冠状动脉扭曲的量化测量方法及应用
发布时间：2018-08-21 09:41
【摘要】：目的:冠状动脉扭曲可以造成冠状动脉血流动力学的改变,扭曲的严重程度被认为与其造成的血流动力学影响具有相关性,提出对冠状动脉的扭曲程度进行准确的测量评价的新方法可以为明确冠状动脉扭曲的所造成的影响提供有利条件。方法:连续录入2014年7月188例临床拟诊“冠心病”且均接受256排冠状动脉CTA检查患者图像及相关临床资料。观测记录患者临床数据及实验室检查结果。CTA血管图像经后处理后,提取心外膜下三支主要冠状动脉血管中轴,获取其在三维空间中的坐标,并对扭曲系数进行量化测量。分析扭曲系数与其他临床观测指标的相关性。建模检验:通过对冠状动脉左前降支的扭曲建模,模型扭曲角度与扭曲系数呈线性相关,相关系数R2=0.999。检验证明该方法对扭曲评价的效果良好。结果:所有入选者平均年龄66.21±10.92岁,年龄最小者39岁,最大93岁。其中男性88例,女性100例;吸烟史阳性患者57例;有饮酒史阳性患者22例;诊断为冠状动性心脏病或既往有该病史的89例;明确诊断高血压病患者106例;明确诊断脑卒中或既往有脑卒中患者86例;明确诊断糖尿病或既往有糖尿病患者49例;左前降支冠脉扭曲平均系数TC3DLAD为0.0906±0.0800;左回旋支扭曲系数平均值TC3DLCX为0.2368±0.2379,右冠状动脉扭曲系数平均值TC3DRCA为0.4242±0.3043。左前降支非扭曲组冠状动脉CTA提示狭窄35例(18.62%),其中显著狭窄12例(12.77%)。扭曲组冠状动脉提示狭窄45例(23.94%);其中显著狭窄21例(22.34%)。左回旋支非扭曲组中,冠状动脉CTA检查提示发生狭窄14例(7.45%),其中显著狭窄5例(5.32%)。扭曲组提示狭窄16例(8.51%),其中显著狭窄6例(6.38%)。右冠状动脉非扭曲组中CTA检查提示发生狭窄18例(9.57%),其中显著狭窄5例(5.32%)。扭曲组提示狭窄29例(15.43%),其中显著狭窄7例(7.45%)。三支冠状动的脉扭曲组中狭窄发生率均高于对照组。在临床资料对比中,左前降支:扭曲组平均年龄68.52±10.46岁,非扭曲组平均年龄64.03±10.97岁。左回旋支:扭曲组平均年龄68.52±10.46岁,非扭曲组平均年龄64.03±10.97岁。右冠状动脉:扭曲组平均年龄68.52±10.46岁,非扭曲组平均年龄64.03±10.97岁。三支冠状动脉的扭曲组平均年龄显著高于非扭曲组(P0.05)。结论:此方法能对冠状动脉在三维空间的扭曲程度进行准确的定量化分析,且结果不受造影投射面、人为测量误差及血管长度的影响。本次研究中右冠状动脉的扭曲系数均值最大,冠状动脉扭曲人群中冠状动脉狭窄发生率较高,提示冠状动脉扭曲可能与冠状动脉狭窄发生相关。年龄因素也可能与冠状动脉扭曲的发生呈正相关。
[Abstract]:Objective: coronary artery distortion can cause changes in coronary hemodynamics, and the severity of the distortion is thought to be associated with the resulting hemodynamic effects. A new method for accurate measurement and evaluation of the degree of coronary artery distortion is proposed, which can provide favorable conditions for determining the effect of coronary artery distortion. Methods: one hundred and eighty-eight consecutive patients with coronary artery disease (CHD) were recorded in July, 2014 and underwent 256-row coronary artery CTA examination. After post-processing, the central axis of three main coronary arteries under epicardium was extracted, their coordinates in three-dimensional space were obtained, and the distortion coefficient was measured quantitatively. To analyze the correlation between distortion coefficient and other clinical observation indexes. Modeling test: by modeling the left anterior descending branch of coronary artery, the torsion angle of the model was linearly correlated with the distortion coefficient, and the correlation coefficient was 0.999. The test results show that the method has good effect on distortion evaluation. Results: the average age of all the candidates was 66.21 卤10.92 years old, the youngest was 39 years old and the oldest was 93 years old. Among them, 88 cases were male, 100 cases were female, 57 cases were positive in smoking history, 22 cases were positive in drinking history, 89 cases were diagnosed as coronary dynamic heart disease or previous history, 106 cases were diagnosed hypertension. 86 patients with stroke or with stroke, 49 with diabetes and 49 with diabetes. The mean distortion coefficient of left anterior descending coronary artery (TC3DLAD), left circumflex artery (TC3DLCX) and right coronary artery (TC3DRCA) were 0.0906 卤0.0800, 0.2368 卤0.2379 and 0.4242 卤0.3043, respectively. The coronary artery stenosis was found in 35 cases (18.62%) by CTA in the left anterior descending branch group, of which 12 cases (12.77%) had significant stenosis. 45 cases (23.94%) showed coronary artery stenosis and 21 cases (22.34%) had significant stenosis. Coronary artery stenosis was found in 14 cases (7.45%) by CTA in left circumflex branch group, of which 5 cases (5.32%) had significant stenosis. In twisted group, 16 cases (8.51%) showed stenosis, 6 cases (6.38%) showed significant stenosis. In the non-twisted right coronary artery group, 18 cases (9.57%) showed stenosis by CTA, 5 cases (5.32%) had significant stenosis. 29 cases (15.43%) showed stenosis in twisted group, 7 cases (7.45%) showed significant stenosis. The incidence of stenosis in the three-branch coronary motility group was higher than that in the control group. In comparison of clinical data, the mean age of the left anterior descending branch was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the left circumflex branch was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the right coronary artery was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the three coronary artery twisted group was significantly higher than that of the non-twisted group (P 0.05). Conclusion: this method can accurately quantify the degree of distortion of coronary artery in three dimensional space, and the results are not affected by projection surface, artificial measurement error and vascular length. In this study, the mean value of right coronary artery distortion coefficient was the highest, and the incidence of coronary artery stenosis was higher in patients with coronary artery distortion, suggesting that coronary artery distortion may be associated with coronary artery stenosis. Age factors may also be positively correlated with the occurrence of coronary artery distortion.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4
