冠状动脉心肌桥138例临床研究

Cinical analysis of 138 cases of coronary myocardial bridge

目的研究冠状动脉造影患者中心肌桥的临床特征以及发生率。方法和结果 3356例行选择性冠状动脉造影术的人群中,共检出心肌桥138例,发生率为4.11%,均为左冠状动脉前降支(LAD)心肌桥,位于LAD远段22例,中段114例,近段2例。无心脏病的孤立心肌桥100例,伴有冠心病的心肌桥26例,伴有瓣膜病6例,伴有心肌病例6例。孤立心肌桥中收缩期冠状动脉狭窄程度≥70%50例,50%～70%34例,<50%16例。138例心肌桥中超声心动图或左心室造影提示有室壁肥厚26例。心电图提示有ST-T改变36例;孤立心肌桥中有胸痛症状50例;行运动负荷试验阳性36例。结论冠状动脉造影是心肌桥的可靠检出手段。心肌桥引起冠状动脉收缩期的高度狭窄而导致心肌缺血症状、心电图ST-T变化、运动负荷试验阳性,狭窄程度越重,上述表现越显著。心肌桥可伴随其他心脏病发生也可孤立存在。

Objective To assess the prevalence of coronary myocardial bridge in patients underwent diagnostic angiography and its clinical features.Methods and Results Among 3356coronary angiograms performed in the department of the cardiology,Suining central hospital,138 patients had myocardial bridge over the left anterior descending arteries.The total prevalence of myocardial bridges was 4.11%.Among these patients,26 patients had coronary artery disease,6 patients had valvular heart disease and 6 patients had cardiomyopathy.100 patients had isolated myocardial bridges.Among the patients with isolated myocardial bridge,50 patients had70% systolic narrowing of coronary artery 34 patients had 50%～70%,16 patients had50%.Among 100 patients with isolated myocardial bridges,50 patients had chest pain and 36 patients had ST-T abnormality in electrocardiogram.26 patients were showed myocardial hypertrophy by left ventriculogram or echocardiogrm.Conclusion Myocardial bridge could be found by Coronary angiography.The prevalence of coronary myocardial bridging in the studied coronary angiographic popoulation was 4.11%.Myocardial bridge could be responsible for symptoms of myocardial ischemia,ST-T abnormality in electrocardiogram and positive result in exercise testing.The symptoms were associated with the degree of narrowing of the left anterior descending artery during systole.