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期刊信息/Journal information
中华心血管病杂志
中华医学会杂志社
中华心血管病杂志

中华医学会杂志社

胡大一

月刊

0253-3758

cjc@cma.org.cn

010-85158281

100710

北京市东城区东四西大街42号

中华心血管病杂志/Journal Chinese Journal of CardiologyCSCD北大核心CSTPCD
查看更多>>1973年2月创刊，中华医学会主办。本刊是心血管病学及其相关学科的专业学术期刊，以从事心血管疾病预防、医疗与科研的医务工作者为主要读者对象。主要栏目有：述评、指南与共识、专题评论、临床研究、基础研究、流行学与人群防治、讲座、综述、学术动态、临床病例讨论等，并刊登由中华医学会心血管病学分会和杂志编辑委员会共同制定的心血管疾病诊治指南。本刊是我国心血管病学领域最具权威性的医学科技期刊，被美国MEDLINE、中国期刊全文数据库（CJCR）等国内外20余个数据库收录。曾荣获第三届国家期刊奖提名奖、中国科技期刊方针“双效期刊”；中国科协“优秀科技期刊二等奖”等。2005－2010年连续6年获“百种中国杰出学术期刊”称号。2008年被中国科协列为“中国精品科技期刊示范项目”。
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    要充分重视问诊

    胡大一范姝婕
    115-116页
    查看更多>>摘要：临床医学的基础是诊断学，诊断学的基础是症状学。每位患者都是因身体不适的症状（如胸闷、发热、腹痛、腹泻等）来就医的。问诊是了解患者症状的主要途径。
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    EROSION研究的过去、现在和未来

    于波范姝婕
    117-119页
    查看更多>>摘要：急性冠脉综合征具有高致死、高致残风险，如何改善其临床预后一直是世界难题。光学相干断层成像技术的应用使在体识别病变病理特征，尤其是斑块侵蚀成为可能。EROSION研究首次证实了基于病变病理特征的个体化介入诊疗的安全性和有效性，打破了“一刀切”的支架置入现状，开创了急性冠脉综合征精准介入诊疗体系。该述评从前期观察性研究基础，EROSION系列研究的设计与发现以及未来研究展望等方面，详述EROSION系列研究的历程及其临床意义。

    急性冠脉综合征光学相干断层成像斑块侵蚀精准介入诊疗

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    基因检测在临床血脂管理中的作用仍在完善中

    陈红范姝婕
    120-122页
    查看更多>>摘要：基因检测正迅速进入临床，为血脂异常的诊断和管理带来了机遇和挑战。它是单基因血脂异常诊断的“金标准”，但对多基因性血脂异常的诊治价值还有待进一步研究。

    基因检测单基因血脂异常多基因血脂异常

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    冠状动脉介入策略中何时选择何种腔内影像学技术

    刘学波白洋
    123-127页
    查看更多>>摘要：冠状动脉造影是评估冠状动脉解剖学特征和指导经皮冠状动脉介入治疗（PCI）的传统影像技术。然而，其不能评估动脉壁、血管尺寸、斑块特征和支架置入结果。腔内成像（IVI）技术可提供血管壁结构、斑块病变和置入物等重要信息，其辅助冠心病诊治的临床价值已得到广泛认可。通过准确评估斑块形态可识别斑块易损特征。在体确定急性冠脉综合征患者“罪犯”斑块并提供影像学特征，精准指导个体化治疗。IVI指导PCI获益的证据日益增多，IVI可规划PCI手术策略、优化支架选择，并提升手术成功率。对支架失败患者进行IVI检查可了解其潜在机制、制定后续治疗方案。不同IVI技术具有各自的优势和局限性，未来各种迭代新技术、影像融合、人工智能融合技术会进入临床应用。

    冠心病腔内成像技术经皮冠状动脉介入治疗

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    成人法布雷病心肌病诊断与治疗中国专家共识

    张抒扬韩雅玲范姝婕
    128-136页
    查看更多>>摘要：法布雷病（FD）是一种X染色体连锁遗传疾病，因GLA基因突变，导致其编码的α半乳糖苷酶A（α-Gal A）活性降低或完全缺乏，造成代谢底物三己糖酰基鞘（Gb3）及衍生物脱乙酰基Gb3（Lyso-Gb3）在多种细胞和组织中贮积，引起多脏器病变。在心血管系统中，FD主要会导致左心室肥厚和（或）传导异常，即FD心肌病。由于FD心肌病是FD成人患者死亡的主要原因，因此结合心脏影像学、酶和底物活性、基因检测以及组织活检等方法的早期诊断，以及早期特异性酶替代疗法对于改善患者预后非常重要。本共识综合总结国内外已发表的FD心肌病诊断与治疗的相关证据，为FD心肌病的诊断与管理提供依据。

