慢性完全冠状动脉堵塞患者侧枝血管、室壁运动和射血分数研究

目的 比较慢性完全冠状动脉堵塞（CTO）有心肌梗死和无心肌梗死患者侧枝血管、室壁运动和射血分数的差异，并分析其原因。方法 对256例诊断为CTO（堵塞时间≥3月）的患者，回顾性分析病史、心肌酶谱、心电图、冠状动脉CT和冠状动脉造影后将其分为心肌梗死组(n=138)和非心肌梗死组(n=118)，比较两组患者的一般临床情况、堵塞血管的位置分布和支数、非堵塞血管病变位置分布和严重程度、侧枝血管Rentrop分级、心脏超声室壁节段运动及射血分数的差异。结果 两组患者一般情况、堵塞冠状动脉位置分布、堵塞血管支数、非堵塞冠状动脉病变位置分布、病变严重程度、侧枝血管分级比较差异均无统计学意义（P>0.05）。心肌梗死组患者的室壁节段运动正常发生率和射血分数均低于非心肌梗死组，但运动消失和矛盾运动发生率均高于非心肌梗死组（P<0.05）。结论 冠状动脉完全堵塞3个月以上，不管堵塞血管支配区域是否发生心肌梗死，Rentrop侧枝血管分级已无差异。虽然冠状动脉完全堵塞时侧枝血管可以保护心肌完全避免心肌梗死发生，但对左心室室壁节段运动和整体功能的保护有限。

Collateral vessel, ventricular segmental wall motion and ejection fraction in patients with chronic total coronary occlusion

Objective To analyse the differences of collateral vessel, ventricular segmental wall motion and ejection fraction between patients with chronic total coronary occlusion (CTO) and myocardial infarction and CTO with non myocardial infarction. Methods Two hundred and fifty-six patients diagnosed as CTO (occlusion duration ≥ 3 months) were retrospectively analysed of medical history, myocardial enzyme pedigree, electrocardiogram, coronary artery CT and coronary arteriography, and were divided into myocardial infarction group（n=138） and non-myocardial infarction group(n=118). The differences in general conditions, location distribution and extent of CTO, lesion distribution and degree of non-occlusion coronary artery, collateral vessel Rentrop grade, segmental ventricular wall motion and ejection fraction on echocardiography were compared between these two groups. Results There was no significant difference in general conditions, location distribution and extent of CTO, lesion distribution and degree of non-occlusion coronary artery and collateral vessel Rentrop grade between these two groups（P>0.05）. Compared with non-myocardial infarction group, the prevalence of normal segmental ventricular wall motion and ejection fraction in myocardial infarction group was significantly lower, while those of akinesia and paradoxical motion were significantly higher (P<0.05). Conclusion There is no significant difference in collateral vessel grade of Rentrop classification between myocardial infarction and non-myocardial infarction in myocardium supplied by occluded artery with CTO duration beyond 3 months. Although collateral vessel can prevent myocardium from myocardial infarction, its protective effects on segmental wall motion and ejection fraction are limited.