OCT 和 IVUS 评价的薄帽纤维粥样斑块特征。
Plaque characteristics of thin-cap fibroatheroma evaluated by OCT and IVUS.
机构信息
Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
出版信息
JACC Cardiovasc Imaging. 2011 Jun;4(6):638-46. doi: 10.1016/j.jcmg.2011.03.014.
OBJECTIVES
The purpose of this study was to assess plaque characteristics of optical coherence tomography (OCT)-derived thin-cap fibroatheroma (TCFA) by integrated backscatter intravascular ultrasound (IB-IVUS).
BACKGROUND
Radiofrequency signal-derived IVUS tissue characterization technology has become clinically available and provided objective and quantitative plaque characteristics of the coronary vessel wall. Integrated backscatter IVUS is one of the tissue characterization methods that can possibly provide quantitative plaque characteristics of the OCT-derived TCFA.
METHODS
Eighty-one coronary lesions with plaque burden >40% were selected and analyzed with both IB-IVUS and OCT. The OCT-derived TCFA was defined as a presence of thin fibrous cap (<65 μm) overlying a signal-poor lesion with diffuse border representing a lipid-rich plaque. By conventional gray-scale IVUS, external elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, plaque plus media (P+M) CSA, plaque burden and remodeling index were measured. By IB-IVUS, plaque characteristics were further classified as fibrosis, dense fibrosis, calcification, or lipid pool.
RESULTS
Optical coherence tomography identified 40 TCFAs (49%) and 41 non-TCFAs. The EEM CSA, P+M CSA, plaque burden, and remodeling index were significantly larger in OCT-derived TCFA than non-TCFA. By IB-IVUS, percentage lipid pool area (= lipid pool area/P+M CSA × 100) was significantly higher (62.4 ± 12.8% vs. 38.4 ± 13.1%, p<0.0001) and percentage fibrosis area (= fibrosis area/P+M CSA × 100) was significantly lower (34.6 ± 11.4% vs. 50.5 ± 8.7%, p<0.0001) in OCT-derived TCFA than non-TCFA. By receiver-operator characteristic curve analysis, percentage lipid pool area ≥55%, percentage fibrosis area ≤41%, and remodeling index ≥1.0 were predictors of OCT-derived TCFA.
CONCLUSIONS
The OCT-derived TCFA had larger plaque burden and positive remodeling with predominant lipid component and less fibrous plaque assessed by IB-IVUS.
目的
本研究旨在通过血管内超声（IVUS）的背向散射积分（IB-IVUS）评估光学相干断层扫描（OCT）检测到的薄帽纤维粥样斑块（TCFA）的斑块特征。
背景
射频信号衍生的 IVUS 组织特征分析技术已在临床上得到应用，并提供了冠状动脉血管壁的客观和定量斑块特征。背向散射积分 IVUS 是一种可能提供 OCT 检测到的 TCFA 的定量斑块特征的组织特征分析方法之一。
方法
选择 81 个斑块负荷>40%的冠状动脉病变，并分别用 IB-IVUS 和 OCT 进行分析。OCT 检测到的 TCFA 定义为薄纤维帽（<65μm）覆盖信号差的病变，边界弥漫代表富含脂质的斑块。通过传统灰阶 IVUS 测量外膜腔横截面积（EEM CSA）、管腔 CSA、斑块加中膜 CSA（P+M CSA）、斑块负荷和重构指数。通过 IB-IVUS，进一步将斑块特征分为纤维化、致密纤维化、钙化或脂质池。
结果
OCT 识别出 40 个 TCFA（49%）和 41 个非 TCFA。OCT 检测到的 TCFA 的 EEM CSA、P+M CSA、斑块负荷和重构指数均明显大于非 TCFA。通过 IB-IVUS，脂质池面积百分比（=脂质池面积/P+M CSA×100）明显更高（62.4±12.8% vs. 38.4±13.1%，p<0.0001），纤维化面积百分比（=纤维化面积/P+M CSA×100）明显更低（34.6±11.4% vs. 50.5±8.7%，p<0.0001）。通过受试者工作特征曲线分析，脂质池面积百分比≥55%、纤维化面积百分比≤41%和重构指数≥1.0 是 OCT 检测到的 TCFA 的预测指标。
结论
与非 TCFA 相比，OCT 检测到的 TCFA 的斑块负荷更大，正性重构，脂质成分占主导地位，纤维化斑块较少，通过 IB-IVUS 评估。
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