Hutchins G M, Bulkley B H, Ridolfi R L, Griffith L S, Lohr F T, Piasio M A
Circulation. 1977 Jul;56(1):32-7. doi: 10.1161/01.cir.56.1.32.
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 greater than 50% narrowing discrepancies in 21 (7%). 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%) infarcted and 10 (7%) aneurysmal segments. However, 58 (41%) 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.
为评估冠状动脉和左心室心肌疾病血管造影测定的准确性，我们对28例患者的临床冠状动脉造影和左心室造影与尸检冠状动脉造影及左心室造影以及心肌病理情况进行了比较。所有患者均在术后死亡且在血管造影后三个月内死亡；其中19例患有缺血性心脏病，4例患有瓣膜性心脏病，5例两者兼有。对315个心外膜冠状动脉节段（不包括接受手术的节段）进行生前和死后管腔闭塞情况比较，结果显示21个节段（7%）存在大于50%的狭窄差异。显著的冠状动脉病变被高估6例，低估15例。在6例高估病例中，3例似乎是由于冠状动脉痉挛；在15例低估病例中，12例是由于图像重叠；6例差异原因不明。对140个心室造影节段的壁运动与心肌病理情况进行比较（不包括任何研究后或围手术期损伤），结果显示运动减弱与48个梗死节段（34%）和10个动脉瘤节段（7%）有良好的相关性。然而，58个（41%）其他节段的心室造影运动减弱或消失，心肌结构正常且冠状动脉供血通畅；19个位于梗死边缘，39个位于扩张或肥厚的心脏中。因此，生前冠状动脉造影闭塞通常表明动脉粥样硬化性狭窄；但节段性壁运动减弱或消失往往并不表明存在心肌病变。这可能归因于严重狭窄冠状动脉分布区域的缺血，也可能是由于心室形态异常。