    法布雷病心肌病诊断治疗

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    IVUS指导DES置入在ACS患者中的长期预后评价：ULTIMATE研究ACS亚组分析

    高晓飞韩冷钱雪松葛震...
    137-143页
    查看更多>>摘要：目的 评估血管内超声（IVUS）指导药物洗脱支架（DES）置入对急性冠脉综合征（ACS）患者长期临床结局的影响。 方法 研究对象来源于ULTIMATE研究，该研究是一项前瞻性、多中心、随机对照研究，于2014年8月—2017年5月在国内8家医院入选1 448例置入DES的冠心病患者。本研究为ULTIMATE研究的亚组分析，将冠心病患者分为ACS组和非ACS组，2组患者均在IVUS或冠状动脉造影指导下置入DES。主要终点是术后3年靶血管失败（TVF）率，包含心原性死亡、靶血管心肌梗死和临床驱动的靶血管血运重建。 结果 1 448例冠心病患者中，ACS组1 136例（78.5%），1 423例（98.3%）患者完成术后3年随访。ACS组患者术后3年的TVF发生率为9.6%（109/1 136），高于非ACS组的4.5%（14/312），log-rank P=0.005。ACS组中IVUS指导下置入DES者的TVF发生率低于冠状动脉造影指导下置入DES架者［7.6%（43/569）比11.6%（66/567），log-rank P=0.019］。ACS组中IVUS指导下DES置入达标组患者术后3年的TVF发生率为5.4%（16/296），低于IVUS未达标组的9.9%（27/273），log-rank P=0.041。 结论 ACS患者置入DES后3年的TVF事件率高于无ACS患者；相比于冠状动脉造影，IVUS指导DES置入可以降低ACS患者术后3年的TVF事件，尤其是IVUS指导下DES置入达标的患者获益更明显。 Objective To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation. Methods Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization. Results ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.

    药物洗脱支架冠状动脉造影血管内超声急性冠脉综合征

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    不同冲洗介质在冠状动脉光学相干断层成像中的应用比较

