Yang Li-Han, Cai Ren-Hui, Wang Lu-Jing, He Li-Ping, Zhao Xin-Xiang
Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China.
Department of Radiology, Wuhan Asian Heart Hospital, China.
Heliyon. 2023 Jun 28;9(7):e17414. doi: 10.1016/j.heliyon.2023.e17414. eCollection 2023 Jul.
The knowledge of coronary artery fistula (CAF) with coronary aneurysm mostly comes from case reports and is very limited. However, the management of CAF with and without aneurysm is different, more understanding of its clinical and imaging features is necessary. This is the first research focus on it through a large comparative study.
To investigate the differences in imaging and clinical features of CAF with and without aneurysms.
We reviewed 96,037 consecutive patients undergoing coronary computed tomography angiogram (CCTA) between 2016 and 2020 and total of 429 CAF adult patients were enrolled. Those patients were divided into the CAF with aneurysm group (321 cases, 74.83%) and CAF without aneurysm group (108 cases, 25.17%) according to whether complicated with coronary aneurysm. Clinical baseline data, electrocardiographic (ECG) characteristics, the presence or absence of coronary atherosclerosis, complication symptoms and fistulous origin, entry site, number and diameter were analyzed. Chi-square test, T-test, Mann-Whitney U tests, and logistic regression analysis were performed.
Most of the clinical baseline data did not differ significantly between the two groups ( > 0.05). However, heart murmur, coronary atherosclerosis, infective endocarditis (IE), fistulous diameter and fistulous entry site were significantly different (＜0.05). Further multivariate logistic regression analysis showed that large fistulous diameter and coronary-cardiac chamber arterial fistulas was dependent risk factors for CAF complicated with aneurysm.
CAF patients with aneurysm were more prone to develop heart murmur than those patients without aneurysm. Different from other sites of aneurysms, coronary atherosclerosis is more common in CAF without aneurysm. Larger fistulous diameter and coronary-cardiac chamber arterial fistula are dependent risk factors for CAF with aneurysms.
冠状动脉瘘（CAF）合并冠状动脉瘤的相关知识大多来自病例报告，非常有限。然而，有动脉瘤和无动脉瘤的CAF治疗方法不同，因此有必要更多地了解其临床和影像学特征。这是第一项通过大型对比研究对其进行关注的研究。
探讨有动脉瘤和无动脉瘤的CAF在影像学和临床特征上的差异。
我们回顾了2016年至2020年间连续接受冠状动脉计算机断层扫描血管造影（CCTA）的96,037例患者，共纳入429例成年CAF患者。根据是否合并冠状动脉瘤，将这些患者分为CAF合并动脉瘤组（321例，74.83%）和CAF无动脉瘤组（108例，25.17%）。分析临床基线数据、心电图（ECG）特征、冠状动脉粥样硬化的有无、并发症症状以及瘘管的起源、入口部位、数量和直径。进行卡方检验、T检验、曼-惠特尼U检验和逻辑回归分析。
两组间大多数临床基线数据差异无统计学意义（>0.05）。然而，心脏杂音、冠状动脉粥样硬化、感染性心内膜炎（IE）、瘘管直径和瘘管入口部位差异有统计学意义（<0.05）。进一步的多因素逻辑回归分析表明，较大的瘘管直径和冠状动脉-心腔动脉瘘是CAF合并动脉瘤的独立危险因素。
合并动脉瘤的CAF患者比无动脉瘤的患者更容易出现心脏杂音。与其他部位的动脉瘤不同，冠状动脉粥样硬化在无动脉瘤的CAF中更为常见。较大的瘘管直径和冠状动脉-心腔动脉瘘是CAF合并动脉瘤的独立危险因素。
