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钱菊英:IVUS和FFR: 指导老年女性患者介入治疗的更佳策略

2015-05-02 赖晓帆 凯德传媒

4月11日上午9点20分,在广州举办的中国南方国际心血管病学术会议的女性心血管病论坛上,来自上海复旦大学附属中山医院的钱菊英教授向我们详细阐述了IVUS和FFR在老年女性患者介入治疗的指导作用。 钱教授首先向我们介绍了女性CHD患者的临床特点。自1980年以来,男性CHD患者的死亡率下降,而女性CHD患者的死亡率反而升高。随着年龄的增加,女性患CHD的风险相对更高。对于心绞痛的病

4月11日上午9点20分,在广州举办的中国南方国际心血管病学术会议的女性心血管病论坛上,来自上海复旦大学附属中山医院的钱菊英教授向我们详细阐述了IVUS和FFR在老年女性患者介入治疗的指导作用。

钱教授首先向我们介绍了女性CHD患者的临床特点。自1980年以来,男性CHD患者的死亡率下降,而女性CHD患者的死亡率反而升高。随着年龄的增加,女性患CHD的风险相对更高。对于心绞痛的病人,介入治疗是否能够改善预后一直是一个备受争议的问题,与心肌缺血的程度有很大关系。研究发现,对于稳定型心绞痛,介入治疗能改善中重度心肌缺血的状况。


传统的血管内超声(IVUS)已经用了20多年的历史。基于女性心脏血管本身与男性不同的特点,女性患者IVUS数值无论是在参考血管节段还是发生病变的位置,其EEM面积都比男性小。而冠脉血流储备分数(FFR)直接反映了狭小病变所导致的机械性狭窄程度对心肌功能的影响。我们可以根据FFR数值的大小来初步判断采取哪种治疗方案。一项五年的随访结果发现,如果FFR大于0.75,没有明显的心肌缺血,采用药物治疗和PCI的情况下效果较好。临床发现,在FFR指导老年女性患者介入治疗起到一定的效果。FFR的临床应用很多,可以指导对左主干疾病,多发血管疾病和冠状动脉临界病变等,另外还可以介入治疗的预后监测。钱教授认为,对于指导老年患者介入治疗,最佳策略就是IVUS+FFR。用IVUS进行形态评估,可以得到更多关于斑块和心脏重构的诊断信息。而FFR可作为功能检测,判断支架本身到底是否理想等,而且能降低支架的使用率。


研究发现,同样的狭窄程度,跟男性相比,女性的FFR数值偏高。其机制可能与女性冠心病患者的年龄比男性偏大,心肌表面积更小和左心室质量更小等因素有关。但是,不管是对男性患者还是女性患者,用FFR来指导治疗都会产生一定的益处。另外,相比男性,如果就FFR而言,女性有很多病变更不需要治疗。最后,钱教授强调,最重要的是不要忘记治疗时要紧密结合病人本身的临床症状。

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    2016-02-28 bnjfy
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    2015-06-13 18619c0a62m

    很强大

    0

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    2015-06-13 18619c0a62m

    有用的资料

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2086160, encodeId=dbee20861602e, content=<a href='/topic/show?id=cee996501dd' target=_blank style='color:#2F92EE;'>#钱菊英#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96501, encryptionId=cee996501dd, topicName=钱菊英)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=bnjfy, createdTime=Sun Feb 28 16:22:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27556, encodeId=375d2e55627, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27557, encodeId=903f2e557f5, content=有用的资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2033487, encodeId=ef3a203348ef8, content=<a href='/topic/show?id=446044648ad' target=_blank style='color:#2F92EE;'>#女性患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44648, encryptionId=446044648ad, topicName=女性患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e0a1165, createdName=jiangfeng5067, createdTime=Sun May 31 10:22:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23225, encodeId=4dea232255a, content=女性的ACS治疗确实值得关注!, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=780e86694, createdName=taiyoo1225, createdTime=Tue May 12 11:53:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22553, encodeId=b3192255391, content=都是新技术组合,不过这篇文章谈得还不深, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Mon May 04 07:54:00 CST 2015, time=2015-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22487, encodeId=ef122248ea7, content=男性, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sun May 03 07:33:00 CST 2015, time=2015-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22436, encodeId=71ee2243629, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat May 02 19:47:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22427, encodeId=1c492242e5c, content=女性有很多的特点, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 02 13:40:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22421, encodeId=7bc522421d3, content=对老年男性呢?, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Sat May 02 12:18:00 CST 2015, time=2015-05-02, status=1, ipAttribution=)]
    2015-05-12 taiyoo1225

