Background: To investigate the risk factors of left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG), and to construct a model that predicts LVEF improvement.Methods: A retrospective analysis was performed on 106 ICM patients who received CABG and underwent cardiac magnetic resonance (CMR) at Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2022. Patients were divided into two groups with improved LVEF and no improved LVEF based on the results of postoperative 6-month transthoracic echocardiography. To analyze the risk factors affecting the LVEF non-improvement after CABG and establish a prediction model.Results: There was LVEF non-improvement in 30.2% (32/106) of patients. Multivariate analysis showed that the number of transmural scar segments and left ventricular end-systolic volume index (LVESVI) were independent risk factors in LVEF non-improvement after CABG [odds ratio (OR) =2.398, 95% CI: 1.607- 3.579, P<0.001; OR =1.036, 95% CI: 1.009-1.063, P=0.008]. The model is built and internally verified. ROC showed that the area under the curve (AUC) was 0.866 (95% CI: 0.792-0.940), calibration curve showed that the probability predicted by the model matched well with the clinical results, and decision curve analysis (DCA) showed that the model had good clinical applicability. During the mean follow-up time of 1.5 years, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the LVEF non improvement group was higher (5.4% vs. 25.0%, P=0.009), and the NYHA grading was higher (P=0.016), when compared to the LVEF improvement group.Conclusions: The prediction model based on the number of transmural scar segments and LVESVI has good diagnostic efficacy. Our findings help to identify patients with improved LVEF and thus guide the selection of clinical treatment strategies.

Background We evaluated whether the number of myocardial infarction (MI) segments connected to the papillary muscle (PM), as assessed using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE), predicts whether moderate ischemic mitral regurgitation (IMR) improves after isolated coronary artery bypass grafting (CABG) to guide the choice of surgical strategy. Methods A total of 54 patients diagnosed with coronary heart disease (CHD) complicated with moderate IMR who underwent isolated CABG were selected continuously in this retrospective study at Beijing Anzhen Hospital. All patients underwent preoperative LGE. The patients were divided into the IMR improved group (37 patients) and the unimproved group (17 patients) according to 1-year postoperative echocardiography. The factors associated with no IMR improvement after isolated CABG were analyzed. There was no trial registration and no publication of the study protocol. Results The number of MI segments connected to PM was an independent risk factor for no IMR improvement after isolated CABG [odds ratio 4.39; 95% confidence interval (CI): 1.93–9.98; P<0.001]. The optimal receiver operating characteristic (ROC) curve cut-off value for no IMR improvement was ≥2 (sensitivity: 82.4%; specificity: 83.8%). Follow-up at 1–5 years (median, 2.8 years) showed that the incidences of major adverse cardiovascular and cerebrovascular events (5.4% vs. 23.5%; P=0.041) and New York Heart Association (NYHA) grade (P=0.026) were higher in the unimproved group. Conclusions In patients with CHD complicated with moderate IMR, the number of MI segments connected to PM is an independent risk factor for no IMR improvement after isolated CABG. Mitral valve surgery should be performed simultaneously with CABG in patients with ≥2 MI segments connected to the PM.

Background Drawing on accumulated patient data from a hospital database, the goal of this retrospective study was to analyze cardiac function associated with global preoperative myocardial scarring assessed by cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG). Methods A total of 57 patients diagnosed with ICM who underwent isolated CABG at Beijing Anzhen Hospital between September 2017 and September 2019 were enrolled in this retrospective study. All these patients underwent a preoperative CMR-LGE examination. Based on postoperative echocardiography results at 6 months, cases were divided into the following 2 groups: improved cardiac function [a difference of left ventricular ejection fraction (LVEF) greater than or equal to 5%] and unimproved cardiac function. The factors contributing to these patients’ unimproved cardiac function were investigated. Results At 6 months after surgery, 64.9% (37/57) of cases had improved cardiac function, and 35.1% (20/57) had no improvement. There was no statistical difference between the 2 groups in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (41.7±7.6 vs. 42.8±8.3; P=0.603), but compared to the improved group, preoperative myocardial scarring was significantly enlarged in the unimproved group (41.9%±6.4% vs. 27.8%±8.5%; P<0.001). In regression analysis, only preoperative myocardial scarring [odds ratio (OR) =1.44; 95% confidence interval (CI): 1.13–1.83; P=0.003] was associated with no change in cardiac function evaluated by echocardiography after CABG. The median follow-up of 1.6 years (range, 0.6–4.1 years) found that the unimproved group had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (8.1% vs. 25.0%; P=0.044), and that the New York Heart Association (NYHA) classification of the unimproved group was higher than that of the improved group (P=0.018). Conclusions In ICM patients, a greater amount of preoperative myocardial scarring is associated with unimproved cardiac function after CABG. The measurement of preoperative myocardial scarring may aid clinicians in identifying patients who would benefit from CABG.

