Coronary Stenosis ; etiology ; pathology ; Diagnostic Imaging ; Humans

The emergence of multi-slice spiral computed tomography (MSCT) has a significant influence on cardiovascular imaging. As a noninvasive technique, MSCT is considered suitable for the evaluation of coronary artery stenosis, quantitative and qualitative assessment of plaque, analysis of cardiac function and myocardial perfusion imaging, and determination of the patency of stents or bypass grafts. Recent studies has shown that noninvasive coronary artery imaging with MSCT is a feasible screening test for suspected coronary artery diseases and a valuable follow-up tool for patients who have undergone interventional or surgical therapeutic procedures.
Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Coronary Stenosis ; diagnostic imaging ; Humans ; Tomography, Spiral Computed

Coronary artery fractional flow reserve (FFR) is a critical physiological indicator for assessment of impaired blood flow caused by coronary artery stenosis. The wire-based invasive measurement of blood flow pressure gradient across stenosis is the gold standard for clinical measurement of FFR. However, it has the risk of vascular injury and requires the use of vasodilators, increasing the time and overall cost of interventional examination. Coronary imaging is playing an important role in clinical diagnosis of stenotic lesions, evaluation of severity of lesions, and planning of therapies. In recent years, the computation of FFR based on the physiological information of blood flow obtained from routinely collected coronary image data has become a research focus in this field. This technique reduces the cost of physiological assessment of coronary lesions and the use of pressure wires. It is beneficial to strengthen the physiological guidance in interventional therapy. In order to better understand this emerging technique, this paper highlights its implementation principle and diagnostic performance, analyzes practical problems and current challenges in clinical applications, and discusses possible future development.
Humans ; Coronary Vessels/diagnostic imaging* ; Fractional Flow Reserve, Myocardial ; Heart ; Constriction, Pathologic ; Coronary Stenosis/diagnostic imaging*

Coronary Stenosis ; diagnostic imaging ; Humans ; Ultrasonography, Interventional ; methods

OBJECTIVES: To check the isolated heart by coronary angiography to discover the location, nature and degree of the coronary artery lesions more accurately and increase the comprehensive evaluation ability of cardiovascular disease. METHODS: Ten fresh isolated hearts with different causes of death were extracted and injected with barium sulphate as contrast substance by ring injector, then developed under Xper FD20 angiography equipment. The obtained pictures and image data were handled by three-dimensional angiography images with the software attached to the angiography equipment. The coronary artery tissues were HE stained and observed by microscope. The HE staining results were compared with the angiographic results. RESULTS: The imaging data obtained from the 10 cases for examination showed 8 cases without coronary artery stenosis and 2 cases with Ⅲ, Ⅳ coronary artery stenosis, which were consistent with HE staining results of coronary artery organization and the both results were confirmed. CONCLUSIONS Isolated coronary angiography has an unique advantage for accurate grading of classification of coronary artery stenosis, examination of vascular malformation and tiny lesions, which can provide reference for the localization of small lesions and basis during the autopsy for identification conclusion.
Autopsy ; Coronary Angiography ; Coronary Stenosis/diagnostic imaging* ; Coronary Vessels/pathology* ; Heart/diagnostic imaging* ; Humans ; Imaging, Three-Dimensional ; In Vitro Techniques

We have established a digital coronary angiograph-analyzing system on the principle of coronary angiographic impulse response, and combined the system with the quantitative coronary analysis (QCA) for investigating the coronary microcirculation (Tmicro(-1)), the minimal stenotic diameter of coronary (MLD) and coronary hemodynamic parameters (mAP, CFV, Rcor) in 20 patients with coronary stenosis. The results showed the minimal stenotic diameter (MLD) and Tmicro(-1) decreased, with the increase of stenosis of proximal coronary. After successful percutaneous coronary intervention treatment, the Tmicro(-1) increased with the increase of MLD and was in linear correlation with MLD (r = 0.87, P < 0.001). In conclusion, The index Tmicro(-1) detected by coronary digital angiographic impulse response analysis system in combination with CFV and QCA would help to evaluate the level of integrated diagnosis of coronary lesion in regard to anatomy and physiology as well as to macro and microcirculation.
Coronary Angiography ; Coronary Circulation ; physiology ; Coronary Stenosis ; diagnostic imaging ; physiopathology ; Humans ; Microcirculation ; physiology

BACKGROUNDAngiographic evaluation of left main coronary artery (LMCA) bifurcation lesions is often limited. two dimensional (2D) quantitative coronary angiography (QCA) with segmental analysis provides accuracy for quantification of the degree of stenosis in the main vessel and side branch ostium but can be affected by foreshortening and variable magnification. The accuracy of three dimensional (3D) QCA has recently developed to overcome 2D QCA limitations, however, accuracy and precision of 3D bifurcation QCA measurements in LMCA bifurcation lesions has not been established.

