右优势型冠状动脉单纯前降支狭窄对左心室整体功能的影响

Effect of simple anterior descending branch stenosis of right-dominate coronary artery on left ventrcular global function

目的：探讨单纯左冠状动脉前降支（ LAD）不同程度狭窄对左心室整体功能的影响。方法：584例256层CT冠脉CTA检查中248例仅有LAD狭窄，按狭窄程度分为正常（≤25％）148例、轻度（26％～50％）58例、中度（51％～75％）22例及重度狭窄（76％以上）20例4组。在工作站测量舒张末期容积（ EDV）、收缩末期容积（ESV ）、每搏输出量（SV）、每分心输出量（CO）、心肌质量（MM）、射血分数（EF）、标准化舒张末期容积（EDVI）、标准化收缩末期容积（ ESVI）、标准化每搏输出量（ SVI）、心脏指数（ CI）、心肌质量指数（ MMI）值。采用单因素方差分析比较LAD不同程度狭窄对LV整体功能参数的影响及spearman相关分析观察LAD狭窄对LV整体功能参数的相关性。结果ESV值：重度组分别与正常组、轻度组、中度组之间差异有统计学意义（ P ＜0–．05），组间差异无统计学意义（ P ＞0．05）。 ESVI值：重度组和正常组比较，差异有统计学意义，其他组间差异无统计学意义（ P ＜0．05）。 MM值：重度组与正常组比较差异有统计学意义（ P ＜0．05），其余组间差异无统计学意义（ P ＞0．05）。 MMI值：重度组与正常组、轻度组之间差异均有统计学意义（ P ＜0．05）。 EF值：重度组和正常组、轻度组、中度组之间差异有统计学意义（ P ＜0．05），其余组间差异无统计学意义。 LAD狭窄程度与MM及MMI值变化之间呈正相关（ r值分别为0．166、0．054， P＜0．01）。结论单纯LAD重度狭窄时明显影响左心室整体功能，表现为ESV、ESVI、MM、MMI、EF值增大。单纯LAD狭窄不同程度与MM、MMI变化呈正相关。

Objective To explore the effect of simple left anterior descending （ LAD） stenosis at different extents on left ventricle （LV） global function.Methods Among 1584 patients examined by 256-slice CT coronary angiography,248 cases showed simple LAD stenosis .According to stenosis extent ,the 248 patients were divided into 4 groups,normal group：（≤25%）（ n =148）,mild stenosis group：（26%-50%）（ n =58）,moderate stenosis group：（51%-75%）（ n =22）,severe stenosis group：（ 〉75%） （ n =20 ） .The related parameters including end-diastolic volume （ EDV ） , end-systolic volume （ESV）,stroke volume （SV）,cardiac output （CO）,myocardial mass （MM）,ejection fraction（EF）,end-diastolic volume index （EDVI）,end-systolic volume index （ESVI）,stroke volume index （SVI）,cardiac output index （CI）,myocardial mass index （ MMI） were detected by means of workstation .The one-factor analysis of variance was used to compare the effect of LAD at different extents on LV global function parameters ,and Spearman ＇s correlation analysis was used to observe and analyze the correlation between LAD stenosis and LV global function parameters .Results There was a significant difference in ESV between severe stenosis group and normal group ,mild stenosis group,moderate stenosis group,respectively （ P 〈0.05）, however,there was no significant difference among the other three groups （ P 〉0.05）.There was a significant difference in ESVI between severe stenosis group and normal group （ F =4.543, P 〈0.01）,however,there was no significant difference among the other groups （ P 〉0.05）.There was a significant difference in MM between severe stenosis group and normal group （ P 〈0.05）,however,there was no significant difference among the other groups （ P 〉0.05）.There was a significant difference in MMI between severe stenosis group and normal group ,mild stenosis group,respectively （ P 〈0.05）.There was a significant difference in EF between severe stenosis group and normal group , mild stenosis group , moderate stenosis group , respectively （ P 〈0.05）,however,there was no significant difference among the other three groups （ P 〉0.05）.LAD stenosis extent was positively correlated to MM and MMI （ r =0.166,0.054,respectively, P 〈0.01）.Conclusion The simple LAD severe stenosis affects obviously LV global function ,with the increase of ESV ,ESVI,MM,MMI,EF.Simple LAD stenosis at different extents is positively correlated to MM and MMI .