应用冠状动脉CTA和计算流体力学无创性评价心肌桥对冠状动脉血流动力学的影响  

Noninvasive evaluation of hemodynamic changes of myocardial bridge using coronary CTA and computational fluid dynamics

作　　者：陆怡菡 余蒙蒙 曾蒙苏 周国锋 LU Yi-han;YU Meng-meng;ZENG Meng-su;ZHOU Guo-feng(Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]上海市影像医学研究所,上海200032

出　　处：《中国临床医学》2021年第3期396-401,共6页Chinese Journal of Clinical Medicine

基　　金：上海市青年科技英才扬帆计划(20YF1435900);上海市临床重点专科项目(W2019-018)。

摘　　要：目的:探讨应用冠脉CT血管成像(CTA)和计算流体力学无创性评价心肌桥对血流储备分数(fractional flow reserve,FFRCT)和壁面切应力(wall shear stress,WSS)变化的影响。方法:选择2020年5月至2020年12月复旦大学附属中山医院行冠脉CTA检查发现的左前降支心肌桥患者50例,根据心肌桥深度分为浅表组(n=25)和深在组(n=25),并选取25例CTA正常者为对照组,比较各组间心肌桥解剖特征、FFRCT值及WSS值的差异。根据FFRCT值将50例心肌桥患者分为FFRCT正常(>0.8)组(n=24)和FFRCT异常(≤0.8)组(n=26),比较2组临床症状、心肌桥解剖特征、WSS值的差异。结果:浅表组和深在组在心肌桥段和心肌桥远端收缩期、舒张期的FFRCT值均低于对照组(P<0.001),在心肌桥远端收缩期和舒张期的WSS值均高于对照组(P=0.037、0.002)。FFRCT正常组和异常组间收缩期心肌桥受压指数差异有统计学意义(P=0.023),FFRCT值异常的心肌桥患者更易发生心绞痛(30.8%vs 8.3%,P=0.048)。结论:心肌桥患者FFRCT值降低,心肌桥远端WSS值升高,收缩期心肌桥受压指数升高时,往往FFRCT值较低,FFRCT值较低患者更易出现心绞痛。Objective:To explore the effect of myocardial bridge(MB)on non-invasive fractional flow reserve(FFRCT)and wall shear stress(WSS)using coronary CT angiography(CTA)and computational fluid dynamics(CFD).Methods:From May 2020 to December 2020,50 patients with MB in left anterior descending artery and 25 controls undergoing coronary CTA in Zhongshan Hospital,Fudan University were included.Patients were divided into superficial(n=25)and deep MB groups(n=25)according to the depth of MB.The differences in anatomical characteristics,FFRCT values,and WSS values among groups were analyzed.The MB group was divided into normal FFRCT(>0.8)and abnormal FFRCT(≤0.8)groups according to FFRCT values.The differences in clinical symptoms,anatomical characteristics,and WSS values between the two groups were analyzed.Results:Compared to control group,the FFRCT values of superficial and deep MB groups decreased in diastolic phase and systolic phase(P<0.001);the WSS values of coronary artery distal to MB were higher in superficial and deep groups in both phases(P=0.037,0.002).A significant difference in systolic MB compression index was found between normal FFRCT and abnormal FFRCT groups(P=0.023).Patients with abnormal FFRCT were more likely to have angina(30.8%vs 8.3%,P=0.048).Conclusions:The FFRCT values of MB patients are lower than those of controls.The WWS values of coronary artery distal to MB are higher than those of controls.The increase of systolic myocardial bridge compression index has a association with the decrease of FFRCT values.Patients with abnormal FFRCT values are more likely to have angina.

关 键 词：心肌桥 冠状动脉CT血管成像 计算流体力学 血流储备分数 壁面切应力 

分 类 号：R445.3[医药卫生—影像医学与核医学]