冠状动脉扭曲的临床特征及意义

Clinical features and significance of coronary tortuosity

目的分析冠状动脉扭曲的临床特征及意义。方法 161例行冠状动脉造影检查未见明显狭窄的患者作为研究对象,其中冠状动脉扭曲组79例,冠状动脉非扭曲组82例。所有受试者均行UCG检查评价左心室舒张功能,回顾性分析冠状动脉扭曲的临床特征及相关危险因素,探究其存在的临床意义。结果冠状动脉扭曲在左回旋支中发生率为62.0%,单支冠状动脉扭曲发生率为57.6%。冠状动脉扭曲组患者的平均动脉压(MAP)、室间隔舒张末期厚度(IVST)、左心室等容舒张期时间(IVRT)、E峰减速时间(EDT)、二尖瓣舒张晚期峰值血流速度(A)、二尖瓣口舒张早期峰值血流速度/组织多普勒二尖瓣环侧壁舒张早期峰值速度(E/E')水平均高于冠状动脉非扭曲组(P均<0.05);而冠状动脉扭曲组患者的二尖瓣口舒张早期峰值血流速度(E)、组织多普勒二尖瓣环侧壁舒张早期峰值速度(E')、二尖瓣口舒张早期峰值血流速度/二尖瓣口舒张晚期峰值血流速度(E/A)水平均低于冠状动脉非扭曲组(P均<0.05)。Logistic回归分析表明,MAP、IVST、DT、E/E'的升高及E/A的降低可能为冠状动脉扭曲的危险因素(P均<0.05)。结论冠状动脉扭曲主要发生在左回旋支,且单支血管扭曲发生率高;冠状动脉扭曲可能是左心室舒张功能减退的指标之一,并与血压密切相关。

Objective To investigate the clinical features and significance of coronary tortuosity. Methods One hundred and sixty-one patients with no apparent stenosis in coronary angiography were recruited as study subjects and assigned into the coronary tortuosity （n =79）and non-tortuosity groups （n =82）.All subjects received ultrasound cardiogram （UCG）to assess the left ventricular diastolic function.Clinical fea-tures and risk factors of coronary tortuosity were retrospectively analyzed to explore its clinical significance.Re-stults The incidence of coronary tortuosity in left circumflex artery was 62.0% and 57.6% for single coronary tortuosity.In the coronary tortuosity group,the mean arterial pressure （MAP）,interventricular septal thick-ness （IVST）,isovolumetric relaxation time （IVRT）,deceleration time of E velocity （DT）,late transmitral inflow （A）velocity and E /E′ratio were significantly higher （all P 〈0.05）,whereas the early transmitral in-flow （E）velocity,early mitral annular inflow （E′）velocity and E /A ratio were considerably lower compared with those in the non-tortuosity group （all P 〈0.05）.Logistic regression analysis revealed that the elevation of MAP,IVST,DT and E /E′and the decrease of E /A might be risk factors of coronary tortuosity（all P 〈0.05）. Conclusions The left circumflex artery is a preponderant site of coronary tortuosity,and the incidence of sin-gle coronary tortuosity is high.Coronary tortuosity might be an indicator of impaired left ventricular diastolic function and intimately associated with blood pressure.