Purpose To evaluate the diagnostic performance of self-navigated whole-heart coronary 3-T magnetic resonance (MR) angiography by using conventional invasive coronary angiography (ICA) as the reference gold standard. Materials and Methods This study was approved by the local ethics committee. Written informed consent was obtained from each patient before the study. Thirty-nine consecutive patients underwent coronary MR angiography and later underwent ICA. Coronary MR angiography was performed with a 3-T imager with contrast agent enhancement during free breathing with self-navigated affine motion correction reconstruction. Coronary segments with reference diameters larger than 1.5 mm were included in the comparison between coronary MR angiography and ICA. The coronary MR angiography images were evaluated by two experienced readers blinded to the ICA results to identify significant luminal narrowing (>50% diameter reduction in reference ICA). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were performed to detect significant coronary artery stenosis. Results Coronary MR angiography examinations were successfully performed in all 39 patients. A total of 327 coronary segments had reference luminal diameter larger than 1.5 mm. Of these 327 coronary segments, 303 (92.7%) segments had a quality score greater than 1 at coronary MR angiography and were included in the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.2%, 75.0%, 81.8%, 70.6%, and 76.9%, respectively, on a per-patient basis. Conclusion Contrast-enhanced self-navigated coronary 3-T MR angiography is a promising technique for the noninvasive detection of clinically significant coronary stenosis. © RSNA, 2016.

目的 评价3.0T MR自动呼吸导航全心冠状动脉磁共振血管成像(CMRA)诊断冠状动脉狭窄的临床应用价值.方法 对50例临床疑诊或确诊冠心病或心肌病的患者行自动呼吸导航对比增强CMRA,其中33例经冠状动脉造影(CAG)证实.评价CMRA图像质量,并与CAG相对照,评价CMRA诊断冠状动脉狭窄的效能.结果 1例CMRA图像质量较差,为1级;余49例CMRA图像质量均满足诊断要求,为2～4级.33例经CAG证实的患者共286段血管中,CRMA可显示238段(238/286,83.22％),未显示48段(48/286,16.78％).以患者数、血管支和血管段为单位,CMRA诊断冠状动脉狭窄的敏感度分别为80.95％(17/21)、79.31％(23/29)、84.62％(33/39),特异度分别为75.00％(9/12)、91.09％(92/101)、75.00％(33/44),阳性预测值(PPV)分别为85.00％(17/20)、71.88％(23/32)、75.00％(33/44),阴性预测值(NPV)分别为69.23％(9/13)、93.88％(92/98)、96.91％(188/194),准确率分别为78.79％(26/33)、88.46％(115/130)、92.86％(221/238).结论 3.0T MR自动呼吸导航对比增强全心CMRA有助于诊断冠状动脉狭窄.

The purpose of this study was to find the circulating microRNAs (miRNAs) co-related with the severity of coronary artery calcification (CAC) and testify whether the selected miRNAs could reflect the obstructive coronary artery disease in symptomatic patients. Patients with chest pain and moderated risk for coronary artery disease (CAD) were characterized with coronary artery calcium score (CACS) from cardiac computed tomography (CT). We analyzed plasma miRNA levels of clinical matched 11 CAC (CACS > 100) and 6 non-CAC (CACS = 0) subjects by microarray profile. Microarray analysis identified 34 differentially expressed miRNAs between CAC and non CAC groups. Eight miRNAs (miR-223, miR-3135b, miR-133a-3p, miR-2861, miR-134, miR-191-3p, miR-3679-5p, miR-1229 in CAC patients) were significantly increased in CAC plasma in an independent clinical matched cohort. Four miRNAs (miR-2861, 134, 1229 and 3135b) were correlated with the degree of CAC. Validation test in angiographic cohort showed that miR-134, miR-3135b and miR-2861 were significantly changed in patients with obstructive CAD . We identified three significantly upregulated circulating miRNAs (miR-134, miR-3135b and 2861) correlated with CAC while detected obstructive coronary disease in symptomatic patients.

