Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with u...Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.展开更多
Background and Objectives The relationship between left atrial(LA)size and congestive heart failure(CHF)is well recognized;however,there is little information on the association of pulmonary vein(PV)diameter and CHF.T...Background and Objectives The relationship between left atrial(LA)size and congestive heart failure(CHF)is well recognized;however,there is little information on the association of pulmonary vein(PV)diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography(MSCT)angiography using a new 64-slice scanner.Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age-and sex-matched non-CHF controls.Compared with controls,CHF patients showed significant greater diameters of left superior pulmonary vein(LSPV)and right inferior pulmonary vein(RIPV)in both anteriorposterior(AP)and superior-inferior(SI)directions(P<0.01),significant dilation of right superior pulmonary vein(RSPV)in AP direction(P<0.05),as well as significant increase of LA transverse,AP,and SI diameters(P<0.01).Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients.This anatomic and geometric changes may participate in the perpetuation of AF.展开更多
Objectives:To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center,and to assess the feasi...Objectives:To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center,and to assess the feasibility,safety and therapeutic efficacy of this management strategy.Methods:Patients were selected to the study if:1)age>65 years;2)with coexistence of two or more cardiovascular diseases which are indications for interventional therapy;3)patients'general condition and organ functions allow the performance of combined multiple procedures;4)the predicted procedure time is within 150 min;5)the predicted contrast medium dosage is within 300 ml.The criteria we analyzed included procedural type,rocedural time,fluoroscopy time,dosage of contrast medium,success rates of the procedures,complications and in-hospital mortality.All patients were followed up for 30.4±9.3 months,to determine the all-cause mortality,recurrence rates and adverse cardiac events.Results:From January 2000 to December 2004,combined interventional procedures were performed on 136 patients,with 2 procedures on 134 patients and 3 procedures on 2 patients.The mean procedure time was 115.4±11.6 min,the mean fluoroscopy time was 35.7±9.3 min,and the mean dosage of contrast medium used was 183.6±19.4 ml.Procedural success rate was 100%,no procedure related death or major complications occurred.Conclusion:Performed by a competent team,combined interventional procedures in elderly patients with multiple cardiovascular diseases were feasible and relatively safe.展开更多
Objective To evaluate the feasibility,safety and efficacy of percutaneous stent implantation for treating left main coronary artery(LMCA)stenosis.Methods Consecutive patients with unprotected left main coronary artery...Objective To evaluate the feasibility,safety and efficacy of percutaneous stent implantation for treating left main coronary artery(LMCA)stenosis.Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention(PCI)at 6 medical centers in China were enrolled.Procedural data and clinical outcomes were obtained from all patients.Results From January 2001 to December 2004,138 patients(79 males and 59 females;mean age:69.7±5.8 years)underwent PCI for LMCA stenosis.Bare metal stents(BMS)were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003(BMS group);.Drug eluting stents(DES)were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004(DES group).Procedural success rate of the 138 cases was 98%(135/138).One patient(0.7%)with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure.During a mean follow up period of 21.3±5.6 months,one patient died from renal failure,one from sudden cardiac death,4 underwent target lesion revascularization(TLR)in the BMS group,which all occurred in patients with bifurcational lesions;whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR.Conclusions(1)PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals.(2)BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA.(3)DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.展开更多
Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angi...Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)展开更多
基金This work is supported by China Capital Medical Development Fund(C03030201).
文摘Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.
文摘Background and Objectives The relationship between left atrial(LA)size and congestive heart failure(CHF)is well recognized;however,there is little information on the association of pulmonary vein(PV)diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography(MSCT)angiography using a new 64-slice scanner.Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age-and sex-matched non-CHF controls.Compared with controls,CHF patients showed significant greater diameters of left superior pulmonary vein(LSPV)and right inferior pulmonary vein(RIPV)in both anteriorposterior(AP)and superior-inferior(SI)directions(P<0.01),significant dilation of right superior pulmonary vein(RSPV)in AP direction(P<0.05),as well as significant increase of LA transverse,AP,and SI diameters(P<0.01).Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients.This anatomic and geometric changes may participate in the perpetuation of AF.
文摘Objectives:To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center,and to assess the feasibility,safety and therapeutic efficacy of this management strategy.Methods:Patients were selected to the study if:1)age>65 years;2)with coexistence of two or more cardiovascular diseases which are indications for interventional therapy;3)patients'general condition and organ functions allow the performance of combined multiple procedures;4)the predicted procedure time is within 150 min;5)the predicted contrast medium dosage is within 300 ml.The criteria we analyzed included procedural type,rocedural time,fluoroscopy time,dosage of contrast medium,success rates of the procedures,complications and in-hospital mortality.All patients were followed up for 30.4±9.3 months,to determine the all-cause mortality,recurrence rates and adverse cardiac events.Results:From January 2000 to December 2004,combined interventional procedures were performed on 136 patients,with 2 procedures on 134 patients and 3 procedures on 2 patients.The mean procedure time was 115.4±11.6 min,the mean fluoroscopy time was 35.7±9.3 min,and the mean dosage of contrast medium used was 183.6±19.4 ml.Procedural success rate was 100%,no procedure related death or major complications occurred.Conclusion:Performed by a competent team,combined interventional procedures in elderly patients with multiple cardiovascular diseases were feasible and relatively safe.
文摘Objective To evaluate the feasibility,safety and efficacy of percutaneous stent implantation for treating left main coronary artery(LMCA)stenosis.Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention(PCI)at 6 medical centers in China were enrolled.Procedural data and clinical outcomes were obtained from all patients.Results From January 2001 to December 2004,138 patients(79 males and 59 females;mean age:69.7±5.8 years)underwent PCI for LMCA stenosis.Bare metal stents(BMS)were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003(BMS group);.Drug eluting stents(DES)were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004(DES group).Procedural success rate of the 138 cases was 98%(135/138).One patient(0.7%)with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure.During a mean follow up period of 21.3±5.6 months,one patient died from renal failure,one from sudden cardiac death,4 underwent target lesion revascularization(TLR)in the BMS group,which all occurred in patients with bifurcational lesions;whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR.Conclusions(1)PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals.(2)BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA.(3)DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.
文摘Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)
