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中华老年病研究电子杂志

中华老年病研究电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 26 -30. doi: 10.3877/cma.j.issn.2095-8757.2024.02.006

临床研究

经胸超声心动图对老年患者左前降支壁冠状动脉的检测价值
马鸿兰1, 李静1, 张小用2,†()   
  1. 1. 710077　西安，西安医学院第一附属医院心血管内科
    2. 710077　西安，西安医学院第一附属医院超声科
  • 收稿日期:2024-01-09 出版日期:2024-05-28
  • 通信作者: 张小用
  • 基金资助:
    西安医学院博士科研启动基金项目(2020DOC07)

Noninvasive detection of the left anterior descending intramural coronary artery by transthoracic echocardiography in elderly patients

Honglan Ma1, Jing Li1, Xiaoyong Zhang2,†()   

  1. 1. Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi’an Medical College, Xi’an 710077, China
    2. Department of Ultrasound Diagnostics, the First Affiliated Hospital of Xi’an Medical College, Xi’an 710077, China
  • Received:2024-01-09 Published:2024-05-28
  • Corresponding author: Xiaoyong Zhang
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马鸿兰, 李静, 张小用. 经胸超声心动图对老年患者左前降支壁冠状动脉的检测价值[J]. 中华老年病研究电子杂志, 2024, 11(02): 26-30.

Honglan Ma, Jing Li, Xiaoyong Zhang. Noninvasive detection of the left anterior descending intramural coronary artery by transthoracic echocardiography in elderly patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2024, 11(02): 26-30.

目的

探讨经胸超声心动图无创检测左前降支壁冠状动脉的可行性及多普勒血流频谱特征。

方法

选取2021年6月1日至2023年12月1日在西安医学院第一附属医院接受超声心动图检查，并经冠状动脉造影或冠状动脉CT血管成像确诊的左前降支壁冠状动脉患者43例。二维超声观察左前降支冠状动脉走行、管腔结构及管壁回声；彩色多普勒血流显像（CDFI）显示其内血流。以二维超声或CDFI显示冠状动脉走行弯曲，"钻入或钻出"心肌组织并舒张期血流加速作为标准诊断壁冠状动脉，记录脉冲多普勒血流频谱，探讨超声心动图特征性表现。

结果

超声心动图二维超声或CDFI共检出左前降支壁冠状动脉患者32例，检出率为74.42%。其中左前降支近段3例，中段25例，远段4例。32例患者脉冲多普勒血流频谱均出现舒张早期"指尖样"血流频谱，其中9例患者出现舒张中晚期"平台样"血流频谱，5例患者出现收缩期"反向"血流频谱，3例患者"钻入"心肌组织处冠状动脉管壁增厚，回声增强。冠状动脉斑块超声检查显示，经胸超声心动图对冠状动脉左主干显示率为100.00%，对前降支近段、中段、远段显示率分别为100.00%、75.00%、6.25%，对右冠状动脉近段、中段、远段显示率分别为61.54%、16.67%、40.00%。

结论

超声心动图可无创检测左前降支壁冠状动脉，检出率较高。二维超声或CDFI显示冠状动脉走行弯曲，"钻入或钻出"心肌组织并舒张期血流加速，脉冲多普勒舒张早期"指尖样"血流频谱，均为其特征性表现。

关键词: 壁冠状动脉, 超声心动图, 彩色多普勒血流显象, 脉冲多普勒血流频谱, 无创
Objective

To investigate the feasibility of noninvasive detection of the left anterior descending intramural coronary artery by transthoracic echocardiography and the characteristics of Doppler flow spectrum.

Methods

A total of 43 patients with intramural coronary artery diagnosed by angiography or computed tomography angiography received echocardiography at the First Affiliated Hospital of Xi 'an Medical College from June 1, 2021 to December 1, 2023 were selected. The diagnosis of intramural coronary artery was based on the curving of coronary artery blood flow with an acceleration blood flow signal during diastolic, and its spectrum of Doppler blood flow was measured.

Results

Echocardiography detected 32 left anterior descending intramural coronary artery, with the detection rate of 74.42%, including 3 in proximal left anterior descending branch, 25 in middle left anterior descending branch, and 4 in distal left anterior descending branch. All 32 patients had a "fingertip-like" Doppler’ blood flow spectrum in early diastole, with 9 patients had a "platform-like" in middle and late diastole, 5 patients had a "reverse" in systole, and 3 patients had an thickened and atherosclerotic changed wall of intramural coronary artery. The display rate of the left main coronary artery by transthoracic echocardiography in the examination of coronary artery plaque was 100.00%. The display rates of the proximal, middle, and distal anterior descending branch were 100.00%, 75.00%, and 6.25%, respectively; and the display rates of the proximal, middle, and distal right coronary artery were 61.54%, 16.67%, and 40.00%, respectively.

Conclusion

Echocardiography could non-invasively detect left anterior descending intramural coronary artery, and the curving of coronary artery blood flow with an "fingertip-like" Doppler’ blood flow spectrum in early diastole maybe the characteristic change.

Key words: Intramural coronary artery, Echocardiography, Color Doppler flow imaging, Pulse Doppler blood flow spectrum, Noninvasive
图1 壁冠状动脉患者二维超声检测典型图像。前降支远段（8#）壁冠状动脉走形弯曲，"钻入"心肌组织处管壁增厚，回声增强注：LV指左室；IVS指室间隔；ICA指冠状动脉
图2 壁冠状动脉患者彩色多普勒血流显像典型图像。2A：前降支中段壁冠状动脉走形弯曲（箭头所示）；2B：前降支中段壁冠状动脉（ICA）走形弯曲，"钻出"心肌组织处颜色变亮（箭头所示）注：LV指左室；RV指右室；ICA指冠状动脉
图3 壁冠状动脉患者脉冲多普勒超声检查典型血流频谱。3A：舒张早期"指尖样"血流频谱（红色线条）与舒张中晚期"平台样"血流频谱（绿色线条）；3B：舒张早期"指尖样"血流频谱（红色线条）、舒张中晚期"平台样"血流频谱（绿色线条）及收缩期"反向"血流频谱（蓝色线条）
图4 冠状动脉造影术显示前降支近段重度狭窄（红色箭头）
图5 前降支近段（6段）狭窄处的五彩混叠血流信号注：AO指主动脉；PA指肺动脉；LAD指左前降支
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