Coronary atherosclerosis lesion features in coronary artery disease patients complicating with metabolic syndrome / 中华心血管病杂志

<p><b>PURPOSE</b>To compare coronary plaque burden, composition, distribution and the degree of coronary artery stenosis in invasive coronary angiography (ICA) diagnosed coronary artery disease (CAD) patients with or without metabolic syndrome (MetS).</p><p><b>METHODS</b>From January 2008 to June 2011, consecutive patients underwent both coronary computed tomography angiography (CCTA) and ICA within three months were enrolled. Patients with history of previous percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) were excluded. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification.</p><p><b>RESULTS</b>The study population consisted of 872 patients [age (60.2 ± 10.0) years, 72.70% males] including 377 patients with MetS and 495 patients without MetS. The median coronary artery calcium score (CACS) was higher in MetS patients than in non-MetS patients [102 (10, 410) vs. 58 (0, 274) , P < 0.01]. Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [19.63% (74/377) vs. 30.71% (152/495) , P < 0.01], while percentage of patients with severe coronary calcium (CACS ≥ 1000) were significantly higher in MetS than non-MetS group [8.22% (31/377) vs. 4.65% (23/495) , P = 0.03]. The proportion of patients with 1-vessel disease was lower [23.61% (89/377) vs. 36.77% (182/495), P < 0.01], 2-vessel [29.71% (112/377) vs. 22.83% (113/495), P < 0.05] and 3-vessel disease [35.54% (134/377) vs. 24.44% (121/495) , P < 0.01] were higher in MetS group than in non-MetS group. Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group (all P < 0.05) .</p><p><b>CONCLUSIONS</b>CAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of calcified plaque in the middle and distal coronary arteries and severer obstructive coronary vessels.</p>

Clinical features of patients with pulmonary artery hypertension associated with hereditary hemorrhagic telangiectasia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestations of patients with pulmonary artery hypertension (PAH) associated with hereditary hemorrhagic telangiectasia (HHT).</p><p><b>METHODS</b>This retrospective analysis summarized the clinical features of 6 patients with PAH associated with HHT hospitalized at department of cardiology in Cardiovascular Institute and Fuwai Hospital between January 2006 and May 2009.</p><p><b>RESULTS</b>The mean age of the 6 patients (3 male) was 34 years (8 - 67 years). Recurrent epistaxis were present in all patients, there were 4 patients with severe PAH and 2 patients with moderate PAH. All of the six patients with PAH associated with HHT were misdiagnosed at the first hospital visit. Clinical symptoms were significantly improved in 4 patients and remained unchanged in 2 patients combined hepatic venous malformation post medical therapy.</p><p><b>CONCLUSIONS</b>Misdiagnosis for patients with PAH associated with HHT is a common phenomenon in daily clinical practice. Patients could benefit from the corresponding medical therapy after the establishment of the correct diagnosis.</p>

Clinic diagnosis and treatment of patients with Cantrell syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the diagnostic feature, treatment and prognosis of patients with Cantrell syndrome.</p><p><b>METHODS</b>Clinical manifestation, diagnosis, operation and follow-up data of 5 patients with Cantrell syndrome were summarized in this retrospective analysis.</p><p><b>RESULTS</b>The age of the 5 patients was 7 days-76 years, definite diagnosis was made in 3 cases and 2 cases presented feature of incomplete Cantrell syndrome. Three patients with full Cantrell syndrome were correctly diagnosed before operation and confirmed by operation. One patient with incomplete Cantrell syndrome (two-vessel stenosis) received bypass surgery. Another asymptomatic patient with incomplete Cantrell syndrome (apical diverticulum of the left ventricle) does not need operation and is under observation. During follow-up, 1 patient died at 60 months after operation and the remaining 4 patients are alive and well.</p><p><b>CONCLUSIONS</b>With the development of modern imaging technology, it becomes easy to make correct diagnose Cantrell syndrome before operation. Prognosis is fine post timely operation and related intervention.</p>

