. Compared with other lipid indicators, ApoB is the strongest predictor for coronary atherosclerosis in asymptomatic non-diabetic population.</p>

Correlation of creatine kinase with patency of stents using coronary computed tomography angiography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the potential correlation between creatine kinase and the long-term patency of coronary drug eluting stents.</p><p><b>METHODS</b>The clinical data of 74 patients who had undergone coronary computed tomography angiography after drug eluting stents implantation were retrospecpectively analyzed. Based on the computed tomography angiography findings,these patients were divided into patency group and non-patency group. The mean follow-up time was (20.5 ± 13.1) months. The serum levels of creatine kinase and creatine kinase isoenzyme were measured to determine the relationship of stent patency with these oxidative-related biomarkers after long-term follow-up. The T test or non-parametric test was adopted to compare the intergroup difference of measurement data,whereas chi-square test was conducted to test the difference of enumeration data. Logistic regression was adopted to analyze the biochemical indexes and clinical information. Only variables with a P value of less than 0.05 in the univariable analyses entered the multivariate Logistic regression model.</p><p><b>RESULTS</b>Patients in the non-patency group had significantly higher serum creatine kinase level compared with patients in patency group [(115.5 ± 51.5)U/L vs.(75.9 ± 29.4)U/L, P=0.012] and significantly higher level of creatine kinase isoenzyme [(3.5 ± 5.3)U/L vs.(1.7 ± 1.3)U/L,P=0.034]. Furthermore,the Logistic analysis showed that serum creatine kinase level (odds ratio=1.573,95% CI=1.022-2.421, P=0.039)was an independent predictor of stent patency.</p><p><b>CONCLUSION</b>Creatine kinase is an independent risk factor associated with stent non-patency.</p>

Value of coronary computed tomography angiography in ruling out coronary artery disease before intermediate- and high-risk non-cardiac surgery / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the value of preoperative coronary computed tomographic angiography (CCTA) in the detection of coronary artery disease (CAD) in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography (ICA).</p><p><b>METHODS</b>The study protocol was approved by our institutional review board and informed consent was given. In this prospective study, 157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved. The non-cardiac surgery included high-risk surgery (17 patients) and intermediate-risk surgery (140 patients). Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome (ACS) or death secondary to ASC, arrhythmias, cardiac revascularization, or cardiac failure. χ(2) test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA.</p><p><b>RESULTS</b>CCTA was of diagnostic value in 145 of 157 patients. Thirty-seven of 145 had no CAD, and 88 of 145 had no significant CAD (<50% stenosis), and non-cardiac surgery was performed in them without preoperative ICA. No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD (≥50% stenosis) and underwent surgery after preoperative ICA. CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA, and 4 of 12 underwent surgery after PCI or CABG. There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not (P=0.45).</p><p><b>CONCLUSIONS</b>In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events, preoperative CCTA is an effective diagnostic tool for detecting CAD. Preoperative ICA can be safely avoided in patients with normal findings or with stenosis<50% in CCTA.</p>

Clinical value of double respiratory navigator-gated high-resolution black-blood coronary artery wall magnetic resonance imaging / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the value of phase ordering with automatic window selection(PAWS)and simultaneous multiple volume(SMV)algorithm double respiratory navigator-gated two-dimensional(2DNAV)dual inversion recovery(DIR)fast spin echo(FSE)high-resolution black-blood coronary artery wall magnetic resonance imaging(MRI)and evaluate its advantages and limitations.</p><p><b>METHODS</b>PAWS and SMV 2DNAV DIR FSE high-resolution black-blood MRI was performed in 21 healthy volunteers. The images were evaluated qualitatively by using four grades(grade 0can not evaluate;grade 1bad;grade 2good;grade 3perfect). Images defined as grade 0 and grade 1 were excluded and those defined as grade 2 and 3 were evaluated further. Thickness of proximal(or middle)segment of right coronary artery(RCA)and left anterior descending branch(LAD)were measured. The difference of wall thickness was analyzed by using two-tailed independent sample t-test. P values of less than 0.05 were considered statistically significant.</p><p><b>RESULTS</b>Among the 38 slice images,31 slices(RCA13 slices,LAD18 slices;grade 214 slices,grade 317 slices)were obtained for further evaluation. The mean thickness of RCA and LAD was(0.94±0.16)and(0.89±0.15)mm,respectively,and the difference was not significant(t=-0.790,P>0.05).</p><p><b>CONCLUSION</b>PAWS and SMV algorithm 2DNAV DIR FSE high-resolution black-blood MRI has certain clinical value for coronary artery wall imaging.</p>

Diagnostic accuracy and its affecting factors of dual-source CT for assessment of coronary stents patency and in-stent restenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.</p><p><b>METHODS</b>One hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>Mean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79.</p><p><b>CONCLUSION</b>DSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.</p>

Volumetric measurement of pericardial and intrathoracic adipose tissues using coronary computed tomography angiography in patients with coronary heart disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the feasibility of volumetric measurement of pericardial adipose tissue (PAT) and intrathoracic adipose tissue (IAT) using coronary computed tomography angiography (CTA), and explore the characteristics of PAT and IAT distribution.</p><p><b>METHODS</b>The CTA images of 109 patients (aged 59.1∓11.7 years) with a clinical diagnosis of coronary heart disease were analyzed. The volumes of PAT and IAT were measured using the axial data from the base to the apex traced manually with the dedicated semiautomatic software program Volume. The related factors and gender difference of PAT and IAT were analyzed.</p><p><b>RESULTS</b>The pericardium was clearly defined on CTA images and the volumes of PAT and IAT were measured accurately in all the cases. The volumes of PAT and IAT were positively correlated to body weight and body mass index (BMI) but independent of age, and IAT was positive correlated to the body height. The IAT of male patients was 67% higher than that of female patients (P<0.05), whereas no such a difference was found in PAT (P<0.05).</p><p><b>CONCLUSION</b>CTA-based semiautomatic segmentation for volumetric quantification of PAT and IAT is highly accurate. The volumes of PAT and IAT are positively correlated to body weight and BMI, and PAT volume exhibits no statistical difference between male and female patients with coronary heart disease.</p>

Incidence of cerebral venous sinus thrombosis in patients with idiopathic intracranial hypertension / 眼科

Objective To explore the rate of incidence of cerebral venous sinus thrombosis(CVST)in patients with idiopathic in- tracranial hypertension(IIH).Design Restrospective case series.Participants 92 cases with idiopathic intracranial hypertension.Meth- otis All patients diagnosed with papilledema from January 1,2000 through May 1,2007 at our ophthalmology center.Consecutive pa- tients with a diagnosis of papilledema were identified.Patients with space-occupying lesions,hydrocepbalus,or meningitis were excluded. The remaining patients were evaluated with lumbar puncture,magnetic resonance imaging(MRI)and magnetic resonance venography (MRV).Main Outcome Measures The rate of incidence of cerebral venous sinus thrombosis(CVST)in patients with idiopathic in- tracranial hypertension(IIH).Results Excluding patients with mass lesions,meningitis,or hydrocephalus,the occurrence of CVST was 7 (7.6%)of 92 patients with presumed IIH.One additional patients had a diagnosis of suspected CVST.Cerebral venous sinus thrombosis was diagnosed in 1 of the 7 patients with MRI alone,whereas it was evident in all 7 patients with MRV.Conclusions Cerebral venous si- nus thrombosis accounts for 7.6% of patients with presumed IIH in our ophthalmology services.Magnetic resonance venography in com- bination with MRI is recommended to identify this subgroup of patients.(Ophthalmol CHN,2007,16:410-413)