    李波李智博王金鹏赵雷...
    144-149页
    查看更多>>摘要：目的 在使用光学相干断层扫描（OCT）指导经皮冠状动脉介入治疗（PCI）过程中，观察造影剂与肝素化生理盐水1∶1混合介质及单纯肝素化生理盐水作为替代介质对OCT成像质量的影响及其安全性。 方法 本研究为单中心前瞻性队列研究。入选2021年10月至2022年8月在吉林大学第二医院心血管内科行PCI并完成OCT检查的慢性稳定型心绞痛或急性冠脉综合征患者。在病变血管相同位置分别使用造影剂（造影剂组）、造影剂与肝素化生理盐水1∶1混合介质（混合介质组）及单纯肝素化生理盐水（生理盐水组）作为冲洗介质行OCT检查。由独立观察者分析所有影像结果并判断管腔成像质量，以清晰成像区域比例（CIF%）作为评价指标对结果进行定量分析。同时测量血管腔平均直径，对比分析3种冲洗介质成像测量的管腔平均直径，观察3种介质对管腔解剖结构、病变病理特征及支架等的成像质量。 结果 共入选了105例患者，包括110支靶血管。入选患者年龄为（60.5±8.4）岁，男性60例（57.1%）。3组均未观察到与冲洗介质相关的并发症，且在管腔解剖结构、病变特征及支架相关特征方面显示了相同的图像质量。混合介质组在左右冠状动脉的检查中均达到与造影剂组相当的CIF%［右冠状动脉100.0%（100.0%，100.0%）比100.0%（100.0%，100.0%），P>0.05，左冠状动脉100.0%（95.9%，100.0%）比100.0%（100.0%，100.0%），P>0.05］；生理盐水组在对右冠状动脉的检查中，达到与造影剂组相当的CIF%［100.0%（97.6%，100.0%）比100.0%（100.0%，100.0%），P>0.05］，而在左冠状动脉CIF%较低［84.9%（75.9%，93.4%）比100.0%（100.0%，100.0%），P<0.05］。对于冠状动脉管腔平均直径的测量，与造影剂组相比，混合介质组及生理盐水组的测量结果在左右冠状动脉的差异均无统计学意义（P>0.05）。 结论 肝素化生理盐水1∶1混合介质可以替代造影剂在PCI中作为冲洗介质进行OCT检查，单纯生理盐水亦在右冠状动脉OCT检查中有良好的效果，且两者作为替代介质进行OCT检查均是安全的。 Objective To explore the effects and safety of saline mixed 1∶1 with contrast medium (mixed medium) and pure heparinized saline as alternative media for optimal Optical Coherence Tomography (OCT) guided percutaneous coronary intervention (PCI). Methods This single-center, prospective cohort study enrolled patients who underwent PCI with OCT guidance for chronic stable angina or acute coronary syndrome at the Department of Cardiology, the Second Hospital of Jilin University from October 2021 to August 2022. The target vessels were examined using OCT with three different flushing media at the same anatomical positions: contrast agent, mixed medium, and pure heparinized saline. An independent observer analyzed all imaging results and evaluated the lumen imaging quality, using the proportion of the clear imaging field (CIF%) as a quantitative measure for analysis. The average luminal diameter was compared among different flushing media. The study also assessed the image quality of the luminal anatomical structures, lesion pathologies, and stents. Results A total of 105 patients were enrolled in the study, including 110 target vessels. The age of the enrolled patients was (60.5±8.4) years, with 60 male patients (57.1%). OCT examinations were successfully completed using all three media, and no related complications were observed in any groups. The three flushing media presented with the same image quality in terms of depicting the lumen anatomical structures, lesion characteristics, and stent-related features. The mixed medium group achieved a comparable CIF% to the contrast group with both right and left coronary arteries (right coronary 100.0% (100.0%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05 left coronary 100.0% (95.9%, 100.0%) vs. 100.0% (100.0%, 100.0%),P>0.05). While the saline group reached a comparable CIF% to the contrast group with right coronary arteries (100.0% (97.6%, 100.0%) vs. 100.0% (95.9%, 100.0%),P>0.05) but showed a significantly lower CIF% with left coronary arteries (84.9% (75.9%, 93.4%) vs. 100.0% (100.0%, 100.0%),P<0.05). For the average diameter of the coronary lumen, there was no statistically significant difference between the mixed medium group and the saline group compared to the contrast group with both right and left coronary arteries (P>0.05). Conclusions A 1∶1 heparinized saline and contrast mixture can serve as a substitute flushing medium for OCT examination during PCI procedure. Pure saline can also yield good results in OCT examination of the right coronary artery, and both alternatives are safe for use as flushing medium in OCT imaging.

    光学相干断层扫描造影剂肝素化生理盐水腔内影像

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    DES置入后5年以上支架内再狭窄新生内膜OCT分析

