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| 1 | 极高强度他汀治疗对冠状动脉粥样硬化消退的影响——ASTEROID试验显示文摘背景:以前的血管内超声(intravascular ultrasound,IVUS)试验证实,他汀治疗可减缓或阻止动脉粥样硬化的进展,但是迄今尚无应用动脉粥样斑块体积百分比(percent atheroma volume,PAV)证实粥样硬化消退的确切证据。PAV是最严格的评价病变进展和消退的IVUS测量指标。
目标:评价极高强度他汀治疗是否能逆转IVUS确定的冠状动脉粥样硬化。
设计和地点:于美国、加拿大、欧洲和澳大利亚53个社区和3级保健中心进行前瞻性开标盲法终点试验(A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden,ASTEROID)。应用马达驱动回撤IVUS评价基线和治疗24个月时冠状动脉粥样斑块负荷。每对基线和随访IVUS测量结果均进行盲法分析。
病例:从2002年11月到2003年10月,507例患者有基线IVUS检查结果,并接受至少1个剂量的研究药物。在24个月后,349例患者具有可用于评估的系列IVUS检查结果。
干预:所有患者均接受瑞舒伐他汀40ms/d强化治疗。
主要观测指标:预先设定了两个一级疗效指标:PAV变化和基线最严重病变10min节段动脉粥样斑块体积变化。二级疗效指标为整个动脉标准化总斑块体积的变化。结果:平均(SD)LDL—C水平由基线时的130.4(34.3)ms/dL降至60.8(20.0)ms/扎,平均下降了53.2%(P〈0.001)。平均(SD)HDL-C水平从基线时的43.1(11.1)ms/dL升至49.0(12.6)ms/dL,平均增加了14.7%(P〈0.001)。整个血管PAV平均(SD)变化为-0.98%(3.15%),中位数为-0.79%(97.5%CI,-1.21%~-0.53%)(与基线比较,P〈0.001)。最严重病变10min节段斑块体积平均(SD)变化为-6.1(10.1)mm^3,中位数为-5.6mm^3(97.5%CI,-6.8~-4.0mm^3)(与基线比较,P〈0.001)。总斑块体积变化中位数降低了6.8%,平均减少了-14.7(25.7)mm^3,中位数为-12.5mm^3(95%CI,-15.1~-10.5mm^3)(与基线比较,P〈0.001)。不良事件少见,与其他他汀试验相似。
结论:应用瑞舒伐他汀40ms/d进行极高强度他汀治疗可使LDL-C平均水平达到60.8ms/dL,使HDL—C增加14.7%。这导致所有3个预先设定的IVUS斑块负荷指标均显示动脉粥样硬化消退。因此,将LDL-C降至低于目前指南规定的水平,同时显著提高HDL-C,可以使冠心病患者动脉粥样硬化斑块消退。这些变化对临床预后的影响尚需进一步研究确定。 | Steven E. Nissen Stephen J. Nicholls Ilks Sipahi Peter Libby Joel S. Raichlen Christie M. Ballantyne Jean Davignon Raimund Erbel Jean Charles Fruchart Jean-Claude Tardif Paul Schoenhagen Tim Crowe Valerie Cain Kathy Wolski Marlene Coormastic E. Murat Tuzcu 仝其广(译) 王淑敏(译) 胡大一(校) | 2006 | 美国医学会杂志(中文版)2006，25，4： | 341 |
| 2 | 冠状动脉血流储备的经胸多普勒超声心动图与冠状动脉内多普勒血流测量的对照研究显示文摘目的 ①探讨经胸声学造影二次谐波多普勒超声心动图 (TTDE)探测冠状动脉左前降支(LAD)远端血流的可行性 ;②与冠状动脉内多普勒 (ICD)相对照 ,分析研究LAD冠状动脉血流储备(CFR)。方法 利用TTDE连续检测 110例患者LAD血流。冠状动脉血流速度储备 (CFVR)为注射腺苷后的最大平均血流速度与静息状态平均血流速度的比值。结果 CFVR探测的成功率为 96%。TTDE所探测的CFVR(2 .83± 0 .68)与ICD所探测的结果 (2 .91± 0 .74)密切相关 (r =0 .83 ,Y =0 .76X + 0 .61,P <0 .0 0 1)。结论 TTDE结合声学造影及二次谐波技术是一项可行、可信的无创性探测CFVR的方法 ,可用于冠状动脉病变的探测及冠脉介入治疗的随访。 | 杨娅 Thomas Bartel 王新房 Raimund Erbel | 2002 | 中华超声影像学杂志2002，11，6： | 23 |
| 3 | 切割球囊成形术与经皮腔内β-射线放射疗法联合治疗冠状动脉支架内再狭窄显示文摘目的 观察切割球囊成形术 (CBA)与经皮冠状动脉 (冠脉 )内 β 射线放射疗法 (β 放疗 )联合治疗支架内再狭窄 (ISR)的疗效及其安全性。方法 冠脉内支架置入术后ISR >70 %的患者2 95例 ,男性 2 0 5例 ,女性 90例 ,平均年龄 (5 9 76± 10 83)岁 ,其中 112例均行CBA联合 β 放疗作为β 放疗组 (n =112 ) ,183例单独采用CBA(89例 )或普通球囊扩张成形术 (94例 )为对照组 (n =183)。弥漫性长病变ISR者回撤 β 放疗导管分段照射。所有患者术前、术后即刻及术后随访期行冠脉造影 ,随访靶血管血运重建 (TVR)和主要不良心血管事件 (MACE)发生率。结果 两组患者的术前及术后即刻冠脉造影结果差异无显著性。随访期 (6 3± 1 6 )月 β 放疗组的最小管腔直径大于对照组 ,管腔直径狭窄百分比小于对照组 ,P <0 0 5。β 放疗组与对照组的心绞痛、心肌梗死及病死率相似(心绞痛为 10 %比 17% ,心肌梗死为 1%比 2 % ,病死率为 0 %比 2 % ) ,但 β 放疗组的TVR和MACE明显低于对照组 (TVR为 5 %比 16 % ,MACE为 11%比 2 1% ,P <0 0 5 )。β 放疗组 2 8例 (2 5 % )弥漫性长病变ISR ,分段照射后随访TVR和MACE无增加。结论 冠脉内 β 放疗和CBA相结合治疗ISR安全、有效 ,TVR和MACE明显降低。采用回撤 β 放疗导管? | 樊冰 葛均波 von Birgelen C 钱菊英 王齐兵 葛雷 陈灏珠 Erbel R | 2004 | 中华心血管病杂志2004，32，5： | 12 |