Objective: To observe the image quality and impact factors of whole-heart coronary magnetic resonance angiography (WH CMRA). Methods: Eighty-eight patients underwent WH CMRA without contrast material at 1.5T MR using 3D ECG-triggered, navigator-gated, fat-suppressed, T2-prepared steady state free precession sequence. Image quality of WH CMRA was evaluated using 4-point scale (1, poor; 4, excellent). Segments which scored of 1 were excluded from further analysis. The diagnostic performance of WH CMRA in detecting stenosis was compared with that of conventional CAG as stenosis ≥50%. Results: (1) Totally 79 patients (79/88, 89.77%) successfully completed examination in (13.28±4.33)min, their heart rate was (67±8)bpm, navigator accept rate was (34.12±8.10)%, body mass index (BMI) was (25.90±3.20)kg/m2. Qualitative image analysis was performed on 79 patients. Except 4 patients scored as 1, the average score for other 75 patients was 2.9±1.0. (2) Conventional CAG was completed in 42 patients (42/75, 56.00%) in (13.50±4.60)min, and their heart rate was (67±10)bpm and image quality was 3.2±0.9. The time interval of WH CMRA and CAG was (5±2) days. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WH CMRA for detecting coronary stenosis based on patient was 90.48% (19/21), 66.67% (14/21), 73.08% (19/26), 87.50% (14/16) and 78.57% (33/42), respectively. (3) No significant difference of mean age, heart rate, scan time, navigator accept rate, BMI nor image quality was found between patients completed WH CMRA and CAG (all P>0.05). Conclusion: The image quality of WH CMRA can satisfy diagnosis of coronary stenosis, which relates to heart rate, breathe pattern and BMI. Copyright © 2013 by the Press of Chinese Journal of Medical Imaging Technology.

Objective: To make a pictorial presentation of the anomalous origin of left coronary artery arising from the pulmonary artery (ALCAPA) appearances in adults on MDCT angiography. Methods: A retrospective evaluation was performed between 2005 and 2011 by ECG-gated coronary MDCT angiography. Total 8 patients included (9-51 years, mean age 29 years, 7 female). Image quality was evaluated firstly. Multi planar reformations (MPRs), maximum intensity projections (MIPs) and 3D volume-rendering techniques were used to evaluate image features. In addition, right and left coronary artery orifices were measured for each case. Results: Total 8/70,000 cases diagnosed ALCAPA by MDCT exam, all image qualities were acceptable. As the diagnose key point, all left coronary artery origin were clearly described, and indirect signs such as dilated and tortuous right/left arteries and collateral vessels between them, enlarged left ventricle were also well showed, the dilated degree of both the RCA and the LCA were marked with ages, the diameter of RCA for each case were a mild wider than that of left one. Other combined signs like papillary muscle calcification, bronchial arteries from aorta to the cardiac and coronary artery degeneration change were also included by MDCT angiography findings in a single data acquisition. No combined inter cardiac malformations in our group. Conclusion: ECG-gated MDCT an-giography plays an important role as a first-line modality in assessment of ALCAPA.

Objective:To retrospectively determine the imaging features of malignant or major congenital coronary artery anomalies(CAA) depicted at multi-detector row computed tomographic(MDCT) angiography.Methods:Between August 2005 and December 2009,38 573 patients(excluding congenital heart disease) underwent imaging with MDCT(64-slice and dual-source CT) by using retrospective electrocardiographic(ECG) gating.Volume rendering,maximum intensity projections and curved multiple planar reformation images were obtained,each study was assessed for the origin,course and terminal point of the anomalous coronary artery,and combined manifestations by 1 experienced radiologist.Results: Total 54 patients(1.40‰,29 female,9～78 years,mean age(51 ± 15) years) of malignant CAA were detected.Four cases(0.10‰) were anomalous left coronary artery originating from the pulmonary artery,adult type.Thirty-eight cases(0.99‰) were anomalous coronary artery originates from the opposite sinus(interarterial course),in which 35 cases were right coronary artery arising from the left sinus of Valsalva,2 cases were left coronary artery arising from the right sinus of Valsalva,and 1 case was single coronary artery.Twelve cases(0.31‰) were multi or larger coronary artery fistula,in which 9 cases were unilateral fistulas(66.67% from the left coronary artery),3 cases from both.The most common site of drainage is the pulmonary artery(n=9),followed by the left ventricle(n=2) and the right atrium(n=1).Two cases were displayed as gigantic aneurysm.Three cases combined with pericardial effusion,2 cases with left ventricular aneurysm.Twelve patients were false-negative diagnosed by echocardiogram during 21 cases.Fifteen cases were verified with coronary angiography,and 11 cases were operated,1 patient died due to coronary aneurysm rupture.Conclusion: MDCTA is an ideal noninvasive technique to evaluate the origin,course,terminal point of malignant CAA and the combined manifestations noninvasively.