    韩燕袁晓航蒋梦婷冯欢欢...
    150-157页
    查看更多>>摘要：目的 基于光学相干断层成像（OCT）探讨药物洗脱支架（DES）置入后5年以上支架内再狭窄（ISR）患者的新生内膜增生（NIH）特性。 方法 本研究为横断面研究。连续入组2010年3月至2022年3月于解放军总医院接受OCT检查的DES-ISR患者。依据发现ISR距离DES置入时间，将入选患者分为支架置入时间≤5年组和支架置入时间>5年组。对OCT图像进行定量和定性分析，比较两组患者的临床资料及病变特征，并通过多因素logistic回归分析支架内新生动脉粥样硬化（ISNA）的临床独立相关因素。 结果 纳入DES-ISR患者230例，年龄（63.1±10.4）岁，男性188例（81.7%），包含249个病变。DES-ISR中位发现时间为6（2，9）年。支架置入时间≤5年组117例（ISR病变122个），支架置入时间>5年组113例（ISR病变127个）。与支架置入时间≤5年组相比，支架置入时间>5年组中异质性［65.4%（83/127）比48.4%（59/122），P=0.007］、弥漫性［46.5%（59/127）比31.2%（38/122），P=0.013］以及伴有巨噬细胞聚集［44.1%（56/127）比31.2%（38/122），P=0.035］的NIH更多见，且ISNA患病率更高［83.5%（106/127）比72.1%（88/122），P=0.031］。多因素logistic回归分析结果显示，ISNA的独立相关因素为女性（OR=0.44，95%CI 0.21~0.90，P=0.026），脂质型ISNA的独立相关因素包括女性（OR=0.48，95%CI 0.23~0.99，P=0.046）及低密度脂蛋白胆固醇水平（OR=1.62，95%CI 1.01~2.59，P=0.046），而钙化型ISNA与支架置入时间（OR=1.18，95%CI 1.07~1.29，P=0.001）独立相关。 结论 支架置入>5年的DES-ISR患者ISNA患病率更高且病变更复杂。性别、低密度脂蛋白胆固醇水平及支架置入时间与ISNA、脂质型ISNA及钙化型ISNA独立相关。 Objective To investigate the characteristics of neointimal hyperplasia (NIH) in patients with in-stent restenosis (ISR) over 5 years post-drug-eluting stent (DES) implantation based on optical coherence tomography (OCT). Methods In this cross-sectional study, patients with DES-ISR who underwent OCT examination at PLA General Hospital between March 2010 and March 2022 were retrospectively included. All patients were divided into≤5 years DES-ISR group and>5 years DES-ISR group according to the time interval after DES implantation. Quantitative and qualitative analyses were conducted on OCT images to compare the clinical data and lesion characteristics of two patient groups. Furthermore, the independent clinical predictive factors of in-stent neoatherosclerosis (ISNA) were analyzed by multivariable logistic regression. Results A total of 230 DES-ISR patients with 249 lesions were included, with an age of (63.1±10.4) years and 188 males (81.7%). The median interval after DES implantation was 6 (2, 9) years. There were 117 patients (122 ISR lesions) in the≤5 years DES-ISR group, and 113 patients (127 ISR lesions) in the>5 years DES-ISR group. Compared with≤5 years DES-ISR,>5 years DES-ISR showed more heterogeneous patterns (65.4% (83/127) vs. 48.4% (59/122),P=0.007), diffuse patterns (46.5% (59/127) vs. 31.2% (38/122), P=0.013), macrophage accumulations (44.1% (56/127) vs. 31.2% (38/122), P=0.035) in NIH and higher prevalence of ISNA (83.5% (106/127) vs. 72.1% (88/122), P=0.031). According to multivariable logistic regression, the independent predictive factor for ISNA was female (OR=0.44, 95%CI 0.21-0.90, P=0.026). Female (OR=0.48, 95%CI 0.23-0.99, P=0.046) and low-density lipoprotein cholesterol level (OR=1.62, 95%CI 1.01-2.59, P=0.046) were independent predictive factors, respectively, for lipid ISNA. Calcified ISNA was independently associated with time interval of post-DES implantation (OR=1.18, 95%CI 1.07-1.29, P=0.001). Conclusion DES-ISR patients with a time interval of>5 years after stent implantation have a higher prevalence of ISNA and more complex lesions. Gender, the level of low-density lipoprotein cholesterol, and the time interval post-DES implantation are independently correlated with ISNA, lipid ISNA, and calcified ISNA.

    药物洗脱支架支架内再狭窄光学相干断层成像新生内膜增生新生动脉粥样硬化

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    妊娠早期心血管代谢风险与不良妊娠结局的深圳出生队列研究

