A Research Based on Hemodynamic Model for Heart-Mural Coronary Artery-Myocardial Bridge

An experimental model for heart-mural coronary artery-myocardial bridge was established based on the theory of hemodynamics. The application of the model demonstrated that it can repeat to great extent the phenomenon of myocardial bridge compressing mural coronary artery that results in abnormal hemodynamic characteristic. The in vitro simulation experiment indicates that the anomaly of normal stress, circumferential stress and wall shear stress mainly occurs in the proximal end. As the oppression level increases, the mean proximal stress and the oscillatory value (maximum-minimum) increase obviously. The experimental model for heart-mural coronary artery-myocardial bridge provides a method to study relationship between myocardial bridge and atherosclerosis.

Coronary artery aneurysm combined with myocardial bridge:A case report

BACKGROUND Coronary artery aneurysm combined with myocardial bridge is a very rare clinical situation.The prognosis of this clinical situation is not yet clear.CASE SUMMARY A coronary artery aneurysm and myocardial bridge in the same segment of the coronary artery were found in a 54-year-old female patient who underwent coronary angiography and intravascular ultrasound examination.Through conservative treatment,the patient was discharged from the hospital smoothly,and she was in good condition during 5 mo of follow-up.CONCLUSION Coronary artery aneurysm combined with myocardial bridge seems to have a good prognosis,but due to the rarity of this clinical situation,further research and follow-up are needed.

Myocardial bridge-related coronary heart disease:Independent influencing factors and their predicting value

BACKGROUND Myocardial bridge(MB)will compress the mural coronary artery(MCA)during the systole and cause myocardial ischemia.In the diagnosis of coronary heart disease(CHD),because the structure of MB is difficult to be observed by coronary angiography(CAG),the clinical study of the influence of MB on CHD is lacking.With the advancement of computed tomography coronary angiography technology,detailed observations of the MB anatomy have realized.AIM To explore the main influencing factors of MB-related CHD and to find potential indicators for predicting MB-related CHD.METHODS A total of 1718 patients with suspected CHD due to the symptoms of myocardial ischemia were enrolled as subjects.Patients diagnosed with CHD were included in a CHD group,and patients with no significant abnormalities were included in a control group.In the CHD group,patients were divided into an MB-CHD subgroup if MB-related CHD was found.In the control group,patients were divided into a simple MB subgroup if MB was found.The patient's clinical data and MB-related indicators,including the branch of MB,MB type(superficial/deep type),MB length,MB thickness,systolic and diastolic compression of the MCA,and MCA systolic stenosis rate were recorded and compared.Logistic regression analysis was used to explore the independent influencing factors of MD-related CHD.ROC curve was used to analyze the diagnostic efficacy of potential indicators for MB-related CHD.RESULTS There were 1060 cases in the CHD group and 658 cases in the control group,and there were 236 cases in the MB-CHD subgroup and 52 cases in the simple MB subgroup.Multivariate logistic regression analysis showed that the combined MB had a significant effect on the occurrence of CHD(P<0.05).MB thickness,systolic compression,diastolic compression,and MCA systolic stenosis rate had significant effects on the occurrence of MB-related CHD(P<0.05).The area under the curve(AUC)of the combination of these influencing factors for the diagnosis of MB-related CHD was 0.959,which was significantly higher than the AUCs of the four indicators separately(P<0.05).The sensitivity was 97.06%and the specificity was 87.63%.CONCLUSION MB thickness,systolic compression,diastolic compression,and MCA systolic stenosis are independent influencing factors for MB-related CHD.The combination of these factors has potential diagnostic value for MB-related CHD.

Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography:Now and in future

Multidetector-row computed tomography(MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years.In selected patients,MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography.Chiou et al reported a delicate infarcted myocardium at-risk score.According to their results,the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score(r = 0.841,P < 0.001).They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk.In this commentary,we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect,detecting reversible myocardial ischemia,assessing myocardial viability,estimating target lesion restenosis,and calculating of fractional flow reserve from MDCT.

Spontaneous coronary artery dissection as a cause of myocardial infarction

Spontaneous coronary artery dissection(SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending(LAD) artery and left circumflex(LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.

Evaluation of intracoronary function after reduction of ventricular rate by esmolol in severe stenotic myocardial bridge: A case report

BACKGROUND Severe stenotic myocardial bridges(MBs)have been reported to lead to intracoronary ischaemia,but the physiological evaluation of MBs using intracoronary function evaluation indicators after intraoperative drug treatment has not been fully established.CASE SUMMARY We performed through snuff fossa for coronary angiography in a patient with chest tightness after repeated exercise,and the results showed that the middle part of the anterior descending branch was a MB with 100%systolic compression.The intracoronary function evaluation(defined as the ratio of distal coronary pressure to aortic pressure with zero microcirculation resistance)was instantaneous wave-free ratio(IFR)without drug and fractional flow reserve(FFR)with adenosine.The IFR was 0.73,and the FFR was 0.66.Then esmolol 0.02μg/kg/min was intravenously injected.The IFR and FFR were measured again when the heart rate dropped to 60 beats/min.The IFR was 0.83,and the FFR 0.65.CONCLUSION This case report is a case of isolated MB with severe stenosis.After intraoperative drug treatment decreased the ventricular rate,an increase in the coronary function evaluation index was immediately observed to confirm the effective improvement of coronary blood flow.

Overview of coronary artery variants, aberrations and anomalies

Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.

Comprehensive assessment of a post-coronary bypass graft patient with cardiovascular magnetic resonance imaging and multi-detector computed tomography

Coronary bypass graft surgery (CABG) is a revascularization procedure which reduces myocardial ischemia and cardiovascular morbidity and mortality in selected patients;however, up to 40% of saphanous vein grafts may degenerate over 10 years. Although coronary angiography is the gold standard to detect graft patency and native vessel disease, sometimes it is difficult to locate the grafts resulting in increased exposure to radiation and contrast administration. This case highlights the utility of cardiac computerized tomography and magnetic resonance imaging to provide comprehensive noninvasive assessment in a patient post CABG.(J Geriatr Cardiol 2007;4:244-247.)

Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study(236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications(typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350(22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending(LAD)(24.6%), followed by distal LAD(3.7%), diagonal branches(2%), ramus intermedius artery(1.4%) and obtuse marginal artery(0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females(P = 0.14). Coronary artery atherosclerosis was found in 51 of 89(57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35(94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.

Myocardial perfusion imaging and infarct characterization using multidetector cardiac computed tomography

Until recently, computed tomography coronary angiography was restricted to the anatomical assessment of coronary stenosis, whereas the functional significance of coronary lesions remained outside of its scope. Nevertheless, the kinetics of iodinated contrast is similar to gadolinium-diethylenetriamine pentaacetic acid used in contrast-enhanced magnetic resonance imaging, allowing assessment of myocardial perfusion and viability by cardiac computed tomography.

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain.Only patients who underwent single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)were included.Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed.Patients with prior history of coronary artery disease(CAD)including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded.True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography,in the same territory as identified on SPECT MPI.Coronary artery dominance was determined on coronary angiography.Patients were divided into group 1 and group 2.Group1 included patients with non-dominant right coronary artery(RCA)(left dominant and codominant).Group2 included patients with dominant RCA anatomy.Demographics,baseline characteristics and positive predictive value(PPV)were analyzed for the two groups.RESULTS The mean age of the study cohort was 57.6 years.Sixtyone point seven percent of the patients were males.The prevalence of self-reported diabetes mellitus,hypertension and dyslipidemia was 36%,71.9%and 53.9%respectively.A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men.For inferior wall ischemia on SPECT MPI,patients in study group 2 had a significantly higher PPV,32/42(76.1%),compared to patients in group 1,in which only 3 out of the 29 patients(10.3%)had true positive results(P value<0.001 Z test).The difference remained statistically significant even when only patients with left dominant coronary system(without co-dominant)were compared to patients with right dominant system(32/40,76.1%in right dominant group,3/19,15.8%in left dominant group,P value<0.001 Z test).There was no significant difference in mean hospital stay,re-hospitalization,and in-hospital mortality between the two groups.CONCLUSION The positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance.More studies are needed to explain this phenomenon.

Novel Approaches for the Use of Cardiac/Coronary Computed Tomography Angiography

Recent developments in the novel imaging technology of cardiac computed tomography(CT)not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology.Foremost,coronary CT angiography(CCTA)enables direct noninvasive examination of both coronary artery stenoses and atherosclerotic plaque characteristics.Calculation of computational fl uid dynamics by cardiac CT allows the noninvasive estimation of fractional fl ow reserve,which increases the diagnostic accuracy for detection of hemodynamically signifi cant coronary artery disease.In addition,a combination of myocardial CT perfusion and CCTA can provide simultaneous anatomical and functional assessment of coronary artery disease.Finally,detailed anatomical evaluation of atrial,ventricular,and valvular anatomy provides diagnostic information and guidance for procedural planning,such as for transcatheter aortic valve replacement.The clinical applications of cardiac CT will be extended with the development of these novel modalities.

以急性心肌缺血为突出表现的儿童冠状动脉心肌桥2例并文献复习总结

目的报道2例以急性心肌缺血为突出表现的儿童冠状动脉心肌桥并文献复习总结。方法介绍本院收治的2例儿童冠状动脉心肌桥病例,检索1990年~2021年的关于儿童冠状动脉心肌桥等研究文献,获取相关数据。对纳入的研究数据采用SPSS 25.0及RevMan 5.0软件进行统计学分析。结果共纳入27篇文献,包括98例患儿,其中男61例,女37例,男女比例1.6∶1,发病年龄(12.2±4.9)岁。最常见的症状是胸痛42例(48%)。98例患儿中包括108段心肌桥,位置在左前降支98段,占比90.7%;统计儿童心肌桥长度(23.5±15.2)mm,厚度(8.6±6.0)mm;合并HCM 46例(52.9%);明确记载的行心肌桥松解术39例(44.8%);随访时间为3个月~10年,随访中死亡者7例,明确记载预后良好的70例(81.4%)。结论儿童冠状动脉心肌桥发病时以急性心肌缺血为突出表现,位置以左前降支中段最常见,治疗则是冠脉狭窄程度+Schwarz分型结合临床综合治疗,大多预后良好。

影响心肌血流下降的因素及其价值研究

目的探讨传统单光子发射计算机断层成像(SPECT)获取的心肌灌注显像、半定量参数以及冠脉造影结果、临床参数对心肌缺血的影响。方法回顾性分析2022年6月至2022年10月在南京医科大学第一附属医院(江苏省人民医院)完成CZT-SPECT检查的116例临床疑似或确诊的冠心病患者临床资料,最终纳入39例患者。以三支主要冠脉区域心肌血流储备功能<2.1作为心肌缺血的诊断标准,绘制冠脉狭窄程度、区域负荷灌注积分(SS)、静息灌注积分(RS)和灌注积分差(DS)诊断心肌缺血的ROC曲线以获得最佳截断值和相应的诊断效能,通过逐步回归法建立预测模型,绘制ROC曲线。结果共计117支主要血管,其中判定为心肌缺血的有36支(30.77%)。冠脉狭窄程度、SS、RS和DS诊断心肌缺血的ROC曲线最佳截断值分别为53%、3.5、1.5、1.5,准确性分别为75.2%、74.4%、70.9%、72.6%,ROC曲线的AUC及95%CI分别为0.78(0.68~0.87)、0.64(0.53~0.74)、0.58(0.49~0.66)、0.65(0.55~0.75)。冠脉狭窄程度、血管区域心肌灌注显像、SS、RS和DS等单因素有意义的指标联合预测心肌缺血的ROC曲线的AUC及95%CI为0.79(0.69~0.88)。逐步回归法踢除变量后,最终模型预测心肌缺血的ROC曲线的AUC及95%CI为0.84(0.76~0.92)。结论SPECT心肌灌注显像中SS>3.5、DS>1.5、RS>1.5对预测心肌缺血有一定的意义,联合多个指标(冠脉造影结果、SS、DS、RS、心肌灌注显像)预测显著提高了对心肌缺血的诊断价值。

