冠脉单支与双支CTO病变对左心功能影响程度的比较

发布时间：2018-05-20 20:26

  本文选题：慢性完全闭塞病变 + 冠状动脉　； 参考：《吉林大学》2017年硕士论文

【摘要】：背景与目的:冠状动脉疾病是导致左心室功能障碍的主要原因,慢性完全闭塞(Chronic total occlusion,CTO)病变在冠状动脉疾病占有一定比例,冠脉CTO病变可以导致心肌冬眠,部分心肌可以坏死形成瘢痕,导致左心功能障碍和左心室重构,与非CTO病变相比,冠脉CTO有更差的左心功能,更高的死亡率。左心功能作为评价冠脉CTO疾病轻重的一项重要指标,鲜有证据比较单支与双支CTO病变对左心功能的影响程度。本文回顾性对单支与双支CTO病变对左心功能的影响程度进行比较,并比较双支CTO病变中不同血管组合对左心功能的影响有无差异。方法:回顾性分析2014年1月至2016年12月吉林大学第二医院心内科1032例经冠状动脉造影检查提示CTO患者的造影资料,按照病变CTO相关血管数目分为单支CTO组和双支CTO组,按照入选和排除标准筛选后,共有129患者符合标准,其中单支CTO组82例,双支CTO组47例,对两组患者的基本信息和左心功能心脏彩超参数包括左心房内径(LA)、左心室内径(LV)、左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)进行统计学差异比较。另外对双支CTO组按病变血管位置分组,其中LAD+RCA组24例、LAD+LCX组8例、LCX+RCA组15例,进一步分析各组之间患者基本信息及左心功能参数进行统计学差异比较。结果:1.双支CTO组较单支CTO组具有更差的左心功能参数,具有更明显扩大的LV大小(53.19±6.69mm vs 50.46±6.56mm,p0.05);具有更低的LVEF(54.89±11.00%vs 61.13±9.70%,p0.05);更高的LVEDV(162.64±51.80ml vs 143.41±47.05ml,p0.05);更高的LVESV(75.70±43.60ml vs 59.11±36.73ml,p0.05)。2.另外在双支CTO病变不同血管组合比较中,显示:(1)LVEF:LAD+LCX组和LCX+RCA组均低于LAD+RCA组(48.63±9.02%vs 59.29±10.24%,P0.05)和(51.20±10.69%vs 59.29±10.24%,P0.05);(2)LVEDV:LCX+RCA组高于LAD+RCA组(183.20±44.47m L vs 144.13±50.73 m L,P0.05);(3)LVESV:LAD+LCX组和LCX+RCA组均高于LAD+RCA组(96.00±46.51m L vs 59.75±38.56 m L,P0.05)和(90.40±42.65 m L vs59.75±38.56 m L,P0.05)。结论:在CTO病变中双支CTO病变较单支CTO病变对左心功能的影响程度更明显,具有更差左心功能。在双支CTO病变三组不同血管组合中,LAD+LCX组合和LCX+RCA组合较LAD+RCA组合具有更差左心功能,对左心功能的影响显著组均合并LCX,提示在双支CTO病变中当存在LCX病变时可能会显著影响左心功能。
[Abstract]:Background & AIM: coronary artery disease is the main cause of left ventricular dysfunction. Chronic complete occlusion total occlusion (CTO) is the major cause of coronary artery disease. Coronary artery CTO disease can lead to myocardial hibernation. Some of the myocardium can necrosis and form scar, leading to left ventricular dysfunction and left ventricular remodeling. Coronary CTO has worse left heart function and higher mortality compared with non CTO lesions. Left ventricular function is an important index to evaluate the severity of coronary CTO disease. There is little evidence to compare the influence of single and double vessel CTO on left ventricular function. The effects of single vessel and double vessel CTO on left ventricular function were retrospectively compared, and the effects of different vascular combinations on left ventricular function in double vessel CTO were compared. Methods: from January 2014 to December 2016, 1032 patients with CTO were analyzed retrospectively by coronary angiography in the Department of Cardiology, second Hospital of Jilin University. According to the number of diseased CTO related vessels, they were divided into two groups: single vessel CTO group and double vessel CTO group. According to the selection and exclusion criteria, a total of 129 patients met the criteria, including 82 cases in single branch CTO group and 47 cases in double branch CTO group. The basic information and echocardiographic parameters of left ventricular function, including left atrial diameter, left ventricular diameter and LVV, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDVV) and left ventricular end-systolic volume (LVESVV) were compared between the two groups. In addition, double-vessel CTO group was divided into two groups according to the location of the diseased vessels, including 24 cases of LAD RCA group with lad LCX group, 8 cases with LCX RCA group (15 cases). The basic information of the patients and the parameters of left ventricular function were analyzed and compared statistically among the two groups. The result is 1: 1. The left ventricular function parameters of the double-branch CTO group were worse than that of the single-vessel CTO group, with significantly larger LV size 53.19 卤6.69mm vs 50.46 卤6.56mm 6.69mm, lower LVEF(54.89 卤11.00%vs 61.13 卤9.70ml / 0.05, higher LVEDV(162.64 卤51.80ml vs 143.41 卤47.05mlp0.05m and higher LVESV(75.70 卤43.60ml vs 59.11 卤36.73ml / p0.05. 鍙﹀�栧湪鍙屾敮CTO鐥呭彉涓嶅悓琛，

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