单纯性冠状动脉瘤样扩张对心房传导时间的影响

摘要

目的 探讨单纯性冠状动脉瘤样扩张(CAE)对心房传导时间的影响.方法 连续入选2015年1-4月于首都医科大学附属北京安贞医院行冠状动脉造影检查确诊为单纯性CAE的患者38例(CAE组)和具有非典型胸痛、冠状动脉造影示心外膜冠状动脉无狭窄的患者49例(对照组).比较2组超声心动图、心电图相关指标以及分析CAE患者冠状动脉造影分布特点.结果 2组超声心动图相关指标差异无统计学意义(P＞0.05).CAE组患者P波最大时限(Pmax)、P波离散度(Pd)均明显高于对照组[(120 ±12) ms比(104± 11) ms、(47±13) ms比(27±10) ms],差异均有统计学意义(均P＜0.01).38例CAE患者累及的冠状动脉节段数平均为(4.6±2.3)个节段.瘤样扩张的冠状动脉分布为左主干12例、左前降支16例、左回旋支13例、右冠状动脉26例.瘤样扩张累及冠状动脉的数目为左主干1例、左主干+单支冠状动脉4例、左主干+两支冠状动脉5例、左主干+三支冠状动脉2例、单支冠状动脉18例、两支冠状动脉7例、三支冠状动脉1例.CAE累及的冠状动脉数目和冠状动脉分布与Pmax和Pd均无相关性,累及的冠状动脉节段数与Pmax(P＜0.001)和Pd(P =0.004)呈正相关.结论 单纯性CAE患者Pmax和Pd明显增加,且瘤样扩张累及的冠状动脉节段数与Pmax和Pd呈正相关.%Objective To explore the effect of isolated coronary artery ectasia (CAE) on atrial conduction.Methods Totally 38 patients with CAE confirmed by coronary angiography (CAE group) and 49 patients with atypical chest pain but without epicardial coronary artery stenosis confirmed by coronary angiography (control group) from January to April in 2015 were enrolled.The indexes of echocardiography and electrocardiograph were compared between groups;the distribution characteristics of coronary artery in angiography in patients with CAE were analyzed.Results The index of echocardiography were not significantly different between groups (P ＞ 0.05).The P-wave maximal duration (Pmax) and P-wave dispersion (Pd) in CAE group were significantly higher than those in control group [(120±12) msvs (104±11) ms,(47±13) ms vs (27±10) ms] (P＜0.01).In CAE group,(4.6± 2.3) segments of coronary artery were involved,which were distributed at left main coronary artery (12 cases),left anterior descending artery (16 cases),left circumflex (13 cases) and right coronary artery (26 cases);the left main coronary artery was involved in 1 case,the left main and single-vessel were involved in 4 cases,the left main and double-vessel were involved in 5 cases,the left main and three-vessel were involved in 2 cases,single,double and three-vessel were involved in 18,7 and 1 case,18 cases in single coronary artery,7 cases in two coronary arteries,1 case in three vessel coronary arteries.CAE involving number and distribution of coronary artery had no correlations with Pmax and Pd,CAE involving number of coronary artery segment was positively correlated with Pmax (P ＜ 0.001) and Pd (P =0.004) was positively correlated.Conclusion Prolonged Pmax and Pd are found in patients with isolated CAE,the Pmax and Pd are positively correlated with ectatic involving segment number.