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 INTRODUCTION INTRODUCTION Treatment of symptomatic patients: • Negative inotropic and/or negative chronotropic agents: Betablocker, 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 Chart Myocardial bridge prevalence 1291 pts (93.2%) no MB MB 95 pts (6.8%) John R Kramer (1982): 12% (PCA) Atar E (2007): 17% (MSCT) Lazoura O (2010): 21% (MSCT) RESULTS Table General characteristic of participants (n = 95) Variable X ± SD or n (%) Age (year) 61.85 ± 12.45 Male 77 (81.1%) Concomitant diseases Hypertension 55 (57.9%) Type Diabetes Mellitus 13 (13.7%) Stable ischemic heart disease 14 (14.73%) RESULTS Table Grading of angina pectoris according to CCS (n = 81) CCS n (%) 35 (43.2%) 30 (37%) 15 (18.6%) (1.2%) Total 81 (100%) RESULTS Table ECG characteristic (n = 81) Variable ECG X ± SD or n (%) Normal 61 (75.3%) ST depression, T (-) 12 (14.8%) ST elevation (9.9%) Li Wan (2005): Abnormal ECG occurred in 10% patients RESULTS Table Echocardiography characteristic (n = 81) X ± SD or n (%) Variable Echocardiography LVDd (mm) 46.74 ± 5.98 LVDs (mm) 29.95 ± 6.38 EF (%) 63.76 ± 10.50 Regional wall dyskinesia (7.4%) LV dilatation 17 (20.9%) RESULTS Chart MB locations (n = 81) 1.20% 2.40% LAD1 LAD2 LAD3 LCX RCA OTHERS 2.40% 3.60% 30.10% Atar E (2007): 60% MB in LAD Lazoura O (2010): 100% MB in LAD, 68% in LAD2 60.30% RESULTS Table The degree of systolic coronary stenosis caused by MB (n = 81) Degree n (%) Mild (< 50%) 52 (64.19%) Moderate (50-74%) 20 (24.69%) Severe Total 75-89% (4.95%) ≥ 90% (6.17%) 81 (100%) RESULTS Table The relation between angina and coronary artery stenosis degree (n = 81) CCS 1-2 Mild and Moderate stenosis (n(%)) Severe stenosis (n(%)) 58 (71.6%) (8.6%) p > 0.05 CCS 3-4 14 (17.3%) (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