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Predictors of long-term clinical outcome of patients with acute massive pulmonary embolism after thrombolytic therapy

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Chinese Medical Journal 2003年第4期116卷 503-509页

作者：刘品明 Nicolas Meneveau francois schiele Jean Pierre Bassand Department of Cardiology Second Affiliated HospitalZhongshan University Service de Cardiologie Centre Hospitalier Universitare

To assess the in-hospital clinical course and the long-term evolution of acute massive pulmonary embolism after thrombolytic therapy and to identify predictors of adverse clinical outcome Methods A total of 260 patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3 9 to 8 4 years Baseline characteristics and variables pre- and post-thrombolysis were identified Particular attention was paid to the clinical events, including death, recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, and major bleeding attributable to the use of anticoagulants Kaplan-Meier event-free survival curves were generated Univariate analysis by means of the log-rank test was used to test each candidate variable for association with clinical outcome Multivariate analysis with the Cox proportional hazard model was used to determine independent predictors of the long-term outcome Results The in-hospital mortality rate was 8 5%, with 68 2% due to pulmonary embolism itself, and the follow-up mortality rate was 31 7%, with 29 2% due to recurrent embolism Factors associated with an adverse outcome in univariate analysis were: (1) prior thromboembolic diseases; (2) duration of anticoagulant therapy 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by pulmonary ventilation/perfusion scintigraphy before hospital discharge Multivariate analysis identified three independent predictors of poor long-term outcome for patients with acute massive pulmonary embolism after thrombolysis; which were: (1) Doppler recording of pulmonary artery systolic pressure >50 mm Hg, with relative risk of 3 78 and a 95% confidence interval of 2 70 to 4 86; (2)

关键词： pulmonary embolism · deep venous thrombosis · thrombolytic therapy

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The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

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Journal of Geriatric Cardiology 2011年第4期8卷 224-229页

作者： Wei Hu francois schiele Nicolas Meneveau Marie-France Seronde Pierre Legalery Jean-francois Bonneville Sidney Chocron Jean-Pierre Bassand Department of Cardiology Min Hang District Central HospitalShanghai 201100China Department of Cardiology University Hospital Jean MinjozBesançon 25000France Department of Radiology University Hospital Jean MinjozBesançon 25000France Department of Cardiac Surgery University Hospital Jean MinjozBesançon 25000France

Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study *** The study group consisted of five males and one female with mean age of 66 years *** of them had chest or back *** one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by *** another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false *** the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance *** IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.

关键词： intravascular ultrasound diagnosis aortic intramural hematom

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Value of intravascular ultrasound imaging in following up patients with replacement of the ascending aorta for acute type A aortic dissection

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Chinese Medical Journal 2008年第21期121卷 2139-2143页

作者： HU Wei francois schiele Nicolas Meneveau Marie-France Seronde Pierre Legalery Fiona Caulfield Jean-Frangois Bonneville Sidney Chocron Jean-Pierre Bassand Department of Cardiology Min Hang Central Hospital Shanghai 201100 China Department of Cardiology Jean Minjoz Hospital Besancon 25000 France Department of Radiology Jean Minjoz Hospital Besancon 25000 France Department of Cardiac Surgery Jean Minjoz Hospital Besancon 25000 France

Background The value of intravascular ultrasound （IVUS） imaging in patients with replacement of the ascending aorta for acute type A aortic dissection （AD） is unknown. The purpose of this study was to assess the potential use of IVUS imaging in this setting. Methods From September 2002 to July 2005, IVUS imaging with a 9 MHz probe was performed in a series of 16 consecutive patients with suspected or established AD. This study focused on 5 of them with replacement of the ascending aorta for acute type A AD. Among these 5 patients, other imaging modalities including aortography, spiral computed tomography, magnetic resonance imaging and transesophageal echocardiography were performed in 5, 3, 3 and 1 patients, respectively. Results There were no complications related to IVUS imaging. For the replaced graft, as other imaging modalities, IVUS could identify all 5 grafts, the proximal and the distal anastomoses, and the ostia of the reimplanted coronary arteries. In 2 cases, IVUS detected 2 peri-graft pseudo-aneurysms （1 per case）, which were also detected by magnetic resonance imaging but omitted by aortography. For the residual dissection, IVUS had similar findings as other imaging modalities in detecting the patency （5/5）, the longitudinal and the circumferential extent, the thrombus （4/5）, the recurrent dissection （1/5） and an aneurysm distal to the graft （5 in 4 patients）. However, it detected more intimal tears and side branch involvements than other imaging modalities （15 vs 10 and 3 vs 1, respectively）. Conclusions In following-up patients with replacement of the ascending aorta for acute type A AD, IVUS imaging can provide complete information of the replaced graft and the residual dissection. So, IVUS imaging may be considered when the four current frequently used imaging modalities can not supply sufficient information or there are some discrepancies between them.

