The Characteristics of Spiral CT Angiography of Middle Segment in Left Anterior Descending Branch Myocardial Bridge and Its Application in Plaque Stability Evaluation
10.3870/j.issn.1672-0741.25.01.039
- VernacularTitle:左前降支中段心肌桥螺旋CT血管造影特征及其在斑块性质稳定性评估中的应用
- Author:
Juan SHAN
1
;
Wentao ZHANG
1
;
Lijuan WANG
1
Author Information
1. 河北省张家口市第一医院放射医学科,张家口 075000
- Publication Type:Journal Article
- Keywords:
left front descending branch;
myocardial bridge;
spiral CT angiography;
plaque property;
stability
- From:
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
2025;54(3):401-408
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the spiral CT angiography(CTA)characteristics,plaque properties,and their role in stability assessment of the middle segment myocardial bridge(MB)in the left anterior descending artery(LAD).Methods From January 2023 to June 2024,300 patients with atherosclerotic plaque(AP)diagnosed by spiral CTA in the Radiology Department of Zhangjiakou First Hospital were enrolled in the MB group.There were 150 patients with LAD-MB in the combined AP group,and 150 patients without MB in the isolated AP group,including 143 men and 157 women.The age range is from 25 to 81 years old,with an average age of(59.44±9.33)years.Baseline data and biochemical indicators of all patients were collect-ed.The general and clinical data were compared between the combined MB group and the isolated AP group.Multivariate re-gression analysis was conducted to identify the risk factors of unstable plaques.Results The number of AP located between 60 and 80 mm from the left coronary sinus ostium is higher in the isolated AP group compared to the combined AP group(P＜0.05).The results of the logistic regression model indicate a consistently observed correlation between the location of MB and the progression of AP(P＜0.05).When MB position＞75mm,its associations with AP lipid volume＞14 mm3(OR=2.42,95％CI:2.20-2.72,P＜0.05)and AP burden＞0.7(OR=2.21,95％CI:1.96-2.40,P＜0.05)were the most significant.The MB positions in the superficial and deep groups were statistically significant(P＜0.05).The lipid volume,length,and load of AP in the superficial group were lower than those in the deep group(P＜0.05).In patients with stable plaques,the levels of to-tal cholesterol(TC),triglyceride(TG),protein kinase R-like endoplasmic reticulum kinase(PERK),C/EBP homologous protein(CHOP)and activating transcription factor 4(ATF4)were lower than those in patients with unstable plaques,while the level of high-density lipoprotein cholesterol(HDL-C)was higher than that in patients with unstable plaques(P＜0.05);The position,thickness,and length of MB in the stable plaque group were lower than those in the unstable plaque group,as well as the degree of coronary compression during systole and diastole.The differences in MB position and thickness between the two groups were significant(P＜0.05).The degree of stenosis,AP lipid volume,AP length,and AP load in the stable plaque group were lower than those in the unstable plaque group(P＜0.05),and the distance between the anterior segment of the bridge AP and MB en-trance in the stable plaque group was higher than that in the unstable plaque group(P＜0.05).In the logistic regression analysis model,TC,TG,HDL-C,LDL-C,PERK,CHOP,ATF4,MB position,MB thickness,stenosis degree,and distance between the anterior bridge AP and MB entrance were protective factors for unstable plaques.AP lipid volume,AP length,and AP load were risk factors for unstable plaques.Conclusion Combined MB will reduce the number of AP at a distance of 60-80 mm from the left coronary sinus opening,causing concentrated contribution of AP in the anterior vessels of the bridge.Deep MB will increase the lipid volume,length,and load of AP,exacerbate its instability,and make it more prone to rupture.
