冠状动脉CT血管成像定量评估心肌桥收缩对壁冠状动脉压迫程度的价值

Study on mural coronary artery compression degree by coronary CT angiography quantitative evaluation of myocardial bridge contraction

目的探究冠状动脉CT血管成像(CCTA)定量评估心肌桥(MB)收缩对壁冠状动脉压迫程度的价值。方法回顾性收集295例2017年8月—2022年3月于我院行CCTA检查证实有MB的患者临床资料,根据壁冠状动脉(MCA)的收缩期狭窄率分为无压迫组(80例)、轻度压迫组(141例)、显著压迫组(74例)。测量并比较3组患者一般资料、左前降支(LAD)、血管密度梯度(TAG)、TAG校正值(TAGs)、MCA血管密度差(MCA-COD)及MB深度和长度的差异。采用受试者工作曲线(ROC)分析TAGs、MCA-COD定量评估MB显著收缩压迫的效能。结果3组性别、年龄、临床症状、高危因素等一般资料比较差异均无统计学意义(P>0.05)。MB患者TAG、TAGs、MCA-COD值随收缩期压迫程度增加而依次降低,且不同组间TAG、TAGs、MCA-COD值比较差异有统计学意义(P<0.05),不同组间MB深度、MB长度比较差异无统计学意义(P>0.05)。ROC曲线结果显示,TAGs和MCA-COD定量评估MB显著收缩压迫的AUC分别为0.844、0.815(P<0.05),二者联合评估的AUC为0.935(P<0.05),联合评估效能更高。结论CCTA可用于定量评估MB患者收缩压迫程度,且TAGs、MCA-COD联合评估MB显著性收缩压迫的效能较高,可为临床诊断提供更为精确的指导。

Objective To explore the value of coronary CT angiography(CCTA)quantitative evaluation of myocardial bridge(MB)on the degree of mural coronary artery compression.Methods The clinical data of patients with MB confirmed by CCTA in the hospital from August 2017 to March 2022 were retrospectively collected.The differences in general data,left anterior descending artery(LAD),transluminal attenuation gradient(TAG),TAG corrected value(TAGs),mural coronary artery(MCA)-contrast opacification difference(MCA-COD)and MB depth and length were detected and compared among patients with different degrees of systolic compression(no compression group,mild compression group,significant compression group).Receiver operating characteristic(ROC)curve was used to analyze the efficiency of TAGs and MCA-COD on quantitatively evaluating MB significant systolic compression.Results From the aspects of general data,there were no statistical differences in gender,age,clinical symptoms,and high-risk factors among no compression group,mild compression group and significant compression group(P>0.05).Comparisons of CCTA parameters showed that the TAG and TAGs of patients with MB were successively reduced with the increase of degree of systolic compression while the MCA-COD was enhanced in turn,and the TAG,TAGs,and MCA-COD were significantly different among different groups(P<0.05),but the differences in MB depth and MB length among the different groups were not statistically significant(P>0.05).In terms of efficiency of TAG-related parameters in the quantitative evaluation of MB significant systolic compression,ROC curve results showed that the AUCs of TAGs and MCA-COD on quantitatively evaluating the significant systolic compression of MB were 0.844 and 0.815(P<0.05),the AUC of the combination of the two was 0.935(P<0.05),and the combined evaluation had higher efficiency.Conclusion CCTA can be used to quantitatively evaluate the degree of systolic compression in patients with MB,and the combined evaluation with TAGs and MCA-COD has high efficiency on the significant systolic compression of MB,which can provide more accurate guidance for clinical diagnosis.