关键词： intravascular ultrasound aortic dissection graft

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Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

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Chinese Medical Journal 2001年第3期114卷 38-41,105页

作者：张大东蔡煦沈卫峰上海第二医科大学附属瑞金医院心脏科上海200025

目的　对 4 1例冠心病患者病变冠状动脉 (冠脉 )在血管内超声 (IVUS)指导下置入支架 ,并评价造影和IVUS及一个月临床结果。方法　本文采用支架置入IVUS标准 :支架内截面积≥近端和远端相关血管腔截面积平均值的 80 % ,结合抗血小板药以... 详细信息

目的　对 4 1例冠心病患者病变冠状动脉 (冠脉 )在血管内超声 (IVUS)指导下置入支架 ,并评价造影和IVUS及一个月临床结果。方法　本文采用支架置入IVUS标准 :支架内截面积≥近端和远端相关血管腔截面积平均值的 80 % ,结合抗血小板药以防支架内亚急性血栓形成。结果　支架置入后 2 5例达到标准 ,不需再扩张 ;14例IVUS不满意者 (造影结果良好 )过扩张支架 ,支架内截面积增加 2 5 7% (P <0 0 5) ;2例因超声导管未跨过支架无超声资料。最终 35例 (90 % )得到满意IVUS(支架内最小截面积 8 5± 2 2mm2 ) ,结合阿司匹林和噻氯匹定治疗 ,无一例死亡、心肌梗死和支架内血栓形成。

关键词：经皮经腔冠状动脉成形术冠状动脉内支架术冠状动脉内超声

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经皮冠状动脉介入术中止血活性的早期改变及与纤溶酶原激活剂抑制物-1基因多态性的相关性

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介入放射学杂志 2007年第9期16卷 584-588页

作者：艾力曼.马合木提 Nicolas Meneveau francois schiele Jean-Pierre Bassand 法国Besancon Franche-comté大学Jean-Minjoz大学中心医院心血管中心新疆医科大学第一附属医院心血管中心

目的探讨经皮冠状动脉介入(PCI)术中冠状动脉内血浆纤溶酶原激活剂抑制物-1(PAI-1)、D-二聚体(D-D)、凝血因子Ⅶ(FⅦa)及可溶性P选择素(CD62P)活性在球囊扩张和支架植入前后的早期改变及其与PAI-1基因多态性的相关性,评估其对急性支架... 详细信息

目的探讨经皮冠状动脉介入(PCI)术中冠状动脉内血浆纤溶酶原激活剂抑制物-1(PAI-1)、D-二聚体(D-D)、凝血因子Ⅶ(FⅦa)及可溶性P选择素(CD62P)活性在球囊扩张和支架植入前后的早期改变及其与PAI-1基因多态性的相关性,评估其对急性支架血栓形成的预测价值。方法选择稳定型心绞痛患者20例,按标准方法行冠状动脉造影且证实冠状动脉狭窄均在70%以上。术中冠状动脉内血样采集顺序依次为:球囊扩张前冠状动脉入口处(Ostium)用引导导管,球囊扩张15min以后及支架植入后15min通过血栓吸引器穿过病灶在病变远端采血。结果PAI-1基因多态性在本组中分布为4G/5G型最多(12例,60%),4G/4G型其次(6例,30%),5G/5G型最少(2例,10%)。4G和5G等位基因频率分别为60%和40%。具有PAI-14G/5G基因型患者冠状动脉内血浆PAI-1、D-D以及FⅦ活性在球囊扩张后较球囊扩张前明显升高且有统计学意义(P均为0.01),然而这些指标在球囊扩张前与支架植入后比较无显著性差异。结论球囊扩张较支架植入更易损伤血管内皮并导致冠状动脉内局部、早期止血活性的一过性增高,具有PAI-14G/5G基因型患者对这种反应较为敏感。PCI术前双联抗血小板药物可以有效抑制血小板活性。

关键词：经皮冠状动脉介入术基因,多态性纤溶酶原激活剂抑制-1 凝血因子Ⅶ 可溶性P选择素 D-二聚体

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药物涂层支架与金属裸支架对稳定型心绞痛患者局部冠状动脉循环组织因子水平早期影响的比较

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中国介入心脏病学杂志 2008年第3期16卷 155-158页

作者：艾力曼·马合木提 Nicolas Meneveau 刘品明 francois schiele Jean-Pierre Bassand 法国Besanon Franche-comté大学大学中心医院心脏中心中山医科大学第二附属医院心内科新疆医科大学第一附属医院心脏中心乌鲁木齐830054

目的比较药物涂层支架(DES)与金属裸支架(BMS)置入前后冠状动脉循环内局部血浆组织因子(TF)水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓(AST)形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证... 详细信息

目的比较药物涂层支架(DES)与金属裸支架(BMS)置入前后冠状动脉循环内局部血浆组织因子(TF)水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓(AST)形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证实有冠状动脉狭窄均在70%以上。其中15例置入DES(DES组),11例置入BMS(BMS组)。全部患者术前给予阿司匹林、氯吡格雷口服,支架置入前静脉给予低分子质量肝素。PCI术中冠状动脉内血样采集顺序依次为:支架置入前后冠状动脉入口处(ostium)用引导导管,支架置入后15 min通过血栓吸引器穿过病灶在病灶下方(beyond the lesion)采血。血浆TF水平检测采用酶联免疫双抗体夹心法(ELISA)。结果PCI术前26例患者在冠状动脉入口处与病灶下方冠状动脉循环内的TF基线水平比较差异无统计学意义(31.50±7.05 ng/L比31.40±7.30 ng/L,P=0.748),但高于正常参考值3倍;支架置入后15min在冠状动脉入口处(29.60±6.96 ng/L比31.50±7.05 ng/L,P=0.135)与病灶下方(30.70±7.70 ng/L比31.40±6.30 ng/L,P=0.230)冠状动脉循环内的TF水平与术前比较,差异亦无统计学意义。术后15min,DES组和BMS组冠状动脉入口处(31.20±4.37 ng/L比30.70±5.39 ng/L,P=0.674)及病灶下方(31.60±5.39 ng/L比29.00±7.96 ng/L,P=0.789)TF水平差异均无统计学意义。结论稳定型心绞痛患者冠状动脉循环血内存在大量的TF。DES和BMS两种支架均不引起冠状动脉内局部、早期血浆TF水平的改变。

关键词：血管成形术,经腔,经皮冠状动脉支架冠状动脉血栓形成组织因子

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