冠状动脉肌桥严重程度与血管痉挛的相关性研究

Correlation between the severity of coronary artery bridge and vasospasm

目的:研究心肌桥(MB)的形态学严重程度与乙酰胆碱(ACh)激发试验引起的血管痉挛之间的关系。方法:共纳入392例无冠状动脉(冠脉)支架的左前降支(LAD)患者行冠脉内ACh激发试验。血管造影冠脉血管痉挛定义为由ACh激发诱导的全部或次全闭塞。MB在冠脉血管造影中产生"挤奶效应"。定量分析LAD中MB的总桥接长度和最大收缩压缩比。结果:LAD中的心肌桥患者有140例(36%),大多数在中段。LAD合并MB患者与无MB的患者相比,并发血管痉挛及ACh激发试验阳性者明显增多。桥接长度与MB的收缩压缩百分比正相关(r=0.37,P<0.001)。在受试者工作特征曲线分析中,桥接长度和收缩压百分比均能显著预测LAD痉挛的发生(AUC:0.74,P<0.001;AUC:0.68,P<0.001)。多元回归分析证明这些因素是激发LAD痉挛的独立预测因子。结论:心肌桥,特别是形态学上严重的心肌桥,可能诱发更大的冠脉痉挛。

Objective:To study the relationship between the morphological severity of myocardial bridge(MB) and vasospasm caused by acetylcholine(ACh) challenge test.Method:A total of 392 patients with left anterior descending(LAD) without coronary stents underwent intracoronary ACh challenge.Angiographic coronary vasospasm was defined as all or subtotal occlusion induced by ACh challenge.MB was identified as a milking effect in coronary angiography.The total bridging length and maximum contraction compression of the MB in the LAD were quantitatively analyzed.Result:There were 140(36%) patients with myocardial bridges in LAD,mostly in the middle.Patients with LAD combined with MB had significantly increased vasospasm and ACh challenge test positive patients compared with patients without MB.The bridging length was positively correlated with the percent shrinkage compression of the MB(r=0.37,P<0.001).In the receiver operating characteristic curve analysis,both bridging length and systolic blood pressure percentage significantly predicted the occurrence of LAD spasm(AUC 0.74,P<0.001 and AUC 0.68,P<0.001).Multiple regression analysis demonstrated that these factors were independent predictors of LAD spasm.Conclusion:Myocardial bridges,especially morphologically severe myocardial bridges,may induce greater coronary spasm.