Application of noninvasive imaging and intelligent analysis in diagnosis and treatment of coronary heart disease in the elderly
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摘要: 冠心病是我国老年人死亡的主要原因，早期发现及有针对性的管理能降低老年冠心病风险和改善预后。无创影像及智能分析技术进步，极大地促进了血管老化及动脉粥样硬化的多模态分子成像、心血管疾病智能影像分析等相关领域的发展，为老年冠心病的个体化评估及管理提供了有效方法。Abstract: Coronary heart disease(CHD) is one of the leading causes of death in the elderly. It is widely acknowledged that the early detection of CHD and targeted management of CVD risk factors are the basis for improving the prognosis of CHD patients. With the deepening of noninvasive imaging and the progress of intelligent analysis, the development of multimodal molecular imaging of vascular aging and atherosclerosis, intelligent image analysis of CVD have greatly promoted, ultimately providing an effective strategy for the individualized assessment and management of elderly patients with CHD.
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Key words:
- coronary heart disease /
- noninvasive imaging /
- intelligent analysis
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表 1 老年冠心病靶向性识别及治疗方面的分子影像学研究
Table 1. Molecular imaging studies on targeted recognition and treatment of coronary heart disease in the elderly patients
探针 成像技术 应用 研究结果 参考文献 靶向金属基质蛋白酶的荧光探针Cy5.5-AF443 近红外荧光成像 靶向性识别 在体可视化易损斑块局部MMP-2的活性，显示斑块可能破裂的风险 Schäfers M，et al.PLoS One.2018，13(10)：e0204305. 靶向血管内皮细胞黏附因子的全氟丁烷纳米微泡探针 增强超声成像 靶向性识别 用于斑块形成早期内皮细胞炎症损伤的成像研究，体外实验证实探针在血管壁内膜组织富集 Punjabi M，et al.Arterioscler Thromb Vasc Biol.2019，39：2520-2530. 靶向OPN纳米探针 荧光/磁共振双模态成像 靶向性识别及治疗 可对易损斑进行特异性强、灵敏度髙的早期精准诊断；对易损斑块实施靶向性光动力治疗，可提高斑块稳定性，从而逆转斑块进展 Feng Cao，et al.Acta Pharm Sin B.2022，12(4)：2014-2028. 靶向动脉粥样硬化斑块的纳米探针 荧光成像 靶向性识别
及治疗在小鼠动脉粥样斑块部位靶向性聚集，通过提高斑块内沉默信息调节因子1蛋白表达，抑制动脉粥样硬化斑块进展，实现动脉粥样硬化诊疗一体化 Feng Cao，et al.Theranostics.2018，8(13)：3693. 
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表 2 老年冠心病诊疗中无创智能影像技术
Table 2. Non-invasive intelligent imaging technology in the diagnosis and treatment of coronary heart disease in the elderly patients
成像工具 图像 应用 研究结果 参考文献 CTA 
运用深度学习，实现钙化血管分割及计算 对于钙化积分严重的病变基于二值解卷积法可消除晕状伪影造成的评估误差提高了诊断效能 Feng Cao，et al.Medical Imaging.2018, doi：10.1117/12.2293289 CT-FFR 
老年疑似胸痛人群的门诊筛查和介入干预策略制定 基于机器学习的FFRCT能准确排除无功能性缺血病变，与FFRQCA相比更适合冠心病患者的无创筛查 Feng Cao，et al.Eur Radiol.2019, 29(7)：3669-3677. CTA 
老年冠脉钙化表型分析 利用CCTA智能分析有助于完善老年冠心病患者的风险分层，指导合理化的降脂治疗 Feng Cao，et al.Eur Radiol.2022, 32(7)：4374-4383. CTA 
在CTA上绘制血管周围脂肪衰减的空间变化图，捕捉冠脉周围微环境可能的炎症，预测心脏死亡风险 提高了心脏事件预测准确性 Oikonomou EK, et al.European Heart Journal, 2019, 40:3529-3543.
