应用血管内超声评价心肌桥壁冠状动脉压缩比对其近段冠状动脉粥样斑块的影响

Impact of coronary artery compression ratio on proximal atherosclerotic plaque with assessment of myocardial bridge by intravascular ultrasound

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 PB_(prox))。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 PB_(prox)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 PB_(prox)三等分点分组后,Max PB_(prox)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。

Objective:We aimed to evaluated the relationship between myocardial bridge (MB)-wall coronary ar-tery compression and the degree of proximal atherosclerotic plaque.Method:We enrolled 80patients with no significant obstructive coronary artery disease in CAG but detected MB in the left anterior descending artery by IVUS from January 2015to 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 PB prox) up to 20mm 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 PB prox tripartite points,and the clinical data and IVUS properties of the three groups were compared for statistical differences.Result:①Anatomically,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 pa-rameter.②Max PB prox positively 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 PB prox is 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.