本文编号：2195313
[Abstract]:Objective: coronary artery distortion can cause changes in coronary hemodynamics, and the severity of the distortion is thought to be associated with the resulting hemodynamic effects. A new method for accurate measurement and evaluation of the degree of coronary artery distortion is proposed, which can provide favorable conditions for determining the effect of coronary artery distortion. Methods: one hundred and eighty-eight consecutive patients with coronary artery disease (CHD) were recorded in July, 2014 and underwent 256-row coronary artery CTA examination. After post-processing, the central axis of three main coronary arteries under epicardium was extracted, their coordinates in three-dimensional space were obtained, and the distortion coefficient was measured quantitatively. To analyze the correlation between distortion coefficient and other clinical observation indexes. Modeling test: by modeling the left anterior descending branch of coronary artery, the torsion angle of the model was linearly correlated with the distortion coefficient, and the correlation coefficient was 0.999. The test results show that the method has good effect on distortion evaluation. Results: the average age of all the candidates was 66.21 卤10.92 years old, the youngest was 39 years old and the oldest was 93 years old. Among them, 88 cases were male, 100 cases were female, 57 cases were positive in smoking history, 22 cases were positive in drinking history, 89 cases were diagnosed as coronary dynamic heart disease or previous history, 106 cases were diagnosed hypertension. 86 patients with stroke or with stroke, 49 with diabetes and 49 with diabetes. The mean distortion coefficient of left anterior descending coronary artery (TC3DLAD), left circumflex artery (TC3DLCX) and right coronary artery (TC3DRCA) were 0.0906 卤0.0800, 0.2368 卤0.2379 and 0.4242 卤0.3043, respectively. The coronary artery stenosis was found in 35 cases (18.62%) by CTA in the left anterior descending branch group, of which 12 cases (12.77%) had significant stenosis. 45 cases (23.94%) showed coronary artery stenosis and 21 cases (22.34%) had significant stenosis. Coronary artery stenosis was found in 14 cases (7.45%) by CTA in left circumflex branch group, of which 5 cases (5.32%) had significant stenosis. In twisted group, 16 cases (8.51%) showed stenosis, 6 cases (6.38%) showed significant stenosis. In the non-twisted right coronary artery group, 18 cases (9.57%) showed stenosis by CTA, 5 cases (5.32%) had significant stenosis. 29 cases (15.43%) showed stenosis in twisted group, 7 cases (7.45%) showed significant stenosis. The incidence of stenosis in the three-branch coronary motility group was higher than that in the control group. In comparison of clinical data, the mean age of the left anterior descending branch was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the left circumflex branch was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the right coronary artery was 68.52 卤10.46 years in the twisted group and 64.03 卤10.97 years in the non-twisted group. The mean age of the three coronary artery twisted group was significantly higher than that of the non-twisted group (P 0.05). Conclusion: this method can accurately quantify the degree of distortion of coronary artery in three dimensional space, and the results are not affected by projection surface, artificial measurement error and vascular length. In this study, the mean value of right coronary artery distortion coefficient was the highest, and the incidence of coronary artery stenosis was higher in patients with coronary artery distortion, suggesting that coronary artery distortion may be associated with coronary artery stenosis. Age factors may also be positively correlated with the occurrence of coronary artery distortion.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4
【二级参考文献】
相关期刊论文 前2条
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2 袁斌;罗伟;黄有胜;刘俊伟;谢毅;罗f 莹;;冠状动脉迂曲无狭窄的胸痛病人的临床分析[J];岭南心血管病杂志;2007年02期
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