- 作者列表："Singh A","Mor-Avi V","Patel AR
:Computed tomography coronary angiography (CTCA) is a widely accepted non-invasive technique for the accurate detection of coronary artery disease (CAD), but comes with a notable limitation stemming from its limited capacity to define the physiologic significance of a given lesion This hampered ability for functional assessment of coronary stenosis may lead to additional testing in an effort to delineate whether ischemia is truly present. An important technique that can overcome this pitfall of CTCA has emerged in the form of stress CT myocardial perfusion (CTP) imaging, which provides the functional assessment necessary, thereby complementing the anatomic information provided by CTCA. The combination of CTCA and CTP permits a single exam to simultaneously detect coronary stenosis and categorize its hemodynamic significance. The accuracy of CTP is now well-described in comparison to a number of reference standards for the diagnosis of CAD, including single photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve (FFR) measurements. While there is not yet a consensus for a single protocol regarding the optimal mode of acquisition and interpretation of CTP, there is a growing body of data to support its integration into clinical use with CTCA as a strategy to improve the detection and management of coronary disease. This review article is aimed to discuss the current clinical applications and methodology of CTP imaging, its strengths and weaknesses as well as some of the debated issues that remain to be resolved in the future.
: 计算机断层扫描冠状动脉造影 (CTCA) 是一种广泛接受的非侵入性技术，用于准确检测冠状动脉疾病 (CAD)，但由于其限定给定病变的生理意义的能力有限，因此存在显著的限制。这种功能性评估冠状动脉狭窄的能力受到阻碍，可能导致额外的测试，以努力描绘缺血是否真正存在。可以克服CTCA这一陷阱的重要技术已经以应力CT心肌灌注 (CTP) 成像的形式出现，其提供了必要的功能评估，从而补充了CTCA提供的解剖学信息。CTCA和CTP的组合允许单次检查同时检测冠状动脉狭窄并对其血液动力学意义进行分类。与许多用于诊断CAD的参考标准 (包括单光子发射CT、心血管磁共振成像以及有和没有血流储备分数 (FFR) 测量的侵入性冠状动脉造影) 相比，CTP的准确性现在得到了很好的描述。虽然尚未就CTP的最佳获取和解释模式达成单一方案的共识，但越来越多的数据支持其与CTCA整合到临床使用中，作为改善冠心病检测和管理的策略。这篇综述文章旨在讨论目前CTP成像的临床应用和方法，其优势和劣势以及未来仍有待解决的一些争议问题。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.