Cầu cơ động mạch vành tỷ lệ hiện mắc, đặc điểm lâm sàng và cận lâm sàng ở người việt nam

Cầu cơ động mạch vành, tỷ lệ hiện mắc, đặc điểm lâm sàng ,và cận lâm sàng, ở người việt nam

Prevalence and characteristics of myocardial bridge in patients undergoing percutaneous

coronary angiography

BS Nguyễn Văn Tuấn - BVQY 103

INTRODUCTION

Myocardial bridge (MB): a muscle bridge over a segment of the coronary arteries that leads to narrowing of coronary artery

Systolic Diastolic

INTRODUCTION

 Prevalence:

• Autopsy: 5,4% ~ 85,7% *

• Angiography: 0,5% ~ 16%

 Clinical significance:

* Jorge R Alegria (2005): Myocardial bridging, European Heart Journal 26, 1159-1168

INTRODUCTION

Treatment of symptomatic patients:

• Negative inotropic and/or negative chronotropic agents: Beta-blocker, calcium antagonists

OBJECTIVE

To investigate the prevalence, clinical and paraclinical characteristics of myocardial bridge

in patients undergoing PCA

SUBJECTS AND METHODS

 SUBJECTS

1386 patients underwent PCA in Department of Cardiology, Military Hospital 103 from 1/2013 to 3/2016

 METHODS

• Descriptive, cross – sectional

• Clinical and paraclinical examination

• Percutaneous coronary angiography (PCA)

SUBJECTS AND METHODS

• Diagnosis of MB: Systolic compression of the artery with narrowing of the lumen and diastolic relaxation

• Grading of angina pectoris: Canadian Cardiovascular Society (CCS) (1976)

• Assessment of coronary artery stenosis *

Mild: < 50%

Moderate: 50 – 74%

Severe: ≥ 75%

* Kern MJ (2013), “The interventional cardiac catheterization handbook third edition”

RESULTS

1291 pts (93.2%)

95 pts (6.8%)

Chart 1 Myocardial bridge prevalence

no MB MB

John R Kramer (1982): 12% (PCA)

Atar E (2007): 17% (MSCT)

Lazoura O (2010): 21% (MSCT)

RESULTS

Table 1 General characteristic of participants (n = 95)

Concomitant

diseases

Hypertension 55 (57.9%)

Type 2 Diabetes

Stable ischemic heart disease 14 (14.73%)

RESULTS

Table 2 Grading of angina pectoris according to CCS (n = 81)

RESULTS

Table 3 ECG characteristic (n = 81)

ECG

ST depression, T (-) 12 (14.8%)

Li Wan (2005): Abnormal ECG occurred in 10% patients

RESULTS

Table 4 Echocardiography characteristic (n = 81)

Echocardiography

LVDd (mm) 46.74 ± 5.98 LVDs (mm) 29.95 ± 6.38

Regional wall dyskinesia 6 (7.4%)

LV dilatation 17 (20.9%)

RESULTS

Chart 2 MB locations (n = 81)

3.60%

60.30% 30.10%

2.40%

1.20%

2.40%

LAD1 LAD2 LAD3 LCX RCA OTHERS

Atar E (2007): 60% MB in LAD

Lazoura O (2010): 100% MB in LAD, 68% in LAD2

RESULTS

Table 5 The degree of systolic coronary stenosis caused by MB (n = 81)

Mild (< 50%) 52 (64.19%) Moderate (50-74%) 20 (24.69%)

Severe

RESULTS

Table 6 The relation between angina and coronary artery stenosis degree (n = 81)

Mild and Moderate stenosis (n(%))

Severe stenosis

CCS 1-2 58 (71.6%) 7 (8.6%)

> 0.05 CCS 3-4 14 (17.3%) 2 (2.5%)

CONCLUSION

 The prevalence of MB is 6.8% of patients

undergoing percutaneous coronary angiography

 Most of MB was found in LAD

 There was no relation between angina and

coronary artery stenosis degree