Hong Heng, Shi Jing-cheng, Ren Hai-ming, Wang Lei, Li Ming-chang, Wang He, Liu Qun, Wang Ming-sheng, Xu Zhi-min, Yao Kang-bao
Department of Cardiology, Beijing Shijingshan Hospital, Beijing, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Jan;41(1):38-43.
To explore the imaging and clinical characteristics and related risk factors of patients with coronary artery stenosis located proximally to myocardial bridging.
This study enrolled 603 patients with angiography evidenced myocardial bridging-mural coronary artery between May 2004 to May 2009. Angiographic and clinic data were collected according to uniform protocol and standard questionnaires were used to obtain patients' demographic and clinical information. Univariate and multivariate analysis were performed to explore related risk factors.
Chest pain was present in 247 cases (41.0%). Dynamic ST-T changes were found in 229 cases (38%). A total of 644 myocardial bridging-mural coronary arteries were detected including 382 (62.4%) segments located proximally to myocardial bridging. Diastolic vessel diameters in the myocardial bridging segment were significantly smaller than reference segments (all P < 0.01). Stepwise multiple regression analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male gender, diabetes, and systolic narrow rate of myocardial bridging-mural coronary arteries were positively related with the narrowing degree of the first coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male, diabetes and dyslipidemia were positively related with the narrowing degree of the most severe coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01).
Myocardial ischemia is common in patients with myocardial bridging and the artery segments located proximally to myocardial bridging are prone to stenosis. Systolic narrow rate of myocardial bridging-mural coronary arteries is one of major determinants of coronary artery stenosis located proximally to myocardial bridging. Whereas the other coronary heart disease risk factors are likely to play more important roles.
探讨心肌桥近端冠状动脉狭窄患者的影像学及临床特征以及相关危险因素。
本研究纳入了2004年5月至2009年5月期间603例经血管造影证实存在心肌桥-壁冠状动脉的患者。按照统一方案收集血管造影及临床资料，并使用标准问卷获取患者的人口统计学和临床信息。进行单因素和多因素分析以探讨相关危险因素。
247例（41.0%）出现胸痛。229例（38%）发现动态ST-T改变。共检测到644条心肌桥-壁冠状动脉，其中382条（62.4%）节段位于心肌桥近端。心肌桥段的舒张期血管直径显著小于对照节段（均P<0.01）。逐步多元回归分析表明，血管分叉病变、非心肌桥-壁冠状动脉的狭窄程度和病变冠状动脉数量、年龄、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、男性、糖尿病以及心肌桥-壁冠状动脉的收缩期狭窄率与心肌桥近端第一处冠状动脉狭窄的狭窄程度呈正相关（P<0.05或P<0.01）。血管分叉病变、非心肌桥-壁冠状动脉的狭窄程度和病变冠状动脉数量、年龄、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、男性、糖尿病和血脂异常与心肌桥近端最严重冠状动脉狭窄的狭窄程度呈正相关（P<0.05或P<0.01）。
心肌桥患者中心肌缺血常见，且心肌桥近端的动脉节段易于狭窄。心肌桥-壁冠状动脉的收缩期狭窄率是心肌桥近端冠状动脉狭窄的主要决定因素之一。而其他冠心病危险因素可能发挥更重要作用。
