Hong Young Joon, Mintz Gary S, Kim Sang Wook, Lee Sung Yun, Kim Seok Yeon, Okabe Teruo, Pichard Augusto D, Satler Lowell F, Waksman Ron, Kent Kenneth M, Suddath William O, Weissman Neil J
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, DC 20010, USA.
J Am Coll Cardiol. 2009 Apr 14;53(15):1257-64. doi: 10.1016/j.jacc.2008.12.048.
We used serial intravascular ultrasound (IVUS) to assess disease progression in nonintervened saphenous vein graft (SVG) segments to determine the natural rate of disease progression in SVG.
There are no serial IVUS studies of disease progression or luminal compromise in SVGs.
We assessed serial (baseline and follow-up at 16.2 +/- 7.4 months) IVUS findings in 50 nonintervened SVG segments in 44 patients. The SVG age was 13.5 +/- 3.6 years.
Overall, from baseline to follow-up, plaque area increased (Delta = +0.58 +/- 1.25 mm(2), p = 0.003), and SVG and minimum lumen area (MLA) decreased (Delta = -0.50 +/- 1.14 mm(2), p = 0.002, and Delta = -1.08 +/- 1.28 mm(2), p < 0.001, respectively). The MLA decreased in 34 lesions (Delta = -1.67 +/- 1.08 mm(2)), and MLA increased in 16 lesions (Delta = +0.19 +/- 0.47 mm(2)). Compared with lesions with an increase in MLA, lesions with a decrease in MLA were associated with: 1) larger baseline SVG and plaque areas and plaque burden (15.57 +/- 3.90 mm(2) vs. 11.55 +/- 2.30 mm(2), p < 0.001; 7.97 +/- 3.77 mm(2) vs. 4.27 +/- 1.92 mm(2), p < 0.001; and 48.7 +/- 14.2% vs. 36.0 +/- 13.4%, p = 0.004, respectively); and 2) a greater decrease in SVG area (Delta = -0.96 +/- 1.05 mm(2) vs. +0.48 +/- 0.58 mm(2), p < 0.001) and greater increase in plaque area (Delta = +0.71 +/- 1.47 mm(2) vs. +0.29 +/- 0.45 mm(2), p < 0.001). The DeltaMLA correlated with both Deltaplaque area (r = -0.589, p < 0.001) and DeltaSVG area (r = 0.470, p = 0.001), and Deltaplaque area correlated with DeltaSVG area (r = 0.436, p = 0.002). There were linear relations between both the Deltaplaque area (r = 0.519, p < 0.001) and Deltalumen area (r = -0.500, p < 0.001) versus follow-up low-density lipoprotein (LDL) cholesterol; a follow-up LDL cholesterol of 100 mg/dl predicted no plaque increase.
Lumen loss in nonintervened SVG segments correlated with an increase in plaque area and a decrease in SVG area (plaque growth and negative remodeling) with a linear relationship between plaque growth versus follow-up LDL cholesterol leading to long-term lumen loss.
我们使用连续血管内超声（IVUS）评估未干预的大隐静脉移植血管（SVG）节段的疾病进展情况，以确定SVG疾病进展的自然速率。
目前尚无关于SVG疾病进展或管腔狭窄的连续IVUS研究。
我们评估了44例患者中50个未干预的SVG节段的连续IVUS结果（基线及16.2±7.4个月的随访）。SVG的使用时间为13.5±3.6年。
总体而言，从基线到随访，斑块面积增加（Δ=+0.58±1.25mm²，p=0.003），SVG及最小管腔面积（MLA）减小（Δ=-0.50±1.14mm²，p=0.002，及Δ=-1.08±1.28mm²，p<0.001）。34个病变的MLA减小（Δ=-1.67±1.08mm²），16个病变的MLA增加（Δ=+0.19±0.47mm²）。与MLA增加的病变相比，MLA减小的病变与以下因素相关：1）更大的基线SVG及斑块面积和斑块负荷（分别为15.57±3.90mm²对11.55±2.30mm²，p<0.001；7.97±3.77mm²对4.27±1.92mm²，p<0.001；及48.7±14.2%对36.0±13.4%，p=0.004）；2）SVG面积更大的减小（Δ=-0.96±1.05mm²对+0.48±0.58mm²，p<0.001）及斑块面积更大的增加（Δ=+0.71±1.47mm²对+0.29±0.45mm²，p<0.001）。ΔMLA与Δ斑块面积（r=-0.589，p<0.001）及ΔSVG面积（r=0.470，p=0.001）均相关，且Δ斑块面积与ΔSVG面积相关（r=0.436，p=0.002）。Δ斑块面积（r=0.519，p<0.001）及Δ管腔面积（r=-0.500，p<0.001）与随访低密度脂蛋白（LDL）胆固醇之间均存在线性关系；随访LDL胆固醇为100mg/dl时预测斑块无增加。
未干预的SVG节段的管腔丢失与斑块面积增加及SVG面积减小（斑块生长和负性重塑）相关，斑块生长与随访LDL胆固醇之间呈线性关系，导致长期管腔丢失。