胸部CT冠状动脉钙化积分与STEMI患者急诊PCI围术期并发症的相关性研究

目的:探讨胸部CT冠状动脉钙化积分(CAC)与急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)围术期并发症的相关性。方法:选取2020年3月至2021年7月保定市第一中心医院心内科收治的263例STEMI患者,均行胸部CT检查和PCI手术,评估CAC积分,并根据CAC积分将患者分成无钙化和轻度钙化组(0~2分,129例)、中度钙化组(3~5分,88例)及重度钙化组(6~9分,46例),分析不同程度钙化组患者围术期并发症及随访期主要心血管事件(MACE)发生情况,比较各组差异并分析其与急诊PCI围术期并发症的相关性。结果:与无钙化和轻度钙化组相比,中度和重度钙化组患者年龄更大,差异有统计学意义(χ^(2)=45.815,P<0.05),高血压、脑梗死、糖尿病、多支病变和MACE的发病率更高,差异有统计学意义(χ^(2)=6.762、11.071、6.064、25.036、21.694,P<0.05)。3组患者eGFR及NT-ProBNP水平比较,差异有统计学意义(F=8.592,Z=20.890,P<0.05)。与重度钙化组相比,无钙化和轻度钙化组冠状动脉血栓发生率较高(χ^(2)=7.748,P<0.05)。根据logistic回归分析,冠状动脉血栓、中度钙化及重度钙化患者是出现轻微并发症的危险因素(OR=4.847、5.280、11.135,P<0.001);年龄越大、患有高血压或冠状动脉重度钙化患者更容易出现严重并发症,术后1年内MACE发生率更高,是围术期并发症的危险因素(OR=1.151、7.982、10.555、21.729,P<0.05)。结论:胸部CT的CAC积分评估出的中度及重度钙化病变患者的围术期并发症发生率更高,基于胸部CT的CAC积分可用于评估急诊PCI围术期的并发症及术后1年内MACE。

庞敏“五位一体”诊疗思路治疗心肌桥经验

冠状动脉心肌桥是一种先天冠脉变异疾病,常出现胸闷、胸痛等临床症状,西医治疗指南尚未完善,常通过药物、手术和介入方式进行治疗。中医将其作为胸痹疾病来进行治疗,各家经临床证实皆取得较好疗效。庞敏教授在从业中总结出“天、人、证、机、病——五位一体”的处方思路,临床中应用于治疗心肌桥疗效显著,患者胸闷、胸痛可见有效缓解。文章旨在介绍吾师庞敏教授的诊疗思路,为临床中治疗冠状动脉心肌桥提供新思维。

冠状动脉CT血管造影诊断心肌桥的临床价值

目的分析冠状动脉CT血管造影诊断心肌桥的临床价值。方法选择2018年12月至2019年11月我院接诊的疑似冠心病患者120例为研究对象,随机均分为两组分别接受CT血管造影和数字减影血管造影(DSA)检查,以出院诊断结果为参照,对比两组心肌桥检出率和诊断准确率。结果CT血管造影心肌桥检出率高于DSA(45.0%vs.30.0%,P=0.026)。CT血管造影心肌桥诊断准确率高于DSA(95.0%vs.76.7%,P=0.027)。结论相比DSA,CT血管造影诊断心肌桥的检出率更高,诊断结准确率更高,临床应用价值较好。

动态^(99m)Tc-sestamibi CZT-SPECT评价老年胸痛患者冠状动脉微血管功能障碍的临床特征

目的冠状动脉微血管功能障碍(coronary microvascular dysfunction,CMVD)常介导非内皮依赖性微血管的异常扩张,引起缺血和心绞痛。对于无心外膜冠状动脉狭窄的心血管疾病,微血管病变起着非常重要的作用,并与心血管事件的增加有关。冠状动脉血流储备(coronary flow reserve,CFR)是微血管水平检测冠状动脉硬化早期征象的最敏感参数之一。新型动态^(99m)Tc-sestamibi CZT-SPECT评估CFR已成为检测CMVD的一种很有希望的技术。我们旨在通过冠状动脉造影和动态CZT-SPECT描述胸痛患者CMVD的患病率、临床特征和预后。方法入选2020年1月至2022年1月因胸痛在华东医院住院的老年(年龄≥60岁患者298例)。他们均接受了冠状动脉造影和动态/常规状态下静息/负荷门控心肌灌注显像(myocardial perfusion imaging,MPI)。在血管水平上,如果任何冠状动脉狭窄<50%且CFR<2,则认为是CMVD。在患者层面,CMVD被认为是非阻塞性冠心病(coronary artery disease,CAD)的一种。我们还收集了病史、生化指标等信息。随访至2023年6月30日。主要不良心血管事件(major adverse cardiovascular event,MACE)定义为:因胸闷胸痛再住院、急性冠脉综合征和死亡。结果73.5%的患者有心绞痛但冠脉造影阴性。30.9%非阻塞性CAD患者有CMVD。非阻塞性CAD中,CFR<2组MACE发生率较CFR≥2组高(P<0.001)。在Logistic回归分析中,发现糖尿病(β1.837,OR 6.227,95%CI 3.07112.831,P<0.001)、冠状动脉慢血流(coronary slow flow,CSF)(β1.150,OR 3.157,95%CI 1.3417.434,P=0.009)和高脂血症(β0.832,OR 2.297,95%CI 1.0525.016,P=0.037)为CMVD的重要预测因子。结论在非阻塞性CAD患者中CMVD的MACE发生率高。糖尿病、高脂血症和CSF是CMVD的独立预测因子。采用动态^(99m)Tc-sestamibi CZT-SPECT定量CFR检测在技术上是可行的,可以反映冠状动脉微血管功能。