| 4 | 新型无创性冠状动脉血流储备检测经胸壁声学造影二次谐波多普勒技术显示文摘目的 研究经胸壁声学造影二次谐波多普勒超声心动图探测左前降支 (LAD)冠状动脉血流储备 (CFVR)的可行性、安全性及可靠性。方法 46例患者经静脉注射利声显 ,利用二次谐波观察LAD血流 ,对多普勒血流图像质量进行分级。CFVR为注射腺苷后的最大平均血流速度与静息状态平均血流速度的比值。结果 CFVR探测的成功率为 98%。注射腺苷后 ,心率加快 ,血压减低。60 %患者有轻微副反应。CFVR为 2 84± 0 65 ,与冠状动脉内多普勒探测的结果密切相关 (r=0 87,P <0 0 0 1 )。结论 经胸壁声学造影二次谐波多普勒超声心动图可明显提高冠状动脉血流探测的成功率 ,是安全、可行。 | 杨娅 王新房 Thomas Bartel Holger Eggebrecht Loredana Latina Raimund Erbel | 2003 | 中华心血管病杂志2003，31，2： | 11 |
| 5 | 冠状动脉造影正常者冠状动脉血流储备的经胸多普勒超声研究显示文摘目的 研究经胸多普勒超声心动图 (TTDE)探测冠状动脉 (冠脉 )造影正常者左前降支(LAD)远端血流的准确性 ;与冠脉内超声 (IVUS)相对照 ,分析影响冠脉造影正常者冠脉血流储备 (CFVR)的病理因素。方法 利用TTDE检测 40例冠脉造影正常者的LAD血流。CFVR为注射腺苷后的最大平均血流速率与静息状态平均血流速率的比值。结果 37例患者成功地进行了CFVR的测量。TTDE所检测的CFVR与冠脉内多普勒 (ICD)所检测的结果密切相关 (Y =0 .65X +0 .92 ,r =0 .88,P <0 .0 0 0 1 )。合并高血压的患者CFVR减低。 34例患者行IVUS检查 ,1 7例LAD内有粥样硬化斑块形成。结论 TTDE是一项可行、可信的无创性检测CFVR的方法。冠脉造影正常者LAD内可有斑块形成 。 | 杨娅 Thomas Bartel 王新房 李治安 Raimund Erbel | 2003 | 中华超声影像学杂志2003，12，8： | 9 |
| 6 | Identification of syndrome X using intravascular ultrasound imaging and Doppler flow mapping显示文摘Background The purpose of this study was to assess the morphological changes and physiological function of coronary arteries in patients presenting with chest pain but having normal coronary angiograms, using intravascular ultrasound imaging (IVUS) and intracoronary Doppler (ICD) flow measurements, in order to elucidate the mechanism of syndrome X. Methods A total of 126 patients [67 males, 59 females, mean age (53.1±13.0) years] who experienced chest pain but had normal coronary angiograms were included in this study. ICD flow measurements of the left anterior descending coronary artery (LAD) were performed using a Cardiometrics FloMap Ⅱ system. Coronary flow velocity reserve (CFVR) was defined as the ratio of the average peak velocity during hyperemia to that at baseline, induced by an intracoronary bolus injection of 18 μg adenosine. A 3.2F or 2.9F 30 MHz mechanical rotating ultrasound catheter (CVIS, Boston Scientific) or a 3.0F 20MHz electronic ultrasound catheter (Endosonics) was used for IVUS. Results The mean CFVR value of the LAD was 2.71±0.74. Reduction of CFVR (<3.0) was found in 82 of 126 (65.1%) patients. IVUS images of the LAD were available for 109 patients. Plaque formation was detected in 76/109 (69.7%) patients. Based on the presence or absence of plaque formation as well as the reduction or non-reduction of CFVR, patients were divided into four groups: Group Ⅰ (n=10), normal IVUS findings and normal CFVR; Group Ⅱ (n=23), normal IVUS findings with reduction in CFVR; Group Ⅲ (n=29), IVUS evidence of plaque formation but normal CFVR; and Group Ⅳ (n=47), IVUS evidence of plaque formation with reduction in CFVR. Conclusion This study shows the important clinical value of a combination of IVUS and ICD in diagnosing patients with angiographically normal coronary arteries. Only 10% of patients studied (Group Ⅰ) were found to be truly free of coronary disease, while 20% of patients (Group Ⅱ) would be diagnosed as suffering from syndrome X. | 钱菊英 葛均波 樊冰 王齐兵 陈灏珠 Dietrich Baumgart Michael Haude Raimund Erbel | 2004 | Chinese Medical Journal2004，，4： | 4 |
