Heart Centre, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
Eur Heart J Cardiovasc Imaging. 2014 Aug;15(8):908-16. doi: 10.1093/ehjci/jeu033. Epub 2014 Mar 11.
The optimal management of asymptomatic subjects at intermediate risk of coronary artery disease (CAD) is often uncertain. Re-stratification to a high- or low-risk category may enable optimization of preventative strategies. Coronary computed tomographic angiography (CCTA) enables a minimally invasive assessment of coronary artery plaque quantity and composition. Non-calcified plaque by CCTA is lipid-rich and more vulnerable to rupture and resultant acute coronary syndromes. The purpose of this study was to determine whether novel approaches to CAD risk stratification, such as plasma lipid profiling, may predict non-calcified plaque burden in intermediate risk subjects.
CCTA and several markers of CAD (including plasma lipid profiling, carotid intima-media thickness, aortic pulse wave velocity, and high-sensitivity C-reactive protein) were prospectively performed in 100 asymptomatic patients at intermediate CAD risk according to the Framingham risk score. Segment stenosis scores (SSS) were calculated to evaluate the burden of total, calcified, and non-calcified coronary artery plaque. Non-calcified plaque was observed in 66 subjects and 158 (11%) of 1425 coronary artery segments. Eighteen lipid species demonstrated significant associations with non-calcified plaque burden, but not with total plaque or calcified plaque burden. No other marker of CAD was found to predict coronary artery plaque burden.
Plasma lipidomic analysis can predict the burden of non-calcified coronary plaque in asymptomatic subjects at intermediate risk of CAD. Re-stratification of these patients by plasma lipid profiling may enable more appropriate and effective primary prevention management strategies.
对于处于冠状动脉疾病（CAD）中等风险的无症状患者，其最佳管理方案通常并不明确。重新分层为高风险或低风险类别可能会优化预防策略。冠状动脉计算机断层扫描血管造影（CCTA）可对冠状动脉斑块数量和成分进行微创评估。CCTA 检测到的非钙化斑块富含脂质，更容易破裂并导致急性冠状动脉综合征。本研究旨在确定 CAD 风险分层的新方法（如血脂谱分析）是否可预测中等风险患者的非钙化斑块负担。
根据弗雷明汉风险评分，对 100 名处于 CAD 中等风险的无症状患者进行前瞻性 CCTA 和几项 CAD 标志物（包括血脂谱分析、颈动脉内膜中层厚度、主动脉脉搏波速度和高敏 C 反应蛋白）检测。计算节段狭窄评分（SSS）以评估总、钙化和非钙化冠状动脉斑块的负担。在 66 名患者和 1425 个冠状动脉节段中的 158 个（11%）中观察到非钙化斑块。有 18 种脂质种类与非钙化斑块负担显著相关，但与总斑块或钙化斑块负担无关。其他 CAD 标志物均未发现可预测冠状动脉斑块负担。
血浆脂质组学分析可预测 CAD 中等风险无症状患者的非钙化冠状动脉斑块负担。通过血浆脂质谱分析对这些患者进行重新分层可能会使更合适和有效的一级预防管理策略成为可能。
