Optical coherence tomography versus intravascular ultrasound in patients with myocardial infarction: a diagnostic performance study of pre-percutaneous coronary interventions.
- 作者列表："Niu Z","Lv X","Zhang J","Bao T
:Accurate coronary measurements are important in guiding percutaneous coronary intervention. Intravascular ultrasound is a widely accepted diagnostic modality for coronary measurement before percutaneous coronary intervention. The spatial resolution of optical coherence tomography is 10 times larger than that of intravascular ultrasound. The objective of the study was to compare quantitative and qualitative parameters of frequency domain optical coherence tomography (FDOCT) with those of intravascular ultrasound and coronary angiography in patients with acute myocardial infarction. Diagnostic parameters of coronary angiography, intravascular ultrasound, and FDOCT of 250 patients with coronary artery disease who required admission diagnosis were included in the analyses. Minimum lumen diameter detected by FDOCT was larger than that detected by quantitative coronary angiography (2.11±0.1 vs 1.89±0.09 mm, P<0.0001, q=34.67) but smaller than that detected by intravascular ultrasound (2.11±0.1 vs 2.19±0.11 mm, P<0.0001, q=12.61). Minimum lumen area detected by FDOCT was smaller than that detected by intravascular ultrasound (3.41±0.01 vs 3.69±0.01 mm2, P<0.0001). FDOCT detected higher numbers of thrombus, tissue protrusion, dissection, and incomplete stent apposition than those detected by intravascular ultrasound (P<0.0001 for all). More accurate and sensitive results of the coronary lumen can be detected by FDOCT than coronary angiography and intravascular ultrasound (level of evidence: III).
: 准确的冠状动脉测量对指导经皮冠状动脉介入治疗很重要。血管内超声是经皮冠状动脉介入治疗前冠状动脉测量的广泛接受的诊断方式。光学相干断层扫描的空间分辨率是血管内超声的10倍。本研究的目的是比较急性心肌梗死患者频域光学相干断层扫描 (FDOCT) 与血管内超声和冠状动脉造影的定量和定性参数。分析了250例需要入院诊断的冠心病患者的冠状动脉造影、血管内超声和FDOCT的诊断参数。FDOCT检测的最小管腔直径大于定量冠状动脉造影检测的最小管腔直径 (2.11 ± 0.1 vs 1.89 ± 0.09毫米，P<0.0001，q = 34.67)，但小于血管内超声检测的最小管腔直径 (2.11 ± 0.1 vs 2.19 ± 0.11毫米，P<0.0001，q = 12.61)。FDOCT检测最小管腔面积小于血管内超声 (3.41 ± 0.01 vs 3.69 ± 0.01平方毫米，P<0.0001)。与血管内超声相比，FDOCT检测到的血栓、组织突出、夹层和支架贴附不全的数量较多 (均P<0.0001)。与冠状动脉造影和血管内超声相比，FDOCT可以检测到更准确和敏感的冠状动脉管腔结果 (证据水平: III)。
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.