| 7 | Assessment of Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients with Angiographically Normal Coronary Arteries显示文摘The measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) with invasive intracoronary Doppler flow wire technique (ICD) was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery (LAD) in 37 of 40 patients with angiographically normal coronary arteries (men 22, women 15, age 20-75 years, mean age 54±12 years). Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 140 μg/kg per min within 48 h after ICD technique. Average peak velocity at baseline (APVb), average peak velocity during hyperemia (APVh) and CFVR determined from TTDE were correlated closely with those from ICD measurements (APVb: y=0.64x+5.04, r=0.86, P<0.001; APVh: y=0.63x+14.36, r=0.82, P<0.001; CFVR: y=0.65x+0.92, r=0.88, P<0.001). For CFVR measurements, the mean differences between TTDE and ICD methods were 0.12± 0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension (P<0.05). Intravascular ultrasound (IVUS ) was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 (50 %) patients. No significant difference in CFVR was found between the patients without plaque formation (3.11±0.49) and those with plaque formation (2.76±0.53, P=0.056). It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal LAD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension. | 杨娅 Thomas BARTEL 李治安 Raimund ERBEL | 2005 | Journal of Huazhong University of Science and Technology(Medical Sciences)2005，25，5： | 3 |
| 8 | Accuracy of myocardial viability imaging by cardiac MRI and PET depending on left ventricular function显示文摘AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging(CMR)compared to[^(18)F]-fluorodeoxyglucose(FDG)-positron emission tomography(PET)depending on left ventricular(LV)function.METHODS One-hundred-five patients with known obstructive coronary artery disease(CAD)and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner.The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement(LGE)imaging for viability assessment in 8 mm long and contiguous short axis slices.All patients underwent PET using[^(18)F]-FDG.Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale:Score 1=no LGE,normal FDG-uptake;score 2=LGE enhancement<50% of wall thickness,reduced FDG-uptake(≥50% of maximum);score 3=LGE≥50% ,reduced FDG-uptake(<50% of maximum);score 4=transmural LGE,no FDG-uptake.Segments with score 1 and 2 were categorized'viable',scores 3 and 4 were categorized as'non-viable'.Patients were divided into three groups based on LV function as determined by CMR:Ejection fraction(EF),<30% :n=45;EF:30% -50% :n=44;EF>50% :n=16).On a segmental basis,the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups.RESULTS CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total.In all patients,CMR detected significantly more scars(score 2-4)than PET:45% vs 40% of all segments(P<0.0001).In the different LV function groups,CMR found more scar segments than PET in subjects with EF<30% (55% vs 46% ;P<0.0001)and EF 30% -50% (44% vs 40% ;P<0.005).However,CMR revealed less scars than PET in patients with EF>50% (15% vs 23% ;P<0.0001).In terms of