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Percutaneous coronary intervention is an important method for the treatment of coronary heart disease. Postoperative dual antiplatelet therapy is an important prerequisite to ensure the safety of surgery. Antiplatelet therapy with clopidogrel still has a high risk of thrombosis, which may be related to CYP2C19 genotyping. Therefore, a brief review of the impact of CYP2C19 genotyping on clopidogrel hyperresponsiveness is made.
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Optical coherence tomography (OCT) has become a key technique in the diagnosis of coronary artery stenosis, which can identify plaques and vulnerable plaques in the image. Therefore, this technique is of great significance for the diagnosis of coronary heart disease. However, there is still a lack of automatic, multi-region, high-precision segmentation algorithms for coronary OCT images in the current research field. Therefore, this paper proposes a multi-zone, fully automated segmentation algorithm for coronary OCT images based on neutrosophic theory, which achieves high-precision segmentation of fibrous plaques and lipid regions. In this paper, the method of transforming OCT images into T in the area of neutrosophics is redefined based on the membership function, and the segmentation accuracy of fiber plaques is improved. For the segmentation of lipid regions, the algorithm adds homomorphic filter enhancement images, and uses OCT to transform OCT images into I in the field of neutrosophics, and further uses morphological methods to achieve high-precision segmentation. In this paper, 40 OCT images from 9 patients with typical plaques were analyzed and compared with the results of manual segmentation by doctors. Experiments show that the proposed algorithm avoids the over-segmentation and under-segmentation problems of the traditional neutrosophic theory method, and accurately segment the patch area. Therefore, the work of this paper can effectively improve the accuracy of segmentation of plaque for doctors, and assist clinicians in the diagnosis and treatment of coronary heart disease.
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Objective To explore the association between frailty and muscle performances of hospitalized elder adults with coronary artery disease.Methods A total of 122 hospitalized patients aged 65-85 years old with coronary artery disease from Department of Geriatrics and Cardiology,Peking Union Medical College Hospital between December 2017 and March 2018 were enrolled in the study.A comprehensive geriatric assessment was performed to evaluate existing comorbidity and geriatric syndromes of the patients.Frailty was assessed using the Clinical Fraity Scale.The patients were classified as frail and non-frail,according to the scale.Muscle performances were assessed using grip strength,gait speed,etc.Whole body and appendicular skeletal muscle mass was detected with bioelectrical impedance analysis in patients with reduced grip strength or slowed gait speed.Appendicular skeletal muscle index (ASMI) was calculated.Results Among all subjects,28 were with frailty (23.0％) and 94 were without (77.0％).The frail patients were older [(76.7±5.4) years vs.(72.2±5.6)years],had higher Charlson comorbidity index [2.0(1.0,2.75)vs.1.0(0,2.0)],and higher proportion of malnutrition (14.29％ vs.1.06％),urinary incontinence (39.29％ vs.15.96％),using walking-aid (28.57％ vs.6.38％),and more kinds of taken drugs (8.1±3.0 vs.6.6±2.7),than the non-frail patients.Prealbumin levels [(207.8±60.0)mg/L vs.(234.3±45.4)mg/L] were lower,and highly sensitive C-reactive protein levels [(5.89±9.57)mg/L vs.(1.89±2.49)mg/L] were higher in the frail patients than in the non-frail patients (all P＜0.05).Compared with non-frail patients,the frail patients had poorer grip strength [(19.67±7)kg vs.(29.23±8.29)kg] and slower gait speed [(0.54±0.2)m/s vs.(0.91±0.22)m/s](all P＜0.001).Spearman rank correlation analyses showed that grip strength was positively correlated with the appendicular skeletal muscle mass(r =0.811),whole body skeletal muscle mass(r =0.74) and the ASMI (r =0.783),respectively.Conclusions The incidence of frailty among hospitalized older adults with coronary artery disease is high.Poor muscle performances were common in these patients.Assessment of frailty and muscle performances can help to evaluate the overall function of older adults with cardiovascular disease in a comprehensive way.
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Optical coherence tomography (OCT) is a new technique applied in cardiovascular system. It can detect vessel intimal, small structure of plaque surface and discover small lesions with its high axial resolution and quantification character. Especially with the application of OCT in characterization of coronary atherosclerotic plaque, diagnosis and treatment strategy making, optimizing percutaneous coronary intervention therapy and assessment after stent planting make the OCT become an efficient tool for cardiovascular disease diagnosis and treatment. This paper presents a novel coronary vessel intimal sequence extraction method based on prior boundary constraints in OCT image. On the basis of conventional Chan-Vese model, we modified the evolutionary weight function to control the evolutionary rate of boundary by adding local information of boundary curve. At the same time, we added the gradient energy term and intimal boundary constraint term based on priori boundary condition to further control the evolutionary of boundary curve. At last, coronary vessel intimal is extracted in a sequence way. The comparison with vessel intimal, manual segmented by clinical scientists (golden standard), indicates that our coronary vessel intimal extraction method is robust to intimal boundary blur, distortion, guide wire shadow and plaque disturbs. The results of this study can be applied to clinical aid diagnosis and precise diagnosis and treatment.
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Objective To study the relationship between the thyroid dysfunction and coronary artery disease (CAD). Methods Two thousands and twelve patients,diagnosed as CAD by coronary angiography from January 2003 to February 2010 in Peking Union Hospital,were enrolled into this study and divided into normal thyroid function, hyperthyroidism, and hypothyroidism groups. The thyroid function data and the coronary angiography findings were compared among three groups. Results The incidence rates of hypertension (40%vs. 69. 4% vs. 78.6%, x2 = 12. 331, P = 0. 01) and hyperlipemia(20. 0% vs. 67.4% vs. 85.7%, x2 =12. 331 ,P=0. 002) in hyperthyroidism patients were significantly lower than normal thyroid function patients and hypothyroidism patients, but no significant differences were found in the comparison of diabetes incidence rates among three groups (20. 0% vs. 41.6% vs. 35.7%, x2 = 2. 114,P =0. 347). According to the coronary angiography findings, we found that the incidence rate of CAD of hypothyroidism patients was higher than hyperthyroidism patients(71.0% vs. 55. 2%, x2. = 1. 804, P = 0. 179), but the difference didn' t reach statistically significant level. Two hyperthyroidism patients had coronary artery spasm and acute myocardial infarction. Conclusion Hypothyroidism had more promotion effect on coronary artery disease than hyperthyroidism,but higher serum thyroxin level increased the risk of coronary spasm and the probability of acute myocardial infarction,which could be well adjusted by medication treatment.