Analysis of complications during and post interventional therapy of congenital heart disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the incidence and cause of complications during and after interventional therapy for congenital heart disease (CHD).</p><p><b>METHODS</b>From April 1986 to April 2009, 388 out of 6029 patients with CHD developed complications during and post interventional therapy, another 5 patients died post procedure, clinical data from these 393 patients were retrospectively analyzed. The patients with severe functional insufficiency requiring intervention or surgery during and after interventional therapy were classified as severe complications.</p><p><b>RESULTS</b>The overall complication rate was 6.44% [7.69% post atrial septal defect occlusion, 4.20% post patent ductus arteriosus (PDA) occlusion, 1.31% post percutaneous balloon pulmonary valvuloplasty, 14.94% post ventricular septal defect occlusion, 3.13% post percutaneous closure of aortopulmonary collaterals, 30.95% post catheter embolotherapy of pulmonary arteriovenous malformations, 12.50% post transcatheter closure of coronary artery fistulae, 20.00% post transcatheter closure of ruptured sinus of Valsava aneurysm, 66.67% post percutaneous balloon aortic valvuloplasty]. The severe complication rate was 0.65%(39/6029). The procedure-related mortality rate was 0.08% (5/6029), 0.26% (2/761) post percutaneous balloon pulmonary valvuloplasty, 0.05% (1/2070) post PDA occlusion, 9.10% (1/11) post balloon atrial septostomy, 33.33% (1/3) post percutaneous balloon aortic valvuloplasty. Emergency Cardiovascular surgery rate was 0.22% (13/6029). Selective surgery was required in 0.13% (8/6029) of patients post procedure. Two patients (0.03%) received permanent pacemaker implantation.</p><p><b>CONCLUSIONS</b>The severe complications and mortality rate of interventional therapy for CHD are relative low. Post procedure follow-up is needed fro monitoring possible procedure-related complications.</p>

Prevalence and risk factors of atrial tachyarrhythmia before and after percutaneous closure of secundum atrial septal defect in patients over 40 years of age / 中华心血管病杂志

<p><b>OBJECTIVE</b>In this study, we attempted to observe the prevalence and risk factors of atrial tachyarrhythmias (AT) before and after transcatheter closure of atrial septal defect (ASD).</p><p><b>METHODS</b>264 adult patients aged over 40 years (67 men and 197 women) who underwent transcatheter closure of ASD between September, 1997 and December, 2005 were included in this study. Incidence of preoperative and postoperative AT was analyzed, risk factors for AT were determined with multivariate stepwise logistic regression analysis.</p><p><b>RESULTS</b>Incidence of AT before closure was 9.1% (24/264). Twenty-nine patients (11.0 percent) developed AT after transcatheter closure (24 atrial fibrillation, 1 paroxysmal flutter, 4 paroxysmal atrial arrhythmia). The prevalence in patients of 40 to 49 years, 50 to 59 years and above 60 years was 4.3%, 14.6% and 26.3%, respectively. Most patients with atrial fibrillation were symptomatic. Compared to patients without AT, patients developed AT after closure were significantly older (53.0 +/- 7.6 years vs. 47.8 +/- 6.6 years, P < 0.01) and had larger defects (23.5 +/- 5.7 mm vs. 21.3 +/- 5.2 mm, P > 0.05), higher systolic pulmonary pressure (38.4 +/- 13.1 vs. 34.1 +/- 10.1, P < 0.05), larger left atrium dimension [(38.0 +/- 3.9) mm Hg (1 mm Hg = 0.133 kPa) vs. (33.6 +/- 4.4) mm Hg, P < 0.01], larger end diastolic right ventricular dimension [(34.7 +/- 5.9) mm vs. (32.1 +/- 6.8) mm, P > 0.05], higher incidence of tricuspid regurgitation (96.6% vs. 75.3%, P = 0.01), higher incidence of preoperative AT (51.7% vs. 3.8%, P < 0.01) and higher incidence of hypertension (27.6% vs. 10.2%, P = 0.013). Multivariate analysis showed that older age [odds ratio (OR) 2.659, 95 percent confidence interval (CI) 1.080 to 6.547, P < 0.05], presence of preoperative AT (OR 54.311, CI 9.819 to 300.395, P < 0.01), and left atrial enlargement (OR 8.529 per 10 mm increment, CI 2.162 to 33.643, P < 0.01) were independent predictors of AT after closure.</p><p><b>CONCLUSIONS</b>Incidence of AT was similar before and after percutaneous closure in patients with atrial septal defects aged 40 years and over. The risk of AT is related to the age at the time of transcatheter closure, the presence of preoperative AT and enlarged left atria.</p>

