多模态心血管磁共振定量评估冠心病患者血管结构和功能的区域性变化：与冠状动脉疾病严重程度的关系。
Multimodal cardiovascular magnetic resonance quantifies regional variation in vascular structure and function in patients with coronary artery disease: relationships with coronary disease severity.
机构信息
Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
出版信息
J Cardiovasc Magn Reson. 2011 Oct 21;13(1):61. doi: 10.1186/1532-429X-13-61.
BACKGROUND
Cardiovascular magnetic resonance (CMR) of the vessel wall is highly reproducible and can evaluate both changes in plaque burden and composition. It can also measure aortic compliance and endothelial function in a single integrated examination. Previous studies have focused on patients with pre-identified carotid atheroma. We define these vascular parameters in patients presenting with coronary artery disease and test their relations to its extent and severity.
METHODS AND RESULTS
100 patients with CAD [single-vessel (16%); two-vessel (39%); and three-vessel (42%) non-obstructed coronary arteries (3%)] were studied. CAD severity and extent was expressed as modified Gensini score (mean modified score 12.38 ± 5.3). A majority of carotid plaque was located in the carotid bulb (CB). Atherosclerosis in this most diseased segment correlated modestly with the severity and extent of CAD, as expressed by the modified Gensini score (R = 0.251, P < 0.05). Using the AHA plaque classification, atheroma class also associated with CAD severity (rho = 0.26, P < 0.05). The distal descending aorta contained the greatest plaque, which correlated with the degree of CAD (R = 0.222; P < 0.05), but with no correlation with the proximal descending aorta, which was relatively spared (R = 0.106; P = n. s.). Aortic distensibility varied along its length with the ascending aorta the least distensible segment. Brachial artery FMD was inversely correlated with modified Gensini score (R = -0.278; P < 0.05). In multivariate analysis, distal descending aorta atheroma burden, distensibility of the ascending aorta, carotid atheroma class and FMD were independent predictors of modified Gensini score.
CONCLUSIONS
Multimodal vascular CMR shows regional abnormalities of vascular structure and function that correlate modestly with the degree and extent of CAD.
背景
心血管磁共振（CMR）血管壁具有高度可重复性，可评估斑块负担和成分的变化。它还可以在单次综合检查中测量主动脉顺应性和内皮功能。先前的研究集中在已确定颈动脉粥样硬化的患者。我们在患有冠状动脉疾病的患者中定义这些血管参数，并测试它们与疾病程度和严重程度的关系。
方法和结果
研究了 100 例 CAD 患者[单支血管病变（16%）；两支血管病变（39%）；三支血管病变（42%）和非阻塞性冠状动脉病变（3%）]。CAD 严重程度和范围表示为改良 Gensini 评分（平均改良评分 12.38 ± 5.3）。大多数颈动脉斑块位于颈动脉窦（CB）。该最易患病节段的动脉粥样硬化与改良 Gensini 评分（R = 0.251，P < 0.05）所表示的 CAD 严重程度和范围呈中度相关。使用 AHA 斑块分类，动脉粥样硬化斑块分类也与 CAD 严重程度相关（rho = 0.26，P < 0.05）。降主动脉远段含有最大的斑块，与 CAD 程度相关（R = 0.222；P < 0.05），但与近端降主动脉无关，近端降主动脉相对不受影响（R = 0.106；P =无意义）。主动脉顺应性沿其长度变化，升主动脉的顺应性最低。肱动脉 FMD 与改良 Gensini 评分呈负相关（R = -0.278；P < 0.05）。在多变量分析中，降主动脉远段粥样斑块负荷、升主动脉顺应性、颈动脉粥样斑块分类和 FMD 是改良 Gensini 评分的独立预测因子。
结论
多模态血管 CMR 显示血管结构和功能的区域性异常，与 CAD 的程度和范围中度相关。
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