Cardiovascular Research Foundation, New York, New York 10022, USA.
J Am Coll Cardiol. 2010 Apr 13;55(15):1590-7. doi: 10.1016/j.jacc.2009.07.078.
We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology.
Plaque stability is related to its histological composition.
We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden >or=40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque.
At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs "healed," 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm(2) [8.2 to 10.7 mm(2)] vs. 6.9 mm(2) [6.0 to 8.2 mm(2)], p = 0.021), vessel (18.7 mm(2) [17.3 to 28.6 mm(2)] vs. 15.5 mm(2) [13.3 to 16.6 mm(2)]; p = 0.010), and plaque (9.7 mm(2) [9.6 to 15.7 mm(2)] vs. 8.4 mm(2) [7 to 9.7 mm(2)], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm(2) [6.2 to 10.0 mm(2)] to 9.0 mm(2) [6.5 to 12.0 mm(2)], p < 0.001), VH-TCFAs (8.6 mm(2) [7.3 to 9.9 mm(2)] to 9.5 mm(2) [7.8 to 10.8 mm(2)], p = 0.024), and ThCFAs (8.6 mm(2) [6.8 to 10.2 mm(2)] to 8.8 mm(2) [7.1 to 11.4 mm(2)], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque.
Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.
我们使用虚拟组织学血管内超声（VH-IVUS）来研究冠状动脉病变形态的自然史。
斑块稳定性与其组织学组成有关。
我们对 99 例患者的 216 个非罪犯病变（斑块负担≥40%）进行了连续（基线和 12 个月随访）VH-IVUS 研究，并对其进行了检查。病变分为病理性内膜增厚（PIT）、VH-IVUS 衍生的薄帽纤维粥样瘤（VH-TCFA）、厚帽纤维粥样瘤（ThCFA）、纤维斑块和纤维钙化斑块。
基线时有 20 个病变为 VH-TCFAs；随访期间，15 个（75%）VH-TCFAs“愈合”，13 个成为 ThCFAs，2 个成为纤维斑块，5 个（25%）VH-TCFAs保持不变。与愈合的 VH-TCFAs 相比，仍为 VH-TCFAs 的病变位于更近端（数值为中位数[四分位数范围]）（16mm[15-18mm] vs. 31mm[22-47mm]，p=0.013），管腔更大（9.1mm2[8.2-10.7mm2] vs. 6.9mm2[6.0-8.2mm2]，p=0.021），血管（18.7mm2[17.3-28.6mm2] vs. 15.5mm2[13.3-16.6mm2]，p=0.010）和斑块（9.7mm2[9.6-15.7mm2] vs. 8.4mm2[7-9.7mm2]，p=0.027）面积也更大；然而，愈合的 VH-TCFAs 和未愈合的 VH-TCFAs 的基线 VH-IVUS 斑块组成没有差异。相反，又出现了 12 个新的 VH-TCFAs；其中 6 个新发的 VH-TCFAs 为 PIT，6 个为基线时的 ThCFA。此外，PIT 最小管腔部位的斑块面积显著增加（7.8mm2[6.2-10.0mm2]至 9.0mm2[6.5-12.0mm2]，p<0.001），VH-TCFAs（8.6mm2[7.3-9.9mm2]至 9.5mm2[7.8-10.8mm2]，p=0.024）和 ThCFAs（8.6mm2[6.8-10.2mm2]至 8.8mm2[7.1-11.4mm2]，p<0.001），同时管腔面积减小，但纤维或纤维钙化斑块则没有。
大多数 VH-TCFAs 在 12 个月的随访中愈合，而新的 VH-TCFAs 也在发展。与纤维和纤维钙化斑块相比，PIT、VH-TCFAs 和 ThCFAs 显示出明显的斑块进展。