    陈艺璇吴琳琳吴晓霞万艳梅...
    158-164页
    查看更多>>摘要：目的 探讨妊娠早期心血管代谢异常与不良妊娠结局（APO）的相关性。 方法 本研究为队列研究。入选2021年1月1日至2022年10月31日在南方医科大学附属深圳妇幼保健院招募的妊娠早期（妊娠6~13+6周）单胎孕妇。记录妊娠早期心血管代谢指标，包括体重指数（BMI）、血压、空腹血糖（FPG）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）。记录APO发生情况，包括妊娠高血压、子痫前期、妊娠期糖尿病、早产、胎儿生长受限、小于胎龄儿、胎盘早剥。妊娠早期以下指标满足1项及以上即定义为心血管代谢异常：BMI升高（BMI≥24 kg/m2）、TG升高（TG≥1.7 mmol/L）、HDL-C降低（HDL-C<1.0 mmol/L）、血压升高［收缩压≥130 mmHg（1 mmHg=0.133 kPa）和（或）舒张压≥85 mmHg］、FPG升高（FPG≥5.6 mmol/L）。将入组患者分为心血管代谢异常组和心血管代谢正常组。采用Poisson回归分析妊娠早期心血管代谢异常和APO的相关性。 结果 最终纳入14 197名孕妇，年龄（32.0±4.1）岁。心血管代谢正常组8 139名，心血管代谢异常组6 058例。心血管代谢异常组孕妇分娩孕周小，且早产、妊娠高血压、子痫前期、妊娠期糖尿病发生率较高（P均<0.05）。多因素Poisson回归分析结果显示，BMI升高（RR=1.22，95%CI 1.15~1.29）、FPG升高（RR=1.59，95%CI 1.38~1.82）、TG升高（RR=1.22，95%CI 1.13~1.31）、血压升高（RR=1.50，95%CI 1.39~1.63）是APO的独立危险因素，而HDL-C降低（RR=0.93，95%CI 0.70~1.23）不是APO的独立危险因素。血压升高（RR=5.57，95%CI 4.58~6.78）、BMI升高（RR=1.71，95%CI 1.40~2.09）、TG升高（RR=1.38，95%CI 1.10~1.74）是子痫前期的独立危险因素；FPG升高（RR=1.70，95%CI 1.45~1.99）对妊娠期糖尿病发生风险影响最大。 结论 妊娠早期血压、BMI、TG和FPG升高与APO密切相关。 Objective To investigate the relationship between cardio-metabolic abnormalities in the first trimester and adverse pregnancy outcomes (APO). Methods This cohort study recruited singleton pregnancies in the first trimester (6-13+6 weeks of gestation) from Shenzhen Maternal and Child Health Care Hospital between January 1, 2021, and October 31, 2022. Cardiometabolic markers, including body mass index (BMI), blood pressure, fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), were recorded during the first trimester. Incidence of APO, including gestational hypertension, preeclampsia, gestational diabetes mellitus, preterm birth, fetal growth restriction, small for gestational age infant, and placental abruption, was documented. Cardiovascular metabolic abnormalities in the first trimester were defined as meeting one or more of the following criteria: elevated BMI (BMI≥24 kg/m²), elevated TG (TG≥1.7 mmol/L), decreased HDL-C (HDL-C<1.0 mmol/L), elevated blood pressure (systolic pressure≥130 mmHg (1 mmHg=0.133 kPa) and/or diastolic pressure≥85 mmHg), elevated FPG (FPG≥5.6 mmol/L). Enrolled women were categorized into abnormal cardio-metabolic and normal cardio-metabolic groups. Poisson regression was employed to analyze the association between cardio-metabolic abnormalities in the first trimester and APO. Results The study included 14 197 pregnant women with an age of (32.0±4.1) years. There were 8 139 women in the normal cardio-metabolic group and 6 058 women in the abnormal cardio-metabolic group. Women with cardio-metabolic disorders in the first trimester had a younger gestational age and higher incidence rates of preterm birth, gestational hypertension, preeclampsia, and gestational diabetes mellitus (all P<0.05). In multivariable Poisson regression, elevated BMI (RR=1.22, 95%CI 1.15-1.29), elevated FPG (RR=1.59, 95%CI 1.38-1.82), elevated TG (RR=1.22, 95%CI 1.13-1.31), and elevated blood pressure (RR=1.50, 95%CI 1.39-1.63) were independent risk factors for APO, while decreased HDL-C (RR=0.93, 95%CI 0.70-1.23) was not. Elevated blood pressure (RR=5.57, 95%CI 4.58-6.78), elevated BMI (RR=1.71, 95%CI 1.40-2.09), and elevated TG (RR=1.38, 95%CI 1.10-1.74) had the greatest impact on the risk of developing preeclampsia. Elevated FPG (RR=1.70, 95%CI 1.45-1.99) had the greatest impact on the risk of gestational diabetes. Conclusions Elevated blood pressure, BMI, TG and FPG in the first trimester are closely related to APO.

    代谢妊娠并发症,心血管妊娠结局队列研究

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    定量血流分数在冠状动脉心肌桥血流动力学评估中的应用价值