To evaluate the ability of black‐blood coronary arterial wall MRI to identify the coronary artery plaque, using intravascular ultrasound (IVUS) as the golden standard.

Objective To observe the characteristics and diagnostic value of coronary artery fistula(CAF) with multi-detector CT angiography(MDCTA).Methods Images of 21 CAF patients who underwent MDCTA using retrospective ECG gating were analyzed.VR,MPR,MIP,CPR were performed for diagnosis of CAF.Results ①Unilateral fistula was detected in 12 patients,including fistula arising from the right coronary artery in 4 patients,from the left coronary artery in 8 patients,while multiple fistulas were found in 9 patients.Pulmonary artery was the most common site of drainage(n=16),followed by the right atrium(n=2),the left ventricle(n=2),and the left atrium(n=1).②The involved arteries manifested as dilatation,anfractuosities or vascular plexus,in which 2 cases complicated with aneurysm,1 case combined with pericardial effusion,1 case with left ventricular aneurysm.No cardiac malformation was detected.③Seventeen patients survived,3 were lost in follow-up,while 1 patient died.Missed diagnosis happened in 5 of 17 patients who underwent echocardiography.CAF was verified in 17 patients with coronary angiography,among which 7 were treated with operation.Conclusion MDCTA is an ideal noninvasive technique for observation on the origin,course,terminal point of CAF and coexistent abnormalities.

MRI是冠状动脉无创性检查手段之一.早期采用双斜靶容积定位法进行分段采集,因定位复杂、不易推广.全心冠状动脉MR成像(whole-heart coronary magnetic resonance angiography,WH CMRA)克服了定位复杂的缺点,但其诊断冠状动脉狭窄的准确性国内报道较少.笔者结合47例患者资料,评价WH CMRA在诊断冠状动脉狭窄方面的价值和限度。

Methods Thirteen patients with suspected CAD were scanned at 1.5 T (MAGNETOM Sonata, Siemens, Germany) after written informed consent was obtained. WH-CMRA was acquired using a 3D ECG-triggered, navigator-gated, fat-suppressed, T2-prepared steady-state-free-precession sequence. Cross-sectional coronary wall imaging (thinkness = 5 mm) was performed using a 2D-black-blood, navigator and ECG-gated, Turbo-Spin-Echo sequence with asymmetric-adiabatic-spectral inversion-recovery fat suppression [3]. Continous slices without gap for wall imaging were positioned from pre to post of the suspected from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010

Desmin-related myopathy (DRM) is known to cause different types of cardiomyopathy. Late gadolinium enhancement cardiovascular magnetic resonance (CMR) has been shown to identify fibrosis in ischemic and non-ischemic cardiomyopathies. We present a rare case of desmin-related hypertrophic cardiomyopathy, CMR revealed fibrosis in the lateral wall of the left ventricle. CMR is superior to conventional echocardiography for the detection of myocardial fibrosis in desmin-related cardiomyopathy, which may be useful to detect early cardiac involvement and predict the patient prognosis.