functional improvement estimation,i.e.,expected improvement after revascularization,CMR identified'viable'segments(score 1 and 2)in 72% of segments across all groups,PET in 80% (P<0.0001).Also in all LV function subgroups,CMR judged less segments viable than PET:EF<30% ,66% vs 75% ;EF=30% -50% ,72% vs 80% ;EF>50% ,91% vs 94% .CONCLUSION CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state.CMR,in general,is less optimistic in functional recovery prediction. | Peter Hunold Heinz Jakob Raimund Erbel Jorg Barkhausen Christina Heilmaier | 2018 | World Journal of Cardiology2018，10，9： | 3 |
| 9 | 冠脉造影正常者的冠脉血流储备分析:经胸多普勒冠脉血流显像与冠脉内超声和多普勒的对照分析显示文摘目的 经胸多普勒超声心动图与冠状动脉内超声 (IVUS)相结合 ,探讨冠脉造影正常者的冠状动脉形态及血流动力学变化。方法 探测 47例冠脉造影正常者前降支 (LAD)IVUS及血流速度并计算冠脉血流储备 (CFVR)。结果 47例患者中 ,14例 (3 0 % )LAD内无斑块 ,CFVR正常 ;16例 (3 4% )无斑块 ,CFVR减低 ;9例 (19% )有斑块 ,CFVR正常 ;8例 (17% )有斑块 ,CFVR减低。结论 冠脉造影正常者中仅 3 0 %为真正的正常 ,其余患者冠脉内或有斑块形成和 /或CFVR受损。 | 杨娅 Thomas Bartel 李治安 Raimund Erbel | 2004 | 中国医学影像技术2004，20，9： | 3 |
| 10 | Tissue Doppler Echocardiography显示文摘 | Erbel R Wallbidge DR Zamorano J | 1996 | Heart1996，76，： | 2 |
| 11 | Anaysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography 显示文摘 | Zeidan Z Erbel R Barkhausen J | 2003 | J Am Soc Echocardiogr2003，16，2： | 1 |
| 12 | Complete reversal of paraplegia after thoracic endovascular aortic repair in a patient with complicated acute aortic dissection using immediate cerebrospinal fluid drainage显示文摘 | Holger Eggebrecht Dirk B?se Thomas Gasser Jaroslav Benedik Petra Mummel Oliver Müller Philipp Kahlert Konstantinos Tsagakis Heinz G. Jakob Raimund Erbel | 2009 | Clinical Research in Cardiology2009，，12： | 1 |
| 13 | Hemodynamic effects of a single intravenous infusion of prostaglandin El in patients with clinically moderate to severe chronic heart failure显示文摘 | Chrader N Erbel R Wittlich N | 1997 | Am J Ther1997，4，： | 1 |
| 14 | Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris: institutional experience and literature review 显示文摘 | Spiecker M Erbel R Rupprecht H J | 1994 | Eur Heart J1994，15，： | 1 |
| 15 | Influence of medical and surgical therapy on aortie dissection evaluated by thansesophageal echocardiography显示文摘 | Erbel R Oelert H Meyer J | 1993 | Circulation1993，87，： | 1 |
| 16 | Hemodynamic effects of a single intravenous infusion of prostaglandin E1 in patients with clinically moderate to severe chronic heart failure显示文摘 | Schrader N Erbel R Wittlich N | | 0，，11： | 1 |
| 17 | Analysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography显示文摘 | Zeidan Z Erbel R Barkhausen J | 2003 | J Am Soc Echocardiogr2003，16，1： | 1 |
| 18 | Intravascular ultrasound imaging of angiographically normal coronary arteries: a prospective study in vivo 显示文摘 | Erbel R Gerber TH | 1994 | Br Heart J1994，71，： | 1 |
| 19 | Coronary microembolization 显示文摘 | Erbel R Heusch G | 2000 | J Am Coll Cardiol2000，36，： | 1 |
| 20 | Diagnosis and management of aortic dissection显示文摘 | Erbel R Alfonso F Boileau C | 2001 | Eur Heart J2001，22，18： | 1 |
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