Atherosclerotic aortic ulcers monitoring by electron beam CT or multi-slice CT / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the evolution of medically treated atherosclerotic aortic ulcers by computed tomography (CT).</p><p><b>METHODS</b>Thirty-five patients (31 men and 4 women, aged from 40 to 79 years, mean 56.2 +/- 10.8 years) with known aortic ulcers were monitored by CT (follow up time 7 - 730 days, mean 135 days), 80 - 100 ml contrast media (Ultravist 300 or 320, or Omnipaque 300 or 320 mg/ml) was injected with a rate of 3.5 - 4.5 ml/s. The scan delayed time was 18 - 30 s. Ulcers dimensions were measured according to maximum depth, maximum length and maximum width.</p><p><b>RESULTS</b>Thirty-one patients with intramural hematomas and 1 patient with atherosclerotic aortic arch aneurysm without intramural hematoma were medically treated and another 3 patients were surgically treated. Intramural hematoma regression was monitored in 31 medically treated patients with intramural hematomas. CT was repeated at 2 weeks, 3 and 6 months. Intramural hematoma resolved gradually during follow up [thickness: (7.69 +/- 4.24) mm at 3 months, (3.06 +/- 1.67) mm at 6 months, P < 0.05 vs. 1st CT: (11.96 +/- 4.16) mm while ulcer maximum depth (11.17 +/- 6.03) mm at 3 months, (11.35 +/- 5.59) mm at 6 months, P < 0.05 vs. 1st CT: (7.36 +/- 6.61) mm, maximum width (14.40 +/- 6.35) mm at 3 months, (18.55 +/- 10.94) mm at 6 months, P < 0.05 vs. 1st CT: (7.15 +/- 6.39) mm, maximum length (17.12 +/- 7.15) mm at 3 months, (18.13 +/- 10.89) mm at 6 months, P < 0.05 vs. 1st CT: (11.64 +/- 10.06) mm increased progressively during follow-up].</p><p><b>CONCLUSION</b>CT was a useful tool for deflecting atherosclerotic aortic ulcers and monitoring therapeutic effects.</p>

Morphological features of secundum atrial septal defect in adult and implications for transcatheter closure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the morphological features of secundum atrial septal defect (ASD) in adult and the implications for transcatheter closure.</p><p><b>METHODS</b>Transcatheter closure using Amplatzer duct occluder was performed in 272 adult patients with ASD from September 1997 to December 2005. The morphological features were evaluated by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). The size, length and thickness of rims, occluder diameter, the complete closure rate, residual shunt rate and complications were compared in patients with deficient and/or thin rims (Group A, n = 135) and patients with well-developed rims (Group B, n = 137).</p><p><b>RESULTS</b>The complete closure rate was 97.8% (132/135) in group A and 99.3% (136/137) in group B. There were 74 cases with deficient rims, 39 cases with thin rims and 22 cases with both deficient and thin rims in group A. Gender distribution, age, operation successful rate, residual shunt rate and complication rate were similar between the 2 groups. The defect diameters measured by TTE (18.9 +/- 5.5 mm vs. 16.5 +/- 4.8 mm, P < 0.01), TEE (22.7 +/- 5.0 mm vs. 20.0 +/- 5.5 mm, P < 0.01) and occluder diameters used (29.1 +/- 5.7 mm vs. 26.0 +/- 5.9 mm, P < 0.01) were significantly larger in groups A than that in group B. The systolic pulmonary artery pressure was also significantly higher in groups A than that in groups B (36.9 +/- 11.9 mm Hg vs. 32.6 +/- 9.1 mm Hg, P < 0.01). There are significant correlations between occluder diameters and defects measured by either TTE or TEE in both groups (group A, TTE: r = 0.709, TEE: r = 0.850; group B, TTE: r = 0.716, TEE: r = 0.915, P all < 0.01).</p><p><b>CONCLUSIONS</b>Poor residual rims were found in around 50% of adult patients with ASD. Transcatheter closure of these defects could be successfully performed with larger occluders. The defect diameters measured by TTE and TEE, especially the latter, could guide the occluder selection.</p>

