The Clinical Study On Effect Of Coronary Myocardial Bridge To The Blood-supply Of Myocardium

Objective:To investigate the relationship between myocardial bridge and the symptoms of the patients,its influencing factors,to formulate a better treatment.Methods:80 patients diagnosed myocardial bridge by coronary angiography in our hospital from January 2006 to September 2009 were selected,51 men,29 women, age 31-70,mean age 52.58±7.95 years. Eliminate the patients with stenosis over than 50% in the major coronary artery and its major branchs, merger other congenital and acquired cardiopulmonary diseases, merger serious diseases of other systems,the patients didn't agree to do the nuclide myocardial perfusion imaging. They all underwent the exercise stress nuclide myocardial perfusion imaging in 3 days,the patients were divided into ischemic group and non-ischemic group according to the results of the nuclide imaging. According to the current clinical treatment for patients with myocardial bridges,the patients were all given p-blockers conventionally after the operation, with beta blocker contraindications give the double hydrogen pyridine calcium antagonists. The clinical information of the patients was collected,including symptom characteristics,history material,coronary angiography results,and the prognosis was followed up.The aim of following up includes if the patients insist takingβ-blocker or not and curative effects.Comparing and analysing the symptom characteristics,history material,coronary angiography results,treatment and the prognosis between the two groups.Results:80 patients with myocardial bridge,ischemic group 15 patients, non-ischemic group 65 patients.The difference between the symptom characteristics of the two groups is not statistically significant(P>0.05).The narrowing below grade III(narrow diameter30%-75%)48 patients,gradeⅢnarrowing(narrow diameter≥75%)32 patients,there is 2 patients of the narrowing below gradeⅢand 13 patients of the gradeⅢnarrowing in the ischemic group,46 patients of the narrowing below gradeⅢand 19 patients of the gradeⅢnarrowing in the non-ischemic group.The stenosis degree of myocardial bridge between the two groups is statistically significant(P<0.01),most of the ischemic groupe is the patients of gradeⅢnarrowing.The age,hypertension,diabetes,hyperlipidemia,cigarette history between the two groups are not statistically significant(P>0.05).Of the 32 grade III narrowing patients,13 patients with myocardial ischemia,mean age 57.50±7.09 years,19 without myocardial ischemia,mean age 50.64±9.11 years,the ages of the patients with myocardial ischemia are older than the without(P=0.023).12 patients in the ischemia group insist taking drug therapy,3 patients in the ischemia group did not insist taking drug therapy,14 patients in the non-ischemic group insist taking drug therapy,51 patients in the non-ischemic group did not insist taking drug therapy,the proportion of the patients who insist taking drug therapy between the two groups is statistically significant(P<0.01);The symptoms of patients who take drug therapy all improved;of the the patients who did not insist taking drug therapy,symptoms of the ischemia group patients did not change at all,the symptoms of 44 patients in the none-ischemia group improved,7 patients did not change,the symptom improving conditions between the two groups is statistically significant(P<0.01).Conclusion:Some patients were confirmed existing myocardial ischemia by objective examination,clinical symptoms were caused by the myocardial bridge,some patients with no evidence of myocardial ischemia,clinical symptoms and the myocardial bridge without a clear correlation.But whether the myocardial bridge leading to myocardial ischemia or not could not be judged by the symptoms. Whether the myocardial bridge leading to myocardial ischemia or not,is much depending on the age and the narrowing degree of the patients. GradeⅠand gradeⅡnarrowing did not influence the blood-supply of myocardium,the elder patients with gradeⅢnarrowing may exist myocardial ischemia;patients without evidence of myocardial ischemia didn't need to be treated,patients with evidence of myocardial ischemia reflected well to the drug therapy.