台湾人心肌桥的 64 排冠状动脉 CT 血管造影的无创评估。
Myocardial bridging in Taiwanese: noninvasive assessment by 64-detector row coronary computed tomographic angiography.
机构信息
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2011 Apr;74(4):164-8. doi: 10.1016/j.jcma.2011.01.037. Epub 2011 Mar 15.
BACKGROUND
Myocardial bridging (MB) is a congenital structural variant in which a segment of the epicardial coronary artery tunnels into and is surrounded by the myocardium. MB has been correlated to some clinical complications of cardiovascular disease (CVD). The depiction rate of MB varies significantly between catheter coronary angiography and autopsy studies. This study aimed to assess the depiction rate of MB among Taiwanese by coronary computed tomographyic angiography (CCTA), to determine the anatomical features of the tunneling vessels, and to evaluate the outcome of patients having MB.
METHODS
Between September 2006 and December 2007, 425 subjects (264 men and 161 women; mean age 59.6 ± 11.7 years) underwent ECG-gated CCTA by a 64-dectector row scanner in our institution. The presence and the location of MB in CCTA images and the presence of atherosclerosis in the tunneling vessels were evaluated and recorded. Major CVD events in the cohort were tracked from the day of CCTA examination until on March 2009 termination of follow-up.
RESULTS
The depiction rate of MB was 20.9% (89/425). A total of 122 MB were depicted by CCTA. Thirty-six tunneling segments (29.5%) were situated in the distal portion of the left anterior descending coronary artery (LAD), 23 segments (18.8%) were in the middle portion of the LAD, 19 (15.5%) were in the first obtuse marginal branch of the left circumflex artery, 18 (14.7%) in the first diagonal branch of the LAD, and 10 (8.1%) were in the ramus medianus. Nine tunneling segments (7.3%) had concomitant atherosclerotic plaques at the time of CCTA. One hundred and nine tunneled segments (89.3%) were superficially located in the myocardium, with a mean depth of 1.9 ± 0.81 mm (range, 0.9-4 mm). Twelve patients with CVD events were recorded during the mean follow-up interval of 21.91 ± 4.03 months (range, 3.08-28.82 months). All 12 patients with CVD events had no MB on CCTA.
CONCLUSION
The depiction rate of MB by CCTA was 20.9% in this study. The most common location of MB was in the LAD. Concomitant atherosclerotic plaques were found in 7.3% of MB cases. Eighty-nine percent of tunneling vessels were superficially situated. None of the enrolled subjects with MB developed CVD event during the follow-up period. No statistical correlation was found between the presence of MB and CVD event (p = 0.057).
背景
心肌桥（MB）是一种先天性结构变异，其中一段心外膜冠状动脉穿过并被心肌包围。MB 与心血管疾病（CVD）的一些临床并发症有关。在导管冠状动脉造影和尸检研究之间，MB 的描述率差异很大。本研究旨在通过冠状动脉计算机断层血管造影（CCTA）评估台湾人 MB 的描述率，确定隧道血管的解剖特征，并评估患有 MB 的患者的结果。
方法
在我们的机构中，2006 年 9 月至 2007 年 12 月期间，425 名受试者（264 名男性和 161 名女性；平均年龄 59.6 ± 11.7 岁）接受了心电图门控 CCTA。评估并记录 CCTA 图像中 MB 的存在和位置以及隧道血管中的动脉粥样硬化情况。从 CCTA 检查之日起至 2009 年 3 月随访结束，对队列中的主要 CVD 事件进行跟踪。
结果
MB 的描述率为 20.9%（89/425）。CCTA 共显示 122 个 MB。36 个隧道段（29.5%）位于左前降支（LAD）的远端，23 个段（18.8%）位于 LAD 的中段，19 个段（15.5%）位于左旋支的第一钝缘支，18 个段（14.7%）位于 LAD 的第一对角支，10 个段（8.1%）位于中隔支。9 个隧道段（7.3%）在 CCTA 时同时存在动脉粥样硬化斑块。109 个隧道段（89.3%）位于心肌浅层，平均深度为 1.9 ± 0.81mm（范围，0.9-4mm）。在平均 21.91 ± 4.03 个月（范围，3.08-28.82 个月）的随访期间，记录了 12 例 CVD 事件患者。所有 12 例 CVD 事件患者的 CCTA 均未见 MB。
结论
在这项研究中，CCTA 显示 MB 的描述率为 20.9%。MB 最常见的位置是 LAD。MB 病例中有 7.3%合并动脉粥样硬化斑块。89%的隧道血管位于浅层。在随访期间，所有入组的 MB 患者均未发生 CVD 事件。MB 的存在与 CVD 事件之间无统计学相关性（p=0.057）。
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