Liu Hui-Liang, Zhang Jiao, Ma Dong-Xing, Luo Jian-Ping, Yang Sheng-Li, Han Wei, Liu Ying, Jing Li-Min, Meng Rong-Ying
Department of Cardiology, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
Chin Med J (Engl). 2009 Mar 20;122(6):622-6.
Unheralded sudden death and acute myocardial infarction are common manifestations of coronary atherosclerosis. Such events are related to thrombotic occlusion at the site of non-flow limiting atherosclerotic plaques in epicardial coronary arteries. This study aimed to assess plaque characterization of nonculprit lesions in patients with acute coronary syndrome (ACS) compared with those with stable angina pectoris (SAP) determined by analysis of intravascular ultrasound (IVUS) radiofrequency (RF) data.
In 81 patients, nonculprit vessels with < 50% diameter stenosis and nontarget segment of culprit vessels with < 50% diameter stenosis were studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software.
Mean lipid core percentage was significantly higher in patients with ACS than in those with SAP ((25.78 +/- 6.30)% vs (9.11 +/- 4.90)%, P < 0.001). In addition, patients with SAP showed more fibrotic vessels ((59.66 +/- 16.87)% vs (49.07 +/- 10.20)%, P < 0.001). There was no significant difference in either mean calcium ((4.37 +/- 2.40)% vs (5.12 +/- 3.00)%, P = 0.225) or fibrolipid ((24.94 +/- 9.40)% vs (25.82 +/- 13.60)%, P = 0.731) percentages in nonculprit vessels, but the mean calcium percentage was significantly higher in nontarget lesions of culprit vessels ((5.51 +/- 3.29)% vs (3.57 +/- 2.10)%, P = 0.003). In addition, there was a positive correlation between lipid core and remodeling index (RI) (r = 0.847, P < 0.001) and a negative correlation between fibrous tissue and RI (r = -0.946, P < 0.001).
In this study, in both nonculprit vessels and nontarget lesion of culprit vessels, plaque characterization of nonculprit lesions determined by spectral analysis of IVUS RF data was significantly different in patients with ACS. The percentage of lipid core was significantly higher in patients with ACS than in those with SAP. Conversely, SAP patients showed more fibrotic content. In vivo plaque composition and morphological changes were related to remodeling of the coronary artery tree.
不明原因的猝死和急性心肌梗死是冠状动脉粥样硬化的常见表现。此类事件与心外膜冠状动脉非血流限制性动脉粥样硬化斑块部位的血栓形成性闭塞有关。本研究旨在通过血管内超声（IVUS）射频（RF）数据分析，评估急性冠状动脉综合征（ACS）患者与稳定型心绞痛（SAP）患者非罪犯病变的斑块特征。
对81例患者的直径狭窄<50%的非罪犯血管以及直径狭窄<50%的罪犯血管的非靶病变节段进行IVUS研究。使用IVUS-虚拟组织学软件从RF数据重建组织图。
ACS患者的平均脂质核心百分比显著高于SAP患者（（25.78±6.30）%对（9.11±4.90）%，P<0.001）。此外，SAP患者的纤维化血管更多（（59.66±16.87）%对（49.07±10.20）%，P<0.001）。非罪犯血管的平均钙含量（（4.37±2.40）%对（5.12±3.00）%，P = 0.225）或纤维脂质含量（（24.94±9.40）%对（25.82±13.60）%，P = 0.731）均无显著差异，但罪犯血管非靶病变中的平均钙含量显著更高（（5.51±3.29）%对（3.57±2.10）%，P = 0.003）。此外，脂质核心与重构指数（RI）呈正相关（r = 0.847，P<0.001），纤维组织与RI呈负相关（r = -0.946，P<0.001）。
在本研究中，无论是非罪犯血管还是罪犯血管的非靶病变，通过IVUS RF数据频谱分析确定的非罪犯病变的斑块特征在ACS患者中均有显著差异。ACS患者的脂质核心百分比显著高于SAP患者。相反，SAP患者的纤维化成分更多。体内斑块组成和形态变化与冠状动脉树的重构有关。