Objective:To evaluate the ability of black blood coronary arterial wall MR imaging to identify the coronary artery plaque,using intravascular ultrasound(IVUS) as the golden standard.Materials and Methods:Eleven patients(mean age 61.8±9.7 years,6 men and 5 women) who plan to do IVUS or had done IVUS examinations,but had not done percutaneous coronary intervention(PCI),underwent black-blood coronary wall MR imaging within 10 days before or after PCI respectively.All scans were performed on a 1.5T MR scanner.Cross-sectional coronary wall imaging was acquired using a 2D double-inversion-recovery,ECG-triggered,navigator-gated,fatsuppressed,Turbo-Spin-Echo(TSE) sequence on the lesion of coronary artery from the ostium to the middle segment continuously without gap.The vessel cross-sectional area(CSA),luminal CSA,maximal wall thickness,plaque burden,CNR [(SIvessel wall-SIperivascular area) /SDnoise) and SNR(SIvessel wall /SDnoise) were measured in each slice which were then compared with the IVUS images.IVUS were divided into 5 mm segments to compare side by side with MRI.Results:Nine coronary arteries and 37 slices from 9 patients were imaged and analyzed by both MRI and IVUS.Two patients were ruled out due to long examination time.Twenty of 37 slices were found plaques on both IVUS and MRI;the plaque burden,SNR,CNR in the coronary wall containing plaque were greater compared to the normal coronary wall(0.70±0.11 vs 0.58±0.14,1.95±0.39 vs 1.48±0.21,5.47±2.06 vs 2.99±0.78,respectively,P0.05).There were good correlation between MRI and IVUS in vessel CSA,lumen CSA,and plaque burden.(13.66±4.52 vs 14.92±6.37,4.62±2.23 vs 6.03±3.85,0.63±0.13 vs 0.60±0.14,respectively,P0.05).Conclusion:Coronary wall MRI can identify coronary plaque in proximal segments.

<正>斑块破裂导致的血栓形成、血管闭塞,是造成急性心肌梗塞的主要原因[1],也是我国成人心脏病住院和死亡的首要原因。冠状动脉造影是临床诊断冠心病的"金标准",但该方法仅能显示管腔、无法观察管壁,不能有效检出易损斑块和血管正性重构[2]。

Methods 13 patients(mean age 56.2 ± 11.8 years, 9 men) with confirmed coronary artery disease by coronary CTA (64MDCT) underwent black-blood coronary wall MRI within 10 days. All scans were performed on a 1.5 T scanner (MAGNETOM Sonata, Siemens, Germany). Cross-sectional coronary wall imaging was acquired using a 2D double-inversion-recovery, ECG-triggered, navigatorgated, fat-suppressed, Turbo-Spin-Echo sequence (TSE) sequence [2] on the lesion coronary artery from the ostium to the middle segment continuously without gap. The vessel cross-sectional area (CSA), luminal CSA, maximal wall thickness, plaque burden, CNR (SI vessel wall SI perivascular area/SD noise) and SNR (SI vessel wall/SD noise) were measured in each slice which were then comfrom 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010

The purpose of this work was to evaluate the suitability of the strong collision approximation to predict the USPIO volume fraction in atherosclerotic rabbits’ vessel wall from the transverse relaxation time, T2*. There was an excellent agreement (R2 = 0.98) between the theory and the measurements for volume fractions larger than 15 ppm. For lower volume fractions the theory agrees with the measurements poorly. The strong collision model may predict correctly the volume fraction from the T2* map when every voxel contains a relatively high number of magnetic particles but fails if the region contains also voxels with few or no particles.

Objective:To observe the acute hemodynamic response of iloprost in secondary pulmonary hypertension of congenital heart disease.Method:Fifteen cases with secondary pulmonary hypertension of congenital heart disease(10 patients with ventricle septal defect, 3 patient with atrium septal defect, 1 patient with patent ductus arteriosus, 1 patient with endocardial cushion defect). All of them sequentially inhaled oxygen 15 min and following 20 μg of iloprost, and the response on hemodynamic and blood gases were monitored.Result:All patients displayed a significant reduction in mean pulmonary arterial pressure (PAP) and total pulmonary resistance (TPR)(P0.001)immediately after inhaled iloprost. There was no seriously decrease in the left cadiac index (CI)(P=0.244). There was no major adverse effects during this test. Conclusion:during acute drug testing, inhaled iloprost lowered PAP safely and efficaciously. Iloprost selectively dilated pulmonary vascular and is no more effect on systemic circulation.

目的探讨静脉推注美托洛尔在冠状动脉CT检查中的作用。方法受检者72例,随机分为美托洛尔静脉推注组(静脉组)和口服组各36例。静脉组推注美托洛尔总剂量10 mg,如心率下降至65次.min-1或血压下降至90/60 mmHg时,停止静脉推注美托洛尔,行冠状动脉多排CT检查;口服组一次给予美托洛尔50 mg。结果静脉组患者50.0%在用药后10 min达到目标心率,口服组中只有19.4%的患者用药后30 min达到目标心率(P<0.01)。结论静脉推注美托洛尔可以快速、有效、安全地减慢心率,使心率过快患者顺利、快速完成冠状动脉CT检查。