孤立性右冠状动脉心肌桥的临床表现特点

Clinical features of solitary myocardial bridge on right coronary artery

目的分析孤立性右冠状动脉心肌桥的临床表现,评价其与冠状动脉CTA、心电图表现的关系。方法从4家综合性医院(上海健康医学院附属周浦医院、上海市浦东医院、上海市浦东新区人民医院、上海市浦东新区公利医院)于2014年1月—2019年1月的放射科医学影像信息系统(picture archiving and communication systems,PACS)中检索出经冠状动脉CTA检查诊断为心肌桥的患者23091例,将其中29例孤立性右冠状动脉心肌桥患者纳入研究组;孤立性左前降支(左冠状动脉前降支)心肌桥患者2511例,采用倾向性评分匹配(propensity score matching,PSM)方法,以年龄和性别为匹配因素,将匹配成功的29例孤立性左前降支心肌桥患者纳入对照组。比较两组患者的临床症状、CTA检查结果、心电图检查结果。结果孤立性右冠状动脉心肌桥的检出率为0.13%(29/23091),显著低于孤立性左前降支心肌桥的10.87%(2511/23091,P<0.01)。两组胸闷不适发生率均为34.48%(10/29),对照组和研究组静息态胸痛发生率分别为51.72%(15/29)和48.28%(14/29),两组间胸闷不适和静息态胸痛发生率的差异均无统计学意义(P值均>0.05)。两组间心肌桥类型、心肌桥部位、壁冠状动脉(MCA)狭窄程度分级的患者构成比的差异均无统计学意义(P值均>0.05)。对照组和研究组心电图异常的患者构成比分别为31.03%(9/29)和51.72%(15/29),两组间的差异无统计学意义(P>0.05);对照组心律失常的患者构成比为10.34%(3/29),显著低于研究组的37.93%(11/29,P<0.05)。结论孤立性右冠状动脉心肌桥临床罕见,解剖上以近中段走行于右心房壁多见,容易引起心律失常。

Objective To investigate clinical manifestations of myocardial bridge(MB)on the solitary right coronary artery(RCA)and its relationship with coronary computed tomography angiography(CTA)and electrocardiogram(ECG)findings.Methods A total of 23091 MB patients from picture archiving and communication system(PACS)of four general hospitals(Shanghai Zhoupu Hospital affiliated to Medical and Health College,Shanghai Pudong Hospital,Shanghai Pudong New Area People’s Hospital,and Shanghai Pudong New Area Public Hospital)in recent five years(from January 2014 to January 2019)were enrolled in this study.There were 29 patients with solitary MB on the RCA and they were assigned to study group.Another 29 patients with solitary MB on the left anterior descending artery(LAD)were selected by the propensity score matching(PSM)based on the age and gender from 2511 patients with solitary MB on the LAD as control group.Clinical findings,CTA and ECG diagnosing results were compared between two groups.Results The detection rate of isolated MB on the RCA was 0.13%(29/23091),which was significantly lower than that on the LAD(10.87%,2511/23091,P<0.01).The detection rate of chest distress and discomfort was 34.48%(10/29)in both groups.The incidence of resting chest pain was 51.72%(15/29)in the study group and 48.28%(14/29)in the control group(P>0.05).There was no significant difference in the type or location of MB,or patient composition ratios of the mural coronary artery(MCA)stenosis grading between two groups(both P>0.05).The detection rate of ECG anomalies was 31.03%(9/29)in the control group and 51.72%(15/29)in the study group(P>0.05).The proportion of arrhythmia patients in the control group was 10.34%(3/29),which was significantly lower than that in the study group(37.93%,11/29,P<0.05).Conclusion Solitary MB on the RCA is rare,anatomically located on the proximal and middle segment of the RCA,and commonly tunneled on the right atrium wall.It is easy to cause arrhythmia.