    王猛范兴满王全龙曹钰琨...
    165-171页
    查看更多>>摘要：目的 探讨新一代定量血流分数（QFR）在心肌桥血流动力学评估中的应用价值以及初步探索形变定量血流分数（D-QFR）与QFR的相关性及相关因素。 方法 本研究为横断面研究。入选2012年6月至2022年6月于空军特色医学中心行冠状动脉造影检查提示单纯性心肌桥患者。采用定量冠状动脉造影测量心肌桥收缩期狭窄率及心肌桥长度。根据Nobel分级标准，将患者分为轻度狭窄组（收缩期狭窄率<50%）和中重度狭窄组（收缩期狭窄率≥50%），测量不同时相（包括收缩期和舒张期）3个位置（MCA入口前1~2 cm、MCA中间段、MCA出口后1~2 cm）的QFR数值，分别记作QFRa、QFRb、QFRc，并且记录加入血管形变信息分析的D-QFR值。将任一时相壁冠状动脉远端QFR≤0.8定义为QFR值异常。比较两组不同位置以及各组内不同位置、不同时相QFR值。采用多因素logistic回归分析QFR值异常的相关因素。采用Spearman秩相关分析D-QFR值与收缩期及舒张期QFR值的相关性。采用多元线性回归分析D-QFR的相关因素。 结果 共入选83例患者，其中男性58例，年龄（57.1±13.1）岁。轻度狭窄组48例，中重度狭窄组35例，两组收缩期及舒张期QFRb、QFRc值差异均有统计学意义（P均<0.05）。组内比较结果显示，QFRb、QFRc在收缩期的测值均低于舒张期；QFRb及QFRc均低于同期的QFRa（P均<0.05）。多因素logistic回归分析结果显示，心肌桥收缩期狭窄率（OR=1.225，95%CI 1.093~1.372，P<0.001）为QFR异常的相关因素。D-QFR值与收缩期及舒张期QFR值均呈正相关（相关系数分别为0.849、0.675，P均<0.001）。多元线性回归分析结果显示D-QFR值与年龄（β=-0.208，P=0.029）、收缩期狭窄率（β=-0.500，P<0.001）及心肌桥长度（β=-0.211，P=0.036）均呈负相关。 结论 心肌桥中远端的QFR值下降；心肌桥收缩期狭窄率为QFR值异常的重要相关因素。D-QFR与收缩期及舒张期QFR值均呈正相关；患者的年龄、收缩期狭窄率及心肌桥长度均是D-QFR值的相关因素。 Objective To explore the application value of quantitative flow ratio (QFR) in the hemodynamic evaluation of myocardial bridge and to preliminarily evaluate the correlation and related influencing factors between deformation quantitative flow ratio (D-QFR) and QFR. Methods This is a cross-sectional study. Patients with CAG-confirmed simple myocardial bridge of the middle anterior descending coronary artery from June 2012 to June 2022 at the Air Force Medical Center were retrospectively included in this study. Systolic stenosis of mural coronary arteries (MCA) and myocardial bridge length were measured using quantitative coronary angiography. The patients were divided into mild stenosis group (<50% systolic stenosis) and moderate-to-severe stenosis group (≥50% systolic stenosis) according to the Nobel grading criteria. At different time periods (systolic and diastolic), the QFR values were measured at 3 locations (1 to 2 cm before the MCA entrance, the middle segment of the MCA, and 1 to 2 cm after the MCA exit), denoted as QFRa, QFRb, and QFRc, respectively, and the D-QFR values, incorporating vessel deformation information, were recorded. The MCA distal QFR≤0.8 in either stage was defined as an abnormal QFR value. QFR values were compared between the two groups at different locations and within each group. Factors associated with abnormal QFR values were analysed using multifactorial logistic regression. Spearman rank correlation analysis was used to examine the correlation between D-QFR values and systolic and diastolic QFR values.Multiple linear regression was used to analyse the factors associated with D-QFR. Results A total of 83 patients were enrolled, including 58 males, aged (57.1±13.1) years. There were 48 cases in the mild stenosis group and 35 cases in the moderate-to-severe stenosis group, and the differences in systolic and diastolic QFRb and QFRc values between the two groups were statistically significant (all P<0.05). Within-group comparisons showed the values of QFRb and QFRc in the systolic phase were lower than those in the diastolic phase QFRb and QFRc were both lower than QFRa during the same period (allP<0.05). Multifactorial logistic regression analysis showed that MCA systolic stenosis (OR=1.225, 95%CI 1.093-1.372, P<0.001) was an influential factor for abnormal QFR. D-QFR values were positively correlated with both systolic and diastolic QFR values (correlation coefficients were 0.849 and 0.675, respectively, bothP<0.01). Multiple linear regression analysis showed that D-QFR values were negatively correlated with age (β=-0.208, P=0.029), systolic stenosis (β=-0.500, P<0.001), and myocardial bridge length (β=-0.211, P=0.036). Conclusions The QFR values in middle and distal of myocardial bridge decrease. The systolic stenosis rate of myocardial bridge is an important factor affecting QFR value. D-QFR is positively correlated with both systolic and diastolic QFR values. Age, myocardial bridge systolic stenosis rate and length are factors influencing the D-QFR values.

    心肌桥定量血流分数冠状动脉冠状动脉造影

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