冠状动脉心肌桥的临床和预后分析

目的　分析心肌桥的临床表现和预后的关系。方法　对 35例心肌桥病例 (其中 2 4例为孤立性心肌桥 )的临床和冠脉造影资料 ,分析心肌桥与冠状动脉粥样硬化、心肌缺血、预后及心肌肥厚的关系。结果　心肌桥在冠状动脉造影上的检出率为 1 2 2 %。心肌桥前段血管粥样硬化组的肌桥收缩期狭窄程度 (6 8%± 15 % )与无粥样硬化组 (5 4 %± 14 % )差异有非常显著意义 (P <0 0 1) ,心电图异常组的肌桥收缩期狭窄程度 (6 3%± 13% )重于心电图正常组 (4 9%± 13% ,P <0 0 5 ) ,但与心绞痛的典型 (5 8%± 15 % )与否 (5 4 %± 15 % )关系不大 ,左室肥厚者的肌桥收缩期狭窄程度 (6 9%±9% )重于非肥厚者 (5 8%± 16 % ,P =0 0 9)。 3～ 5 0 (2 6 6± 17 7)个月的随访期内无恶性临床事件发生。结论　 (1)心肌桥的狭窄程度越重 ,造成的心肌缺血越严重 ,即出现心电图异常的可能性就越大 ;(2 )心肌桥有促发或加速其前段冠状动脉血管发生粥样硬化病变的倾向 ,且与心肌桥的狭窄程度有关 ;(3)左室肥厚可能促进本不严重的心肌桥的发生 ;(4 )心肌桥的预后良好。

Clinical manifestation and prognosis of myocardial bridge

OBJECTIVE: To study the clinical manifestation, angiographic features, and prognosis of myocardial bridge. METHODS: A retrospective analysis was made on the data of the clinical manifestation, coronary angiography, and prognosis of 35 patients with myocardial bridge, 29 males and 6 females, with an average age of 52.0 +/- 9.5 years, out of 2 871 patients undergoing coronary angiography 1 January 1996 - 20 February 2001. RESULTS: The detection rate of myocardial bridge, mostly in the middle or distal parts of left anterior descending branch and 24 being isolated myocardial bridge, was 1.22% in coronary angiography. There was a significant difference in the extent of diameter stenosis during systolic stage between the group with atherosclerosis (68% +/- 15%, n = 15) and the group without atherosclerosis (54% +/- 14%, n = 20) in the vessel proximal to myocardial bridge (P < 0.01). The systolic diameter stenosis was more severe in the abnormal ECG group (63% +/- 13%, n = 12) than in the normal ECG group (54% +/- 14%, n = 12), P < 0.05. However, the systolic stenosis extent of myocardial bridge in the patients with typical angina pectoris (58% +/- 15%, n = 11) was not significantly different from that in the patients with atypical angina pectoris (54% +/- 15%, n = 13). The systolic stenosis extent of myocardial bridge were 69% +/- 9% (n = 7) and 58% +/- 16% (n = 26) in the patients with and without left ventricular wall hypertrophy respectively (P = 0.09). No malignant event occurred during the follow-up period of 3 - 50 months. CONCLUSION: (1) The more severe the extent of systolic diameter stenosis, the more severe the myocardial ischemia and the more the possibility of abnormal ECG. (2) Myocardial bridge tends to promote or accelerate the atherosclerosis of the vessels proximal to it. (3) Left ventricular wall hypertrophy may promote the formation of myocardial bridge clinically. (4) The prognosis of myocardial bridge is good.