Impact of coronary artery compression ratio on proximal atherosclerotic plaque with assessment of myocardial bridge by intravascular ultrasound
-
摘要: 目的:应用血管内超声 (IVUS) 评价左前降支心肌桥及壁冠状动脉 (冠脉) 压缩与其近段冠脉粥样硬化程度的关系。方法:入选2015-01-2018-05入住我院心内科患者80例, 所有患者冠脉造影证实无明显狭窄病变, 而IVUS检查发现左前降支存在心肌桥。应用IVUS测量心肌桥位置、心肌桥长度、心肌桥厚度等解剖参数;IVUS测量壁冠脉压缩比以及心肌桥近端20mm内冠脉的最大斑块负荷 (Max PBprox)。单元线性回归分析壁冠脉压缩程度与心肌桥长度、厚度、位置的关系。根据Max PBprox三等分点将患者分为A、B、C 3组, 比较3组间的临床资料、IVUS测量值是否有统计学差异。结果:① 测得所有患者心肌桥长度为 (20.8±12.7) mm, 心肌桥厚度为 (0.71±0.49) mm, 心肌桥位置为 (37.4±11.3) mm, 壁冠脉压缩比为 (23.9±11.8)%, 单元线性回归分析显示壁冠脉压缩程度与心肌桥长度 (r=0.287, P=0.067)、心肌桥厚度 (r=0.296, P=0.086) 和心肌桥位置 (r=0.301, P=0.073) 均无显著相关性。② 根据Max PBprox三等分点分组后, Max PBprox严重程度与壁冠脉压缩比呈正相关 (P＜0.05), 而与心肌桥长度 (P=0.450)、心肌桥厚度 (P=0.126) 及心肌桥位置 (P=0.364) 无关。结论:心肌桥近端冠脉粥样斑块负荷与壁冠脉压缩比呈正相关, 而与心肌桥长度、厚度及位置无关, 这有助于识别高危心肌桥病变患者。壁冠脉压缩程度与心肌桥长度、厚度及位置无显著相关。Abstract: Objective: We aimed to evaluated the relationship between myocardial bridge (MB) -wall coronary artery compression and the degree of proximal atherosclerotic plaque.Method: We enrolled 80 patients with no significant obstructive coronary artery disease in CAG but detected MB in the left anterior descending artery by IVUS from January 2015 to May 2018.The properties such as the position, the length and the maximum thickness of MB were measured by IVUS.We also measured the maximum plaque load (Max PBprox) up to 20 mm proximal to the MB entrance.Simple Regression Analysis was used to evaluate the relationship between the degree of coronary artery compression and the length, Max thickness and location of MB.The patients were divided into groups A, B and C according to the Max PBproxtripartite points, and the clinical data and IVUS properties of the three groups were compared for statistical differences.Result: ① Anatomically, the MB length was (20.8±12.7) mm, the MB thickness was (0.71±0.49) mm, and the MB position was (37.4±11.3) mm.Functionally, artery compression ratio was (23.9±11.8)%.In simple regression Analysis, artery compression ratio has no correlation with the MB parameter. ② Max PBproxpositively was correlated with artery compression ratio (P＜0.05), rather than the length of the myocardial bridge (P=0.450), the thickness of the myocardial bridge (P=0.126) and myocardial bridge position (P=0.364).Conclusion: Max PBproxis positively correlated with artery compression ratio, rather than the length, thickness and location of MB, which is helpful to identify patients with high-risk MB.Artery compression ratio has no significant correlation with the length, thickness and location of MB.
-
Key words:
- intravascular ultrasound /
- myocardial bridge /
- coronary atherosclerosis
-
-
[1] Ishimori T, Raizner AE, Chahine RA, et al.Myocardial bridges in man:clinical correlations and angiographic accentuation with nitroglycerin[J].Cathet Cardiovasc Diagn, 1977, 3 (1):59-65.
[2] 叶新和, 杨承建, 徐欣.冠状动脉心肌桥的研究进展[J].心血管病学进展, 2009, 30 (1):179-181.
[3] Lin S, Tremmel JA, Yamada R, et al.A novel stress echocardiography pattern for myocardial bridge with invasive structural and hemodynamic correlation[J].JAm Heart Assoc, 2013, 2 (2):e000097.
[4] Tsujita K, Maehara A, Mintz GS, et al.Comparison of angiographic and intravascular ultrasonic detection of myocardial bridging of the left anterior descending coronary artery[J].Am J Cardiol, 2008, 102 (12):1608-1613.
[5] Ishikawa Y, Akasaka Y, Suzuki K, et al.Anatomic properties of myocardial bridge predisposing to myocardial infarction[J].Circulation, 2009, 120 (5):376-383.
[6] 王旖旎, 林平, 高学琴, 等.基于OCT冠状动脉粥样硬化斑块稳定性影响因素影响[J].临床心血管病杂志, 2016, 32 (9):886-889.
[7] Kim JW, Seo HS, Na JO, et al.Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound[J].Heart, 2008, 94 (6):765-769.
[8] Iuchi A, Ishikawa Y, Akishima-Fukasawa Y, et al.Association of variance in anatomical elements of myocardial bridge with coronary atherosclerosis[J].Atherosclerosis, 2013, 227 (1):153-158.
[9] Ishii T, Hosoda Y, Osaka T, et al.The significance of myocardial bridge upon atherosclerosis in the left anterior descending coronary artery[J].J Pathol, 1986, 148 (4):279-291.
[10] 马淑华, 黎叶芳, 袁珠, 等.心肌桥-壁冠状动脉的形态学特征与冠状动脉近段粥样硬化病变的关系[J].中国循证心血管病学杂志, 2018, 11 (5):578-580+584.
[11] Kim PJ, Hur G, Kim SY, et al.Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries:a comparison between computed tomography and invasive coronary angiography[J].Circulation, 2009, 119 (10):1408-1416.
[12] Inaba S, Okayama H, Higashi H, et al.Usefulness of transthoracic Doppler echocardiography for noninvasive assessment of coronary blood flow in a patient with symptomatic myocardial bridging[J].Eur J Echocardiogr, 2011, 12 (3):E15.
[13] Berry JF, von Mering GO, Schmalfuss C, et al.Systolic compression of the left anterior descending coronary artery:a case series, review of the literature, and therapeutic options including stenting[J].Catheter Cardiovasc Interv, 2002, 56 (1):58-63.
[14] Ishikawa Y, Akasaka Y, Akishima-Fukasawa Y, et al.Histopathologic profiles of coronary atherosclerosis by myocardial bridge underlying myocardial infarction[J].Atherosclerosis, 2013, 226 (1):118-123.
[15] Miyamoto Y, Okura H, Kume T, et al.Plaque characteristics of thin-cap fibroatheroma evaluated by OCTand IVUS[J].JACC Cardiovasc Imaging, 2011, 4 (6):638-646.
[16] 付大伟, 伍崇海, 钟赟, 等.心肌桥与无心肌桥者在冠状动脉粥样硬化过程中危险因素的差异[J].临床心血管病杂志, 2015, 31 (2):141-144.
[17] 徐永平, 赵新斌, 赵鹤亮, 等.心肌桥-壁冠状动脉与心肌缺血的相关性研究[J].临床心血管病杂志, 2018, 34 (7):709-712.
-
计量
- 文章访问数: 53
- PDF下载数: 84
- 施引文献: 0
下载: