Heart and Vascular Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the University of Kiel), Am Kurpark 1, Bad Segeberg, Germany.
J Cardiovasc Med (Hagerstown). 2010 May;11(5):345-51. doi: 10.2459/JCM.0b013e328333ebb2.
Patients with diabetes mellitus are known to be at increased risk for acute cardiovascular events. We used intravascular ultrasound virtual histology (IVUS-VH) to examine whether nonobstructive coronary artery lesions of diabetic patients have distinct plaque composition and morphology compared with nondiabetic patients.
A total of 41 patients (13 diabetic and 28 nondiabetic) with proximally located angiographically nonobstructive coronary lesions were prospectively enrolled. In addition to plaque geometry, IVUS-VH lesion evaluation of the fibrous, fibro-fatty, necrotic core and calcified plaque components was performed. An IVUS-derived thin-cap fibroatheroma (IDTCFA) was defined as a lesion with a confluent necrotic core of at least 10% lumen cross-sectional area without evident overlying fibrous tissue and a plaque atheroma volume of at least 40% in at least three consecutive frames.
Coronary artery lesions of diabetic and nondiabetic patients had similar plaque geometry. Lesions of diabetic patients were more likely to be positively remodeled than those of nondiabetic patients (67 vs. 27%, respectively, P = 0.02). Plaques of diabetic patients had significantly higher necrotic core percentages (23.3 +/- 6.1 vs. 17.1 +/- 8.7%, P = 0.03) and lower fibro-fatty tissue percentages (8 +/- 5 vs. 14.2 +/- 7.5%, P = 0.01) than those of nondiabetic patients. In addition, IDTCFAs were significantly more prevalent at the minimal lumen area site of diabetic patients compared to nondiabetic patients (92 vs. 54%, respectively, P = 0.02). After adjustment for various confounders, diabetes mellitus remained as the only independent clinical predictor of IDTCFAs at the minimal lumen area site [odds ratio (OR) 9.43, 95% confidence interval (CI) 1.06-84.04, P = 0.04].
Nonobstructive coronary artery lesions of diabetic patients have distinct compositional and morphological features, suggesting that these differences may explain the increased likelihood of coronary events in diabetic patients.
已知糖尿病患者发生急性心血管事件的风险增加。我们使用血管内超声虚拟组织学（IVUS-VH）检查糖尿病患者的非阻塞性冠状动脉病变是否与非糖尿病患者的斑块成分和形态有明显不同。
共纳入 41 名（糖尿病 13 名，非糖尿病 28 名）近端血管造影非阻塞性冠状动脉病变患者。除斑块几何形状外，还进行 IVUS-VH 病变评估，包括纤维、纤维脂肪、坏死核心和钙化斑块成分。血管内超声衍生的薄帽纤维粥样瘤（IDTCFA）定义为管腔横截面积至少 10%有融合性坏死核心，无明显纤维组织覆盖，至少三个连续帧中斑块粥样瘤体积至少 40%的病变。
糖尿病和非糖尿病患者的冠状动脉病变具有相似的斑块几何形状。糖尿病患者的病变更可能呈正性重构，而非糖尿病患者的病变更可能呈负性重构（分别为 67%和 27%，P = 0.02）。糖尿病患者的斑块中坏死核心的百分比显著更高（23.3 ± 6.1%比 17.1 ± 8.7%，P = 0.03），纤维脂肪组织的百分比显著更低（8 ± 5%比 14.2 ± 7.5%，P = 0.01）。此外，与非糖尿病患者相比，糖尿病患者的最小管腔面积处 IDTCFA 的发生率明显更高（分别为 92%和 54%，P = 0.02）。在校正各种混杂因素后，糖尿病仍然是最小管腔面积处 IDTCFA 的唯一独立临床预测因子[比值比（OR）9.43，95%置信区间（CI）1.06-84.04，P = 0.04]。
糖尿病患者的非阻塞性冠状动脉病变具有明显的组成和形态特征，提示这些差异可能解释了糖尿病患者发生冠状动脉事件的可能性增加。
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