摘要
目的探讨经冠状动脉造影(CAG)评估的左主干(LMCA)口部狭窄的严重程度与使用血管内超声(IVUS)测量结果相比被高估的原因。方法选取自2018年1月至2021年1月于北部战区总医院经CAG诊断为LMCA口部存在严重狭窄(目测直径狭窄程度≥50%)的62例冠状动脉粥样硬化性心脏病(CAD)患者为研究对象。根据IVUS测量的LMCA口部最小管腔面积是否≥6 mm^(2),将所有患者分为高估(OE)组(n=37)与未高估(NOE)组(n=25)。比较两组患者使用定量冠状动脉造影(QCA)和IVUS测量的相关参数。结果QCA相关参数比较:OE组的参考血管直径显著高于NOE组,组间比较,差异有统计学意义(P<0.05)。两组患者的造影所显示的LMCA口部最小血管直径、狭窄程度及造影无返流的比例比较,差异均无统计学意义(P>0.05)。IVUS相关参数比较:两组患者的LMCA口部斑块性质比较,差异均无统计学意义(P>0.05)。OE组患者的LMCA口部最小管腔面积和外弹力膜面积大于NOE组,LMCA口部的斑块负荷程度、向心指数和血管重构比例均小于NOE组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析发现,血管重构、圆形开口和QCA参考血管直径是造成LMCA口部狭窄程度被高估的独立影响因素(P<0.05)。结论IVUS分析证实,圆形开口和血管重构有助于CAG对LMCA口部狭窄程度的准确判断,而中度程度狭窄(狭窄程度<50%)和较大的LMCA参考血管直径则会造成对LMCA口部狭窄程度的高估。
Objective To investigate the overestimation of the severity of left main coronary artery(LMCA)ostium as assessed by coronary angiography(CAG)compared with intravascular ultrasound(IVUS).Methods A total of 62 patients with coronary atherosclerotic heart disease(CAD)who were diagnosed with severe LMCA ostium stenosis(visual diameter stenosis≥50%)by coronary angiography in General Hospital of Northern Theater Command from January 2018 to January 2021 were selected as the study subjects.All patients were divided into overestimated(OE)group(n=37)and non-overestimated(NOE)group(n=25)according to whether the minimum lumen area of LMCA ostium measured by IVUS was be equal or greater than 6 square millimeters.The parameters measured by quantitative coronary angiography(QCA)and IVUS were compared between the two groups.Results Comparison of QCA-related parameters:the reference vessel diameter in OE group was significantly higher than that in NOE group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the minimum diameter of mouth vessels of LMCA ostium,the degree of stenosis and the ratio of angiography without reflux between the two groups(P>0.05).Comparison of IVUS related parameters:there was no statistical significance in LMCA ostium plaque characteristics between two groups(P>0.05).The minimum lumen area and external elastic membrane area of LMCA ostium in OE group were larger than those in NOE group,and the plaque load degree,centripetal index and proportion of vascular remodeling of LMCA ostium were smaller than those in NOE group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that vascular remodeling,circular ostium and QCA reference vessel diameter were the independent influencing factors for the overestimation of LMCA ostium stenosis(P<0.05).Conclusion IVUS analysis confirmed that round opening and vascular remodeling helped CAG accurately judge the degree of LMCA ostium stenosis,while moderate
作者
于杰
盛宇贺
王颖东
祁俊仙
李子琪
王斌
荆全民
YU Jie;SHEN Yu-he;WANG Ying-dong;QI Jun-xian;LI Zi-qi;WANG Bin;JING Quan-min(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Graduate School,Dalian Medical University,Dalian 116000,China;Graduate School,China Medical University,Shenyang 110001,China)
出处
《临床军医杂志》
CAS
2022年第3期274-279,共6页
Clinical Journal of Medical Officers
基金
辽宁省民生科技计划联合计划项目(2021JH2/10300104)
关键词
左主干
口部病变
血管内超声
冠状动脉粥样硬化性心脏病
定量冠状动脉造影
Left main coronary artery
Ostium lesion
Intravascular ultrasound
Coronary atherosclerotic heart disease
Quantitative coronary angiography