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[1] 国家心血管病中心.中国心血管健康与疾病报告2021[J]. 心肺血管病杂志,2022,41(12):1205-1211. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG202304001.htm
[2] Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2014, 63: 2935-2959. doi: 10.1016/j.jacc.2013.11.005
[3] 曹丰, 李天志, 薛万国, 等. 中国老年疾病临床多中心报告[J]. 中华老年多器官疾病杂志, 2018, 17(11): 801-808. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201811001.htm
[4] Paneni F, Diaz Canestro C, Libby P, et al. The aging cardiovascular system: understanding it at the cellular and clinical levels[J]. J Am Coll Cardiol, 2017, 69: 1952-1967.
[5] Andersson C, Vasan RS. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease: clinical risk scores are sufficient to define primary prevention treatment strategies among asymptomatic patients?[J]. Circ Cardiovasc Imaging, 2014, 7(2): 390-397. doi: 10.1161/CIRCIMAGING.113.000470
[6] Badimon L, Bugiardini R, Cubedo J. Patho-physiology of acute coronary syndromes in the elderly[J]. Int J Cardiol, 2016, 222: 1105-1109. doi: 10.1016/j.ijcard.2016.07.205
[7] Gutiérrez E, Flammer AJ, Lerman LO, et al. Endothelial dysfunction over the course of coronary artery disease[J]. Eur Heart J, 2013, 34(41): 3175-3181. doi: 10.1093/eurheartj/eht351
[8] Paneni F, Osto E, Costantino S, et al. Deletion of the activated protein-1 transcription factor JunD induces oxidative stress and accelerates age-related endothelial dysfunction[J]. Circulation, 2013, 127(11): 1229-1240, e1-21. doi: 10.1161/CIRCULATIONAHA.112.000826
[9] Thompson AM, Wagner R, Rzucidlo EM. Age-related loss of SirT1 expression results in dysregulated human vascular smooth muscle cell function[J]. Am J Physiol Heart Circ Physiol, 2014, 307(4): H533-541. doi: 10.1152/ajpheart.00871.2013
[10] Oellerich MF, Potente M. FOXOs and sirtuins in vascular growth, maintenance, and aging[J]. Circ Res, 2012, 110(9): 1238-1251. doi: 10.1161/CIRCRESAHA.111.246488
[11] Seifert R, Kuhlmann MT, Eligehausen S, et al. Molecular imaging of MMP activity discriminates unstable from stable plaque phenotypes in shear-stress induced murine atherosclerosis[J]. PLoS One, 2018, 13(10): e0204305. doi: 10.1371/journal.pone.0204305
[12] Punjabi M, Xu L, Ochoa-Espinosa A, et al. Ultrasound molecular imaging of atherosclerosis with nanobodies: translatable microbubble targeting murine and human VCAM(Vascular Cell Adhesion Molecule)1[J]. Arterioscler Thromb Vasc Biol, 2019, 39(12): 2520-2530. doi: 10.1161/ATVBAHA.119.313088
[13] Ma S, Motevalli SM, Chen J, et al. Precise theranostic nanomedicines for inhibiting vulnerable atherosclerotic plaque progression through regulation of vascular smooth muscle cell phenotype switching[J]. Theranostics, 2018, 8(13): 3693-3706. doi: 10.7150/thno.24364
[14] 田天, 王亚斌, 曹丰, 等. 目测和定量冠状动脉造影分析软件评估冠状动脉狭窄的比较[J]. 中华老年多器官疾病杂志. 2018, 17(5): 351-354. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201805009.htm
[15] Al'Aref SJ, Maliakal G, Singh G, et al. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry[J]. Eur Heart J, 2020, 41(3): 359-367. doi: 10.1093/eurheartj/ehz565
[16] Liu X, Wang Y, Cao F, et al. Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?[J]. Eur Radiol, 2019, 29(7): 3669-3677. doi: 10.1007/s00330-019-06023-z
[17] Wang Y, Chen H, Sun T, et al. Risk predicting for acute coronary syndrome based on machine learning model with kinetic plaque features from serial coronary computed tomography angiography[J]. Eur Heart J Cardiovasc Imaging, 2022, 23(6): 800-810.
[18] Sun T, Wang Y, Wang X, et al. Effect of long-term intensive cholesterol control on the plaque progression in elderly based on CTA cohort study[J]. Eur Radiol, 2022, 32(7): 4374-4383.
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