Clinical evaluation of intracoronary in-stent stenosis by electron-beam CT single flow mode study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic accuracy and clinical value of electron-beam CT (EBCT) single flow mode study (EBCTSF) in combination with EBCT coronary angiography (EBCTCA) and three dimensional reconstruction using medial axis reformation (MAR) for diagnosis of coronary in-stent stenosis.</p><p><b>METHODS</b>Electrocardiogram-gated EBCT single coronary scanning (without and with contrast medium) was performed in 25 consecutive coronary heart disease (CHD) patients during a short breathhold. EBCTSF was then performed at the level nearly distal to stent. Three-dimensional coronary images were reformed using MAR. EBCT findings were compared with that of conventional coronary angiography (CAG).</p><p><b>RESULTS</b>Thirty-five intracoronary stents were implanted in thirty-one diseased vessel segments. EBCTSF procedure was unsuccessful in 2 patients (successful rate was 92.0%, 23/25). There was a significant decrease in flow peak value (Dp), increased value (Deltad) and area under curve (A), and a significant increase in prolonged peak time (Td) in stenosed stents compared to normal stents (P < 0.05). EBCTCA was successful for all patients. Seven stenosed stents (5 in left anterior descending branch and 2 in right coronary) were correctly evaluated with EBCT. Compared with CAG, EBCTSF in combination with EBCTCA images and MAR reconstruction images had a diagnostic sensitivity of 85.0% (6/7) and a specificity of 92.9% (26/28) for detecting significant in-stent stenosis (> 50% lumen diameter). Positive and negative predictive value were 75.0% (6/8) and 96.5% (26/27) respectively. Compared with EBCT cross-section images alone, or cross-section images and three-dimensional images, the diagnostic accuracy increased from 80.0% and 88.6% to 91.4% (32/35).</p><p><b>CONCLUSIONS</b>Noninvasive EBCTSF can be used to quantitatively analyze coronary flow characteristics. This technique, used in combination with EBCTCA and three dimensional reconstruction using MAR, seems to be an effective imaging modality in identifying coronary in-stent stenosis. For stent-implanted patients with atypical and nonischemic chest pain after coronary intervention, the above-mentioned technique is of important value for evaluating therapeutic effect and follow-up results.</p>

Effects of image quality of intravenous three-dimensional electron beam coronary angiography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To identify reasons for poor image quality and nonassessability of coronary artery segments, and compare results between early and late diastolic triggering on coronary electron beam angiography (EBA).</p><p><b>METHODS</b>One hundred patients referred for EBA were studied. Contrast-enhanced transaxial coronary images were acquired using electrocardiographic triggering and reconstructed three-dimensionally using volume rendering techniques. The image quality of coronary segments and image artifacts were analyzed statistically.</p><p><b>RESULTS</b>Volume rendering was failed in 7 patients (7%) due to cardiac and breathing motions. Image quality was the best with the left main (LM), and worst with the left circumflex (LCX) coronary artery (P < 0.001). The image quality decreased systematically from proximal to distal within each coronary artery (P < 0.001). Forty percent R-R interval triggering on electrocardiography was better than 80% for image quality. The nonassessable segments occurred in 3% of LM, 2%, 8%, and 5% of proximal, 24%, 22%, and 12% of mid, 64%, 45%, and 20% of distal segments of the left anterior descending (LAD), LCX, and right coronary artery (RCA), respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>The major limitations of coronary EBA are in suboptimal spatial resolution and image artifacts. The image quality could be improved by using optimal electrocardiographic triggering.</p>

A comparative study of the influence of different bowtie of 64 multi-slice CT on cardiac image quality and radiation dosage / 中华放射学杂志

0.05 indicating no statistical difference.However,the noise measurements for the L and C groups were 30.05 and 27.80,respectively,with P

The diagnosis of atherosclerotic aortic ulcer by electron beam CT / 中华放射学杂志

Objective To evaluate the clinical value of electron beam computed tomography (EBCT)in the diagnosis of atherosclerotic aortic ulcer.Methods Sixty-eight consecutive patients(55 men and 13 women,aged 40—85 years,mean 65.12?9.55 years)with atherosclerotic aortic ulcer,who underwent EBCT scans from December 2001 to December 2004,were studied retrospectively.Contrast- enhanced continuous volume scanning(CVS)was performed by Imatron C-150XP EBCT scanner with 6 mm or 3 mm slice thickness and 100 milliseconds acquisition time.The scan was started 18—30 s after the injection of 80—100 ml contrast medium at the rate of 3.5—4.5 ml/s.Results In sixty-eight patients with atherosclerotie aortic ulcer,50 patients had acute aortic syndromes,36 had intramural hematomas,15 had atherosclerotic aortic aneurysms,3 had aortic dissections.46 patients with progresive ulcer usually had acute aortic syndrome while 22 patients with stable ulcer didn't(P

