冠状动脉三维重建各血管段最佳投照角度的分布规律  

Three-dimensional quantitative coronary angiographic assessment of the optimal viewing angle in the coronary segments

作　　者：郝培远[1] 高传玉[1] 陈爱华[2] 宋旭东[2] 李志樑[2] 袁义强[3] 

机构地区：[1]河南省人民医院心内科,河南郑州450003 [2]南方医科大学珠江医院心内科 [3]南方医科大学附属河南心血管病医院心内科

出　　处：《中华高血压杂志》2013年第10期959-964,共6页Chinese Journal of Hypertension

基　　金：2011年郑州市医学博士创业基金项目

摘　　要：目的通过冠状动脉三维重建定量分析方法对冠状动脉造影主支不同血管段(右冠状动脉和左前降支近、中、远段,左主干,左回旋支近、远段)最佳投照角度规律进行研究。方法采用简单随机抽样方法抽取2010-10-2011-05河南省人民医院心血管内科、南方医科大学珠江医院心血管内科、南方医科大学附属河南心血管病医院内科(年造影均≥1500例,介入≥800例)行冠状动脉造影的76例患者共185段靶血管的影像资料,进行回顾性三维重建分析,最终纳入183段(排除因左回旋支近段起始处被严重遮挡1段,因左回旋支近段闭塞1段)。从靶病变2个视图的投照影像中重建出三维靶血管并生成对靶血管有最少短缩或延长率的最佳投照角度。对主支不同血管投照角度进行统计分析。结果与常规投照角度比较,右冠状动脉和左前降支近、中、远段,左主干最佳投照角度短缩率降低,而左回旋支近、远段差异无统计学意义。右冠状动脉近、中、远段三维最佳投照角度(°)分别为右前斜位+足位:(-12.3±22.3)+(15.7±11.5)、(-8.9±27.7)+(18.1±19.1)、(-21.8±24.7)+(-20.0±21.4);左前降支近、中、远段为(35.6±11.4)+(-5.3±23.1)、(27.1±9.3)+(-26.0±31.3)、(-3.5±23.1)+(-20.2±11.0);左主干为(5.7±19.6)+(3.9±22.5);左回旋支近、远段为(-25.8±22.1)+(22.5±18.1)、(-1.2±25.3)+(13.2±13.8)。结论冠状动脉三维重建系统能成功实现对左主干和三条主支血管不同血管段的三维重建,采用三维定量分析方法模拟计算不同血管段的最佳投照角度规律具有很好的可行性。Abstract： Objective To explore the characteristics of the optimal viewing angle in different coronary segments [proximal right coronary artery （RCA）, middle RCA, distal RCA, proximal left anterior descending artery （LAD）, middle LAD, distal LAD, proximal left circumflex artery （LCX）, distal LCX and left main trunk （LMT）] by three-dimensional quantitative coronary angiography （ 3D-QCA）. Methods Seventy-six patients were recruited by simple random sampling from hospitals of Henan Provincial People, Zhujiang hospital of Southern Medical University, Henan Cardiovascular Hospital Affiliated to Southern Medical University. A total of 185 target vessels were calcu-lated by 3D-QCA, and two vessels were excluded due to vessel overlap in the beginning position of LCX or occlusion in proximal LCX. Target vessel was reconstructed in 3D-QCA according to two coronary angiographic views, and the optimal angle with the least reduction and elongation of target vessel length was assessed. Results Compared with conventional angle, the least reduction of target vessel length in RCA, LAD and LMT were reduced by the op-timal angle, while there was no significant difference in proximal and distal LCX. The optimal viewing angle was obtained from 3D-QCA （°）at right anterior oblique {RAO） and caudal： proximal RCA （-12.3 ± 22.3}＋（ 15.7±11.5） ,middle（-8.9±27.7）＋（18.1±19.1）,distal（-21.8±24.7）＋（-20.0±21.4）; LMT （5.7±19.6）＋ （3.9 ± 22.5） ; proximal LAD （35.6±11.4）＋（-5.3±23.1） ,middle（27.1±9.3）＋（-26.0±31.3）, distal（ -3.5±23.1）＋（-20. 2±11.0） ; proximal LCX （-25.8±22.1） ＋ （22.5±18.1）,distal（-1.2±25.3） ＋ （13.2±13.8）, respectively. Conclusion It is proved that all main branch vessels except LCX could be successfully reconstructed by 3D coronary reconstruction system, and the optimal angle using 3D-QCA has a good feasibility.

关 键 词：冠状动脉造影 三维重建 最佳投照角度 分布规律 

分 类 号：R543[医药卫生—心血管疾病]