METHODSWe investigated whether such 3D and 2D bifurcation QCA measurements differ in their accuracy in assessing significant LMCA bifurcation lesions defined by intravascular ultrasound (IVUS) as a minimum luminal area (MLA) <6 mm(2) of LMCA and MLA <4 mm(2) of proximal left anterior descending (LAD) and/or proximal left circumflex (LCX) RESULTS: LMCA bifurcation lesions were assessed in 44 patients undergoing elective percutaneous coronary intervention. From 2D QCA measurements, MLA correlated moderately with threshold intravascular ultrasound MLA for LMCA (r = 0.81, P < 0.000 1), LAD (r = 0.54, P = 0.000 1) and LCX (r = 0.58, P < 0.000 1). Severity of lesion as MLA by derived 3D QCA, correlated moderately with threshold intravascular ultrasound MLA for LMCA (r = 0.84, P < 0.000 1), LAD (r = 0.53, P = 0.000 2); LCX (r = 0.66, P < 0.000 1). Overall, the C statistics tended to be slightly higher for 3D QCA and 2D QCA measurements in LMCA segment compared with proximal LAD and LCX segments, and there were no significant predictive power of percent diameter stenosis and percent area stenosis on 3D QCA for LCX IVUS MLA <4 mm(2) (percent diameter stenosis: area under curve 0.55, cutoff 23%, sensitivity 88%, specificity 37%, P = 0.618 6; percent arer stenosis: area under curve 0.56, cutoff 41%, sensitivity 83%, specificity 38%, P = 0.518 4, respectively).

CONCLUSIONSThe accuracy of 3D bifurcation QCA in detecting significant LMCA bifurcation lesions is limited, especially the proximal LCX ostium. When IVUS is not available or contraindicated, 3D QCA may assist in the evaluation of intermediate LMCA lesions with MLA.

Aged ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Coronary Stenosis ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Ultrasonography

OBJECTIVETo explore the imaging and clinical characteristics and related risk factors of patients with coronary artery stenosis located proximally to myocardial bridging.

METHODSThis study enrolled 603 patients with angiography evidenced myocardial bridging-mural coronary artery between May 2004 to May 2009. Angiographic and clinic data were collected according to uniform protocol and standard questionnaires were used to obtain patients' demographic and clinical information. Univariate and multivariate analysis were performed to explore related risk factors.

RESULTSChest pain was present in 247 cases (41.0%). Dynamic ST-T changes were found in 229 cases (38%). A total of 644 myocardial bridging-mural coronary arteries were detected including 382 (62.4%) segments located proximally to myocardial bridging. Diastolic vessel diameters in the myocardial bridging segment were significantly smaller than reference segments (all P < 0.01). Stepwise multiple regression analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male gender, diabetes, and systolic narrow rate of myocardial bridging-mural coronary arteries were positively related with the narrowing degree of the first coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male, diabetes and dyslipidemia were positively related with the narrowing degree of the most severe coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01).

CONCLUSIONSMyocardial ischemia is common in patients with myocardial bridging and the artery segments located proximally to myocardial bridging are prone to stenosis. Systolic narrow rate of myocardial bridging-mural coronary arteries is one of major determinants of coronary artery stenosis located proximally to myocardial bridging. Whereas the other coronary heart disease risk factors are likely to play more important roles.

Aged ; Coronary Angiography ; Coronary Stenosis ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; diagnostic imaging ; pathology ; Risk Factors

OBJECTIVE: To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). METHODS: Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. RESULTS: Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio () in the vulnerable plaque group was 5.022 (95% :3.254-7.751, < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (=3.149, 95% :1.987-4.992, < 0.01); but the difference did not seen in stable plaque group (=1.721, 95% :0.798-3.712, >0.05). CONCLUSIONS This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.
Computed Tomography Angiography ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; Coronary Stenosis ; diagnostic imaging ; Humans ; Infant ; Plaque, Atherosclerotic ; diagnostic imaging ; pathology ; Prognosis ; Risk Factors

Catheter Ablation/adverse effects* ; Coronary Stenosis ; Coronary Vessels/diagnostic imaging* ; Humans