Noninvasive detection and evaluation of coronary atherosclerotic plaques with multi-slice spiral CT:a comparative study with intravascular ultrasonograhy / 中华放射学杂志

Objective To evaluate the capability and accuracy of multi-shce spiral computed tomography(MSCT)in detecting atherosclerotic plaques in nonstenotic coronary arteries with reference to the findings of intravascular ultrasound(IVUS)in a segment analysis.Methods Both IVUS exams and 16-row MSCT scans were performed on 35 consecutive patients among whom 30 patients had successful MSCT scans.A total of 94 coronary segments without significant coronary stenoses were paired-analyzed both on IVUS and MSCT segment by segment.The plaques were classified as calcified,fibrotic and soft types according to the echogeneity on IVUS.Plaque attenuation on MSCT was measured and expressed by Hounsfield units(HU).Results When referred to IVUS,MSCT had a sensitivity of 82.1%(46/56)and specificity of 89.5% (34/38),respectively in detectiong any plaques.For the detection of calcified plaques,the sensitivity and specificity were 92.1%(35/38)and 96.4%(54/56),respectively.For the detection of mixed and noncalcified plaques,MSCT had sensitivity of 73.2%(30/41)and specificity of 88.7%(47/53).But for the detection of the noncalcified plaque,the sensitivity was 66.7%(12/18). According to the findings On IVUS,the plaques were classified as calcified(n=19),fibrotic(n=19)and soft(n=16).The CT attenuation of calcified plaques was(489?169)HU(196 to 817 HU),fibrotic plaques(69?21)HU(25 to 117 HU)and soft plaques(23?18)HU(-12 to 47 HU).Nonparametric Kruskal-Wallis test revealed a significant difference of plaque attenuation among the three groups(P

Preliminary study of X-ray dosage reduction using post-processing filter in 64-slice spiral CT cardiac examination / 中华放射学杂志

0.05).(3)The average CTDIvol values were 60?5 mGy,88?10 mGy for 2C_2 and NC_2(C_2)groups,respectively.The corresponding ED values were(12.3?1.0)and(18.0?2.0)mSv,respectively.The CTDIvol and ED values for 2C_2 group were about 32% lower than those of NC_2 group and were statistically significant with P

Radiography comparison of the pulmonary embolism / 中华放射学杂志

Objective To evaluate the application value of X-ray,echocardiogram,pulmonary perfusion scintigraphy,EBCT,Magnetic resonance Pulmonary angiography in diagnosis of PTE.Methods Twenty-five consecutive patients clinically diagnosed of having PTE were examined from july 2003 through March 2004. Patients underwent X-ray chest plain film, echoeardiogram, electronic beam computed tomographie (EBCT)angiography,ventilation-perfusion (V-P)seintigraphy,Magnetic resonance Pulmonary angiography (MRPA)and puhnonary angiography according to a strict diagnostic protocol.Two of the independent readers reviewed the pulmonary angiography and record all of the lobe and segmental involved in PTE and compared with other image method.Results Pulmonary angiography:all of the patients success underwent the technique,the pulmonary artery branch with PTE was in 556 of 775 branches (71.7%). Chest radiography had hints of diagnosis in 12 of 25 patients.Nine patients diagnosed with echocardiogram. Right heart enlargement was in 21,and pulmonary hypertension in 18.V-P scintigraphy revealed 247 segmental involved with PTE of 500 (52.0% ),and the sensitivity was 64.66% compare with the pulmonary angiography.There were 523 pulmonary branches involved PTE with EBCT pulmonary angiograpy of 775 branches,and the sensitivity was 94.06%.MRPA: 8 of 10 patients succeed in the technique, 155 branches of 248 were detected with PTE(62.5% ),the sensitivity was 81.29%.Conclusions EBCT is a high sensitivity method in diagnosis of PTE.Chest radiography and echocardiogram are the first-line modality of PTE.V-P scintigrapby is the valid compensation in diagnosis subsegmental pulmonary artery with PTE when EBCT miss diagnosis.Gd-CE-MRPA may be the second-line modality in diagnosis of PTE.