冠状动脉壁内走行及其与冠状动脉粥样硬化的关系的功能影响。
The Functional Effects of Intramural Course of Coronary Arteries and its Relation to Coronary Atherosclerosis.
机构信息
Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland.
Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland; Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
出版信息
JACC Cardiovasc Imaging. 2015 Jun;8(6):697-704. doi: 10.1016/j.jcmg.2015.04.001. Epub 2015 May 14.
OBJECTIVES
This study observed hemodynamic consequences of myocardial bridging and its relation to coronary atherosclerosis.
BACKGROUND
Myocardial bridging is seen as intramural course by computed tomography angiography (CTA) or systolic compression by invasive coronary angiography. Segments with myocardial bridging are in previous studies closely associated with proximal atherosclerotic plaques.
METHODS
We prospectively studied 100 patients 63 ± 7 years of age with intermediate likelihood of coronary artery disease. Segments with superficial (>1 mm) or deep (>2 mm) intramural course were identified using CTA. Myocardial perfusion was studied by 15-Oxygen water positron emission tomography and systolic compression by invasive coronary angiography.
RESULTS
Myocardial bridging was detected in 34 (34%) patients in 48 different vascular segments. Of these, 24 (50%) were deep and systolic compression was present in 14 (29%). In patients without obstructive coronary artery disease, myocardial stress perfusion distal to myocardial bridging was comparable with remote control regions (3.3 ± 0.9 ml/g/min vs. 3.3 ± 0.7 ml/g/min, n = 24, p = 0.88). Stress perfusion was comparable in segments with and without systolic compression (3.0 ± 0.9 vs. 2.7 ± 1.0 ml/g/min, p = 0.43). Atherosclerotic plaques were more frequent in proximal (71%) than myocardial bridging (7%) or distal (21%) segments. The presence of atherosclerosis and the average number of plaques were comparable in coronary arteries with and without myocardial bridging (73% vs. 60%, p = 0.14 and 2.0 ± 1.7 vs. 1.5 ± 1.6, p = 0.06). Median Agatston coronary calcium score was not elevated in vessels with myocardial bridge (15 [interquartile range: 0, 129] vs. 50 [interquartile range: 0, 241], p = 0.21).
CONCLUSIONS
Myocardial bridging of coronary arteries is common on CTA, but only approximately one-third of these show systolic compression. Myocardial bridging is not associated with reduced myocardial perfusion during vasodilator stress. Atherosclerosis is located predominantly proximal to myocardial bridging but atherosclerotic burden and presence of vulnerable plaques were comparable.
目的
本研究观察了心肌桥的血流动力学后果及其与冠状动脉粥样硬化的关系。
背景
计算机断层血管造影（CTA）显示心肌桥为壁内走行，或有创冠状动脉造影显示收缩期受压。先前的研究发现，有心肌桥的节段与近端粥样硬化斑块密切相关。
方法
我们前瞻性研究了 100 例年龄 63±7 岁、中等程度冠状动脉疾病风险的患者。使用 CTA 识别浅表（>1mm）或深部（>2mm）壁内走行的节段。通过 15-O 水正电子发射断层扫描研究心肌灌注，通过有创冠状动脉造影研究收缩期受压。
结果
34 例（34%）患者的 48 个不同血管节段存在心肌桥，其中 24 例（50%）为深部，14 例（29%）有收缩期受压。在无阻塞性冠状动脉疾病的患者中，心肌桥远端的心肌应激灌注与远程对照区相当（3.3±0.9ml/g/min 比 3.3±0.7ml/g/min，n=24，p=0.88）。有收缩期受压和无收缩期受压的节段之间的应激灌注也相似（3.0±0.9 比 2.7±1.0ml/g/min，p=0.43）。粥样斑块在近端（71%）比心肌桥（7%）或远端（21%）更常见。有心肌桥和无心肌桥的冠状动脉中，动脉粥样硬化的存在和平均斑块数量相似（73%比 60%，p=0.14 和 2.0±1.7 比 1.5±1.6，p=0.06）。有心肌桥的血管中，Agatston 冠状动脉钙评分中位数不高（15[四分位距：0，129] 比 50[四分位距：0，241]，p=0.21）。
结论
冠状动脉 CTA 上常见心肌桥，但只有约三分之一的心肌桥显示收缩期受压。在血管扩张剂应激期间，心肌桥不伴心肌灌注减少。粥样硬化主要位于心肌桥近端，但粥样硬化负荷和易损斑块的存在相似。
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