Fujii Kenichi, Mintz Gary S, Carlier Stéphane G, Costa Jose di Ribamar, Kimura Masashi, Sano Koichi, Tanaka Kaoru, Costa Ricardo A, Lui Joanna, Stone Gregg W, Moses Jeffrey W, Leon Martin B
The Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
Am J Cardiol. 2006 Aug 15;98(4):429-35. doi: 10.1016/j.amjcard.2006.03.020. Epub 2006 Jun 19.
Angiographic studies have shown that lesions preceding nonfatal acute events are usually not hemodynamically significant. This has led to the concept that plaque ruptures occur at minimal disease sites. We used intravascular ultrasound to create a prerupture "profile" of unstable (vulnerable) plaques. We analyzed 112 ruptured plaques detected by intravascular ultrasound. Reference and lesion external elastic membrane (EEM) and lumen areas were measured to calculate prerupture estimates of plaque area, plaque burden (plaque/EEM area), eccentricity, area stenosis, and remodeling. The narrowest coefficients of variance were for lesion EEM area, maximum plaque thickness, and plaque burden, reference lumen area, and remodeling index (coefficients of variance 0.29, 0.25, 0.12, 0.29, and 0.18, respectively); conversely, there was great variability in measurements of calcification and lumen compromise (minimum lumen area and area stenosis). When using the 5 variables with the narrowest coefficient of variance, we found that 67% of ruptured plaques fit all of following 10th or 90th percentile parameters (> 14.3 mm2 lesion EEM area, > 8.1 mm2 reference lumen area, > 1.6 mm maximum lesion plaque thickness, > 0.63 lesion plaque burden, and > 0.87 remodeling index). Further, 89% of ruptured plaques fit 4 of 5 parameters and 96% fit 3 of 5 parameters. In conclusion, plaque ruptures do not occur at minimal disease sites. Rather, vulnerable (rupture-prone) plaques predictably have significant plaque accumulation and remodeling and occur in larger arteries. It is only the degree of lumen compromise that is variable and often insignificant.
血管造影研究表明，非致命性急性事件之前的病变通常在血流动力学上并不显著。这导致了斑块破裂发生在疾病程度最轻部位的概念。我们使用血管内超声来创建不稳定（易损）斑块破裂前的“特征”。我们分析了通过血管内超声检测到的112个破裂斑块。测量了参考部位和病变部位的外弹力膜（EEM）及管腔面积，以计算斑块面积、斑块负荷（斑块/EEM面积）、偏心度、面积狭窄和重塑的破裂前估计值。病变EEM面积、最大斑块厚度、斑块负荷、参考管腔面积和重塑指数的方差系数最窄（分别为0.29、0.25、0.12、0.29和0.18）；相反，钙化和管腔狭窄（最小管腔面积和面积狭窄）的测量存在很大变异性。当使用方差系数最窄的5个变量时，我们发现67%的破裂斑块符合以下所有第10或第90百分位数参数（病变EEM面积>14.3mm²，参考管腔面积>8.1mm²,最大病变斑块厚度>1.6mm，病变斑块负荷>0.63，重塑指数>0.87）。此外，89%的破裂斑块符合5个参数中的4个，96%符合5个参数中的3个。总之，斑块破裂并非发生在疾病程度最轻的部位。相反，易损（易破裂）斑块可预测地具有显著的斑块积聚和重塑，且发生在较大动脉中。只有管腔狭窄程度是可变的，且通常不显著。
