Correlation of Coronary Arteriograms and Left Ventriculograms with Postmortem Studies
Correlation of Coronary Arteriograms and Left Ventriculograms with Postmortem Studies
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冠状动脉造影和左心室造影与尸检的相关性
DOI：
10.1161/01.cir.56.1.32
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发表时间：
1977
期刊：
影响因子：
37.8
通讯作者：
Mark A. Piasio
中科院分区：
文献类型：
--
作者：
G. Hutchins;B. H. Bulkley;R. Ridolfi;L. Griffith;F. Lohr;Mark A. Piasio
为了评估冠状动脉和左心室心肌疾病的血管造影测定的准确性，我们比较了28例患者的临床与尸检冠状动脉造影和左心室造影与心肌病理学，所有这些患者均在术后和血管造影后3个月内死亡; 19例有缺血性心脏病，4例瓣膜性心脏病，5例两者兼而有之。比较315个心外膜冠状动脉节段的死前和死后管腔闭塞，排除手术后的，显示21个节段的管腔狭窄差异> 50%（7%）。显著冠状动脉病变被高估6例，低估15例。在6例高估中，3例似乎是由于冠状动脉痉挛;在15例低估中，12例是由于重叠图像; 6例差异无法解释。将140个心室造影节段的室壁运动与心肌病理进行比较，排除任何研究后或围手术期损伤，显示运动减少与48个（34%）梗死节段和10个（7%）室壁运动减少节段具有良好的相关性。然而，58个（41%）其他节段的心室造影运动较差或缺失，心肌结构正常，冠状动脉供应通畅; 19个位于梗死边缘，39个位于扩张或肥厚的心脏。因此，死前冠状动脉造影闭塞通常表明动脉粥样硬化狭窄，但减少或缺乏节段性室壁运动往往不表明心肌病变。这可能是由于冠状动脉严重狭窄的分布中的缺血，也可能是由于心室地形异常。
To assess the accuracy of angiographic determinations of disease of coronary arteries and left ventricular myocardium we compared clinical with postmortem coronary arteriograms and left ventriculograms with myocardial pathology in 28 patients, all of whom died postoperatively and within three months of angiography; 19 had ischemic heart disease, four valvular heart disease, and five both. Comparison of pre and postmortem lumenal occlusion in 315 epicardial coronary segments, excluding those operated upon, showed > 50%percnt; narrowing discrepancies in 21 (7%percnt;). Significant coronary artery lesions were overestimated in six and underestimated in 15. Of the six overestimations, three appeared to be due to coronary spasm; of the 15 underestimations, 12 were due to overlapping images; six discrepancies were unexplained. Comparison of wall motion in 140 ventriculogram segments with myocardial pathology, excluding any post-study or perioperative injury, showed good correlation of reduced motion with 48 (34%percnt;) infarcted and 10 (7%percnt;) aneurysmal segments. However, 58 (41%percnt;) other segments had poor or absent ventriculogram motion, with structurally normal myocardium and patent coronary artery supply; 19 were on infarct margins and 39 in dilated or hypertrophied hearts. Thus, premortem coronary arteriographic occlusions generally indicate atherosclerotic narrowing; but decreased or absent segmental wall motion frequently does not indicate a myocardial lesion. It may be attributable to ischemia in the distribution of a critically narrowed coronary artery or it could be due to abnormal ventricular topography.