冠状动脉狭窄严重程度和冠状动脉侧支循环对慢性心肌瘢痕范围的影响：来自定量冠状动脉造影和延迟强化磁共振成像的见解
Influence of coronary artery stenosis severity and coronary collateralization on extent of chronic myocardial scar: insights from quantitative coronary angiography and delayed-enhancement MRI.
作者信息
Bexell Daniel, Setser Randolph M, Schoenhagen Paul, Lieber Michael L, Brener Sorin J, Ivanc Thomas B, Balazs Eva M, O' Donnell Thomas P, Stillman Arthur E, Arheden Håkan, Wagner Galen S, White Richard D
机构信息
Departments of Diagnostic Radiology and Clinical Physiology, Duke University Medical Center, Durham, NC, USA.
出版信息
Open Cardiovasc Med J. 2008;2:79-86. doi: 10.2174/1874192400802010079. Epub 2008 Sep 10.
OBJECTIVES
In patients with chronic ischemic heart disease, the relationship between coronary artery lesion severity and myocardial scarring is unknown.The purpose of this study was to examine the relationship between proximal coronary artery stenosis severity, the amount of coronary collateralization, and myocardial scar extent in the distal distribution of the affected coronary artery based on both quantitative coronary angiography (QCA) and delayed-enhancement magnetic resonance imaging (DE-MRI).
METHODS
Thirty-four patients (26 males, 8 females; age range: 35-86 years) with a coronary artery containing a single, proximal stenosis >/=30% by quantitative coronary angiography (QCA) underwent DE-MRI. The relationship between stenosis severity, collateralization, and myocardial scar morphology (area, transmurality and patchiness) was examined using linear mixed-model ANCOVA.
RESULTS
There was a statistically significant correlation between stenosis severity and scar extent (r=0.53, p<0.01). Patients with hemodynamically significant stenoses (>/=70%) exhibited significantly greater collateralization (p<0.05) and scar extent (p<0.01) than patients with <70% stenosis. However, scarring was often found in patients with stenoses <70%. Also, greater stenosis severity (93+/-14%) and mean scar extent (41+/-35%) were found in patients with collaterals than in patients without collaterals (diameter stenosis 48+/-10%, p<0.01) (scar extent 19+/-29%, p=0.01).
CONCLUSIONS
Using QCA and DE-MRI, we demonstrate a significant relationship between coronary artery stenosis severity and myocardial scar extent, in the absence of a documented history of acute infarction. The relationship likely reflects increasing ischemia leading to scar formation in the range of angiographically significant stenosis. However, in the absence of collateralization, scar was observed without significant stenosis, especially in females.
目的
在慢性缺血性心脏病患者中，冠状动脉病变严重程度与心肌瘢痕形成之间的关系尚不清楚。本研究的目的是基于定量冠状动脉造影（QCA）和延迟强化磁共振成像（DE-MRI），探讨近端冠状动脉狭窄严重程度、冠状动脉侧支循环量与受累冠状动脉远端分布区心肌瘢痕范围之间的关系。
方法
34例患者（26例男性，8例女性；年龄范围：35-86岁），经定量冠状动脉造影（QCA）显示冠状动脉存在单一近端狭窄≥30%，接受了DE-MRI检查。使用线性混合模型协方差分析研究狭窄严重程度、侧支循环与心肌瘢痕形态（面积、透壁性和斑片状）之间的关系。
结果
狭窄严重程度与瘢痕范围之间存在统计学显著相关性（r=0.53，p<0.01）。血流动力学显著狭窄（≥70%）的患者比狭窄<70%的患者表现出明显更大的侧支循环（p<0.05）和瘢痕范围（p<0.01）。然而，狭窄<70%的患者也常发现有瘢痕形成。此外，有侧支循环的患者比无侧支循环的患者狭窄严重程度更高（93±14%），平均瘢痕范围更大（41±35%）（直径狭窄48±10%，p<0.01）（瘢痕范围19±29%，p=0.01）。
结论
使用QCA和DE-MRI，我们证明在没有急性梗死病史记录的情况下，冠状动脉狭窄严重程度与心肌瘢痕范围之间存在显著关系。这种关系可能反映了缺血增加导致在血管造影显示有显著狭窄的范围内形成瘢痕。然而，在没有侧支循环的情况下，在无明显狭窄时也观察到瘢痕，尤其是在女性中。
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