基于临床指标、CT冠状动脉钙化评分和心外膜脂肪组织的机器学习预测心肌梗死风险研究

目的:评估机器学习(ML)的性能,将临床参数与CT冠状动脉钙化(CAC)评分和自动心外膜脂肪组织(EAT)量化相结合,以预测无症状受试者的心肌梗死(MI)和心源性死亡的长期风险。方法:选取2013年1月至2015年10月于解放军总医院第五医学中心进行体检的1058名存在心血管危险因素且未发生冠心病症状的受试者,在进行CAC评分后进行长期随访。使用全自动深度学习方法量化EAT体积和密度。采用受试者工作特征(ROC)曲线分析临床资料、动脉粥样硬化性心血管疾病风险评分、CAC评分和自动EAT测量来训练ML极端梯度增强,并使用重复的10倍交叉验证进行模型验证。结果:在8年随访期间,1058名受试者中61例发生了MI和(或)心源性死亡事件。ML的ROC曲线下面积(AUC)明显高于动脉粥样硬化性心血管疾病(ASCVD)风险和CAC评分预测事件(ML:0.82;ASCVD:0.77;CAC:0.77)。根据ASCVD和CAC、EAT的ML比仅具有临床变量的ML更能预测MI和心脏死亡[AUC为0.82(95%CI:77~87)vs.0.78(95%CI:0.72~0.84),P=0.02]。ML高分数受试者生存率随时间增长下降程度较大,因此ML得分较高的受试者更有可能经历事件。结论:整合临床和定量影像学变量的ML可以为心血管危险因素患者提供长期风险预测。

多排螺旋CT和心血管造影对心肌桥-壁冠状动脉诊断价值的对比研究

目的:对比多排螺旋CT和心血管造影对心肌桥-壁冠状动脉的诊断价值。方法:选取2022年1月—2023年3月接受诊疗的50例疑似心肌桥-壁冠状动脉患者作为研究对象,所有患者均接受多排螺旋CT和心血管造影检查。对比两种检查方式的结果、壁冠状动脉埋藏深度与狭窄程度相关性及诊断价值。结果:多排螺旋CT检查的壁冠状动脉长度及埋藏深度均大于心血管造影,差异有统计学意义(t=6.983、4.866,P<0.05);多排螺旋CT检查的狭窄程度低于心血管造影,差异有统计学意义(t=6.283,P<0.05);多排螺旋CT检查的深埋型心肌桥-壁冠状动脉狭窄程度明显高于表浅型心肌桥-壁冠状动脉,差异有统计学意义(t=5.975,P<0.05);心血管造影检查下深埋型心肌桥-壁冠状动脉狭窄程度明显高于表浅型心肌桥-壁冠状动脉,差异有统计学意义(t=6.387,P<0.05)。多排螺旋CT和心血管造影诊断表浅型心肌桥-壁冠状动脉、深埋型心肌桥-壁冠状动脉Kappa值为0.954,一致性较高。结论:多排螺旋CT和心血管造影对心肌桥-壁冠状动脉诊断效能相对一致,其中多排螺旋CT更易于检出壁冠状动脉长度及埋藏深度,而心血管造影则在狭窄程度的判断方面有显著价值,必要时可采取联合检查方式,以实现优势互补。