    女性的ACS治疗确实值得关注!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2086160, encodeId=dbee20861602e, content=<a href='/topic/show?id=cee996501dd' target=_blank style='color:#2F92EE;'>#钱菊英#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96501, encryptionId=cee996501dd, topicName=钱菊英)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=bnjfy, createdTime=Sun Feb 28 16:22:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27556, encodeId=375d2e55627, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27557, encodeId=903f2e557f5, content=有用的资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2033487, encodeId=ef3a203348ef8, content=<a href='/topic/show?id=446044648ad' target=_blank style='color:#2F92EE;'>#女性患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44648, encryptionId=446044648ad, topicName=女性患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e0a1165, createdName=jiangfeng5067, createdTime=Sun May 31 10:22:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23225, encodeId=4dea232255a, content=女性的ACS治疗确实值得关注!, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=780e86694, createdName=taiyoo1225, createdTime=Tue May 12 11:53:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22553, encodeId=b3192255391, content=都是新技术组合,不过这篇文章谈得还不深, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Mon May 04 07:54:00 CST 2015, time=2015-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22487, encodeId=ef122248ea7, content=男性, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sun May 03 07:33:00 CST 2015, time=2015-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22436, encodeId=71ee2243629, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat May 02 19:47:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22427, encodeId=1c492242e5c, content=女性有很多的特点, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 02 13:40:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22421, encodeId=7bc522421d3, content=对老年男性呢?, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Sat May 02 12:18:00 CST 2015, time=2015-05-02, status=1, ipAttribution=)]
    2015-05-04 lovetcm

    都是新技术组合,不过这篇文章谈得还不深

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2086160, encodeId=dbee20861602e, content=<a href='/topic/show?id=cee996501dd' target=_blank style='color:#2F92EE;'>#钱菊英#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96501, encryptionId=cee996501dd, topicName=钱菊英)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=bnjfy, createdTime=Sun Feb 28 16:22:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27556, encodeId=375d2e55627, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27557, encodeId=903f2e557f5, content=有用的资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2033487, encodeId=ef3a203348ef8, content=<a href='/topic/show?id=446044648ad' target=_blank style='color:#2F92EE;'>#女性患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44648, encryptionId=446044648ad, topicName=女性患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e0a1165, createdName=jiangfeng5067, createdTime=Sun May 31 10:22:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23225, encodeId=4dea232255a, content=女性的ACS治疗确实值得关注!, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=780e86694, createdName=taiyoo1225, createdTime=Tue May 12 11:53:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22553, encodeId=b3192255391, content=都是新技术组合,不过这篇文章谈得还不深, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Mon May 04 07:54:00 CST 2015, time=2015-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22487, encodeId=ef122248ea7, content=男性, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sun May 03 07:33:00 CST 2015, time=2015-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22436, encodeId=71ee2243629, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat May 02 19:47:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22427, encodeId=1c492242e5c, content=女性有很多的特点, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 02 13:40:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22421, encodeId=7bc522421d3, content=对老年男性呢?, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Sat May 02 12:18:00 CST 2015, time=2015-05-02, status=1, ipAttribution=)]
    2015-05-03 hbwang006

    男性

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2086160, encodeId=dbee20861602e, content=<a href='/topic/show?id=cee996501dd' target=_blank style='color:#2F92EE;'>#钱菊英#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96501, encryptionId=cee996501dd, topicName=钱菊英)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=bnjfy, createdTime=Sun Feb 28 16:22:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27556, encodeId=375d2e55627, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27557, encodeId=903f2e557f5, content=有用的资料, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sat Jun 13 18:29:00 CST 2015, time=2015-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2033487, encodeId=ef3a203348ef8, content=<a href='/topic/show?id=446044648ad' target=_blank style='color:#2F92EE;'>#女性患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44648, encryptionId=446044648ad, topicName=女性患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e0a1165, createdName=jiangfeng5067, createdTime=Sun May 31 10:22:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23225, encodeId=4dea232255a, content=女性的ACS治疗确实值得关注!, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=780e86694, createdName=taiyoo1225, createdTime=Tue May 12 11:53:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22553, encodeId=b3192255391, content=都是新技术组合,不过这篇文章谈得还不深, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Mon May 04 07:54:00 CST 2015, time=2015-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22487, encodeId=ef122248ea7, content=男性, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sun May 03 07:33:00 CST 2015, time=2015-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22436, encodeId=71ee2243629, content=很强大, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat May 02 19:47:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22427, encodeId=1c492242e5c, content=女性有很多的特点, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 02 13:40:00 CST 2015, time=2015-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=22421, encodeId=7bc522421d3, content=对老年男性呢?, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Sat May 02 12:18:00 CST 2015, time=2015-05-02, status=1, ipAttribution=)]
    2015-05-02 huaxipanxing

    很强大

    0

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    2015-05-02 hbwang006

    女性有很多的特点

    0

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    2015-05-02 medcardio

    对老年男性呢?

    0

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