Objective To explore the correlation between traditional Chinese medicine (TCM) blood stasis pattern of coronary heart disease (CHD) and coronary angiography result, so as to screen dangerous patterns and provide evidence for the objectification of TCM pattern differentiation. Methods Literature on correlation between blood stasis pattern and coronary angiography results from January 1992 to May 2012 were searched in the following databases: China Academic Journal Network Publishing Database (CAJD), Chinese Biomedical Literature Database (CBM), China Doctor Dissertation Full-text Database (CDFD), Chinese Selected Master’s Theses Full-Text Databases (CMFD), PubMed and MEDLINE. According to the inclusion and exclusion criteria, literature screening, data extraction and methodological quality assessment of the included studies were conducted. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 28 studies involving 4 901 patients were included. The results of meta-analysis showed that, there is a significant significance between blood stasis pattern and the following coronary angiography result, namely, number of culprit vessels (OR=1.38, 95%CI 1.08 to 1.77, Plt;0.05), severity of stenosis (OR=1.79, 95%CI 1.04 to 3.08, Plt;0.05), and Gensini score (OR=7.74, 95%CI 3.99 to 11.49, Plt;0.05). Conclusion Compared with other TCM patterns, CHD with blood stasis pattern easily tends to present multi-vessels lesions, more than 75% stenosis and higher Gensini score, indicating the condition of CHD with blood stasis pattern is more severe than with other patterns. Due to the discrepancy of pattern differentiation and the limited quality of original studies, this conclusion is insufficient to be fully applied into clinical practice, and more large scale and high quality clinical trials are required.
Objective To explore clinical application and significance of coronary angiography （CAG） prior to heart valve replacement for patients with rheumatic valvular heart disease （RVHD）. Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results，313 patients were divided into two groups. In the coronary artery lesion （CAL） group，there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion （non-CAL）group，there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL，and the overall prevalence of CAL was 9.27%. In CAL group，11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient （3.45%） died of low cardiac output syndrome （LCOS）. In non-CAL group，5 patients （1.76%） postoperatively died mainly because of LCOS，ventricular fibrillation，sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group （P＜0.05）. There was no statistical difference in postoperative mortality，incidence of LCOS，acute renal failure，respiratory failure，reexploration for bleeding，intraoperative blood loss，mechanical ventilation time or hospital stay between the two groups（P＞0.05）. There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years （OR=5.534，P=0.005），male gender （OR=2.335，P=0.038） and diabetes mellitus （OR=4.265，P=0.006） were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL （age≥55 years，male gender and diabetes mellitus），CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.
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 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.
The diameter of the giant coronary artery aneurysm is at least 4 times bigger than that of the normal coronary artery and 2-3 times bigger than that of the normal coronary artery aneurysm. Giant coronary artery aneurysm is rare in clinic with a reported morbidity which is less than 0.3%. Just like ordinary coronary artery aneurysm, coronary artery atherosclerosis is the main cause of the giant coronary artery aneurysm. Most giant coronary artery aneurysms are asymptomatic, but some patients may have heart-related clinical emergency in short term and may have thrombosis which can lead to embolism and fistula which can cause rupture in long term. Surgical treatment is the first chioce for giant coronary artery aneurysm now. However, the interventional therapy will also be an important way to treat the disease in the future. In this article, we review the diagnosis, clinical manifestation, treatment and other aspects of giant coronary artery aneurysm as follows.
ObjectivesTo systematically review the efficacy and safety of intravascular ultrasound (IVUS) and coronary angiography-guided percutaneous coronary intervention (PCI) in left main coronary artery disease. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the efficacy and safety of IVUS and coronary angiography-guided PCI in left main coronary artery disease from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 7 studies involving 7 777 patients were included. The results of meta-analysis showed that: compared with PCI guided by coronary angiography, the incidence of cardiac death (OR=0.45, 95%CI 0.34 to 0.61, P<0.000 01), myocardial infarction (OR=0.67, 95%CI 0.53 to 0.84, P=0.004), major adverse cardiovascular events (OR=0.46, 95%CI 0.34 to 0.61, P<0.000 01), total deaths (OR=0.54, 95%CI 0.44 to 0.67, P<0.000 01), and in-stent thrombosis (OR=0.28, 95%CI 0.18 to 0.45, P<0.000 01) occurred in PCI guided by IVUS were lower. The differences were statistically significant. However, there were no statistical significance in the incidence of target revascularization in PCI (OR=0.80, 95%CI 0.40 to 1.61, P=0.54) and revascularization of target lesions (OR=0.68, 95%CI 0.36 to 1.27, P=0.23) between two groups.ConclusionsCurrent evidence shows that the IVUS-guided PCI can decrease the incidence of cardiac death, myocardial infarction, MACEs, stent thrombosis, total death and has no effect on target lesion revascularization and target vessel revascularization. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Coronary angiography (CAG) as a typical imaging modality for the diagnosis of coronary diseases hasbeen widely employed in clinical practices. For CAG-based computer-aided diagnosis systems, accurate vessel segmentation plays a fundamental role. However, patients with bradycardia usually have a pacemaker which frequently interferes the vessel segmentation. In this case, the segmentation of vessels will be hard. To mitigate interferences of pacemakers and then extract main vessels more effectively in CAG images, we propose an approach. At first, a pseudo CAG (pCAG) image is generated through a part of a CAG sequence, in which the pacemaker exists. Then, a local feature descriptor is employed to register the relative location of pacemaker between the pCAG image and the target CAG image. Finally, combining the registration result and segmentation results of main vessels and pacemaker, interferences of pacemaker are removed and the segmentation of main vessels is improved. The proposed method is evaluated based on 11 CAG images with pacemakers acquired in clinical practices. An optimization ratio of the Dice coefficient is 12.04%, which demonstrates that our method can remove overlapping pacemakers and achieve the improvement of main vessel segmentation in CAG images.Our method can further become a helpful component in a CAG-based computer-aided diagnosis system, improving its diagnosis accuracy and efficiency.