右冠状动脉起自左冠窦患者的CT解剖及CT-FFR特征与临床症状的相关性研究  

Correlation of Computed Tomography Angiography and Fractional Flow Reserve Features with Symptoms in Patients with Right Coronary Artery Originating from the Left Coronary Sinus

作　　者：毛亮 王小强[1] 刘晓龙 翟宁[1] 陈月芹[1] MAO Liang;WANG Xiaoqiang;LIU Xiaolong;ZHAI Ning;CHEN Yueqin(Department of Radiology,Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院医学影像科,山东济宁272000

出　　处：《CT理论与应用研究(中英文)》2025年第1期17-22,共6页Computerized Tomography Theory and Applications

基　　金：济宁市重点研发计划(基于冠状动脉CTA及CT-FFR对冠状动脉先天变异患者发生不良心血管事件的预测研究(2024YXNS061));济宁市重点研发计划(多模态心脏磁共振对射血分数保留的心力衰竭诊断及预后评估价值的研究(2022YXNS011));济宁市重点研发计划(基于多模态CMR和生物标记物探究慢性心力衰竭患者预后不良的危险因素及预测模型的构建(2023YXNS142))。

摘　　要：目的:通过冠状动脉CTA及CT血流储备分数(CT-FFR)探讨右冠状动脉起自左冠窦(AORL)的解剖及血流动力学特征与临床症状的相关性。方法:回顾性分析2018年1月至2023年12月期间在我院行CCTA检查检出AORL且走行于主动脉-肺动脉间或肺动脉下、无有意义粥样硬化狭窄的患者151例,按有无临床症状分为有症状组87例,无症状组64例。通过CCTA图像比较两组患者RCA的解剖学差异;通过CT-FFR软件测量、比较两组患者RCA距开口3 cm处的CT-FFR值。结果:两组患者右冠状动脉开口形态、起始角、近段管腔狭窄率、狭窄段长度及与肺动脉的位置关系存在统计学差异。RCA起始处夹角与有无临床症状呈中度相关性(r=0.566),RCA开口形状、近段管腔狭窄率、狭窄段长度及与肺动脉的位置关系均与有无临床症状呈低度相关性。有症状组与无症状组CT-FFR分别为(0.94±0.02)和(0.97±0.01),差异有统计学意义,且与有无临床症状呈中度相关性(r=0.594)。结论:在AORL患者中,右冠状动脉裂隙状开口、小的起始角、近段管腔狭窄、狭窄段较长及大动脉间走行是引起临床症状的CCTA解剖特征;右冠状动脉CT-FFR改变与心血管症状发生相关,但其在测量方法及临界值的确定仍有待研究。Objective:This study aimed to explore the association between the anatomical and hemodynamic characteristics and the clinical symptoms in patients with the origin of the right coronary artery from the left coronary sinus(AORL)using coronary computed tomography angiography(CCTA)and CT fractional flow reserve(CT-FFR).Methods:A retrospective analysis was conducted on 151 patients with AORL detected by CCTA between January 2018 and December 2023 at our hospital.Patients were divided into the symptomatic(n=87)and asymptomatic(n=64)groups.CCTA images were used to compare anatomical differences of the RCA between both groups.CT-FFR values were measured and compared at 3 cm from the RCA ostium.Results:There were significant statistical differences between both groups regarding the RCA ostial morphology,origin angle,proximal lumen stenosis rate,length of the stenotic segment,and its relation to the pulmonary artery.The angle at the RCA ostium showed moderate correlation with clinical symptoms(r=0.566),whereas the ostial shape,proximal lumen stenosis rate,length of the stenotic segment,and relation to the pulmonary artery showed low correlation with symptoms.CT-FFR values were(0.94±0.02)and(0.97±0.01)for the symptomatic and asymptomatic groups,respectively,with a significant difference and moderate correlation with clinical symptoms(r=0.594).Conclusion:In patients with AORL,anatomical features,such as a slit-like RCA ostium,smaller origin angle,proximal lumen stenosis,long stenotic segment,and course between large arteries,are associated with clinical symptoms.Changes in CT-FFR are related to cardiovascular symptoms;however,further research is needed to determine measurement methods and critical values.

关 键 词：CT血管成像 冠状动脉变异 血流储备分数 

分 类 号：R814[医药卫生—影像医学与核医学]