Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.
Am Heart J. 2014 May;167(5):715-22. doi: 10.1016/j.ahj.2014.01.011. Epub 2014 Feb 26.
In a prospective study, we previously identified plaque disruption (PD: plaque rupture or ulceration) in 38% of women with myocardial infarction (MI) without angiographically obstructive coronary artery disease (CAD), using intravascular ultrasound (IVUS). Underlying plaque morphology has not been described in these patients and may provide insight into the mechanisms of MI without obstructive CAD.
Forty-two women with MI and <50% angiographic stenosis underwent IVUS (n = 114 vessels). Analyses were performed by a blinded core laboratory. Sixteen patients had PD (14 ruptures and 5 ulcerations in 18 vessels). Plaque area, % plaque burden, lumen area stenosis, eccentricity, and remodeling index were calculated for disrupted plaques and largest plaque by area in each vessel.
Disrupted plaques had lower % plaque burden than the largest plaque in the same vessel (31.9% vs 49.8%, P = .005) and were rarely located at the site of largest plaque (1/19). Disrupted plaques were typically fibrous and were not more eccentric or remodeled than the largest plaque in the same vessel.
Plaque disruption was often identifiable on IVUS in women with MI without obstructive CAD. Plaque disruption in this patient population occurred in fibrous or fibrofatty plaques and, contrary to expectations based on prior studies of plaque vulnerability, did not typically occur in eccentric, outwardly remodeled, or soft plaque in these patients. Plaque disruption rarely occurred at the site of the largest plaque in the vessel. These findings suggest that the pathophysiology of PD in women with MI without angiographically obstructive CAD may be different from MI with obstructive disease and requires further investigation.
在一项前瞻性研究中，我们先前使用血管内超声（IVUS）在 38%无血管造影阻塞性冠状动脉疾病（CAD）的心肌梗死（MI）女性中发现斑块破裂（PD：斑块破裂或溃疡）。这些患者的潜在斑块形态尚未描述，可能为无阻塞性 CAD 的 MI 机制提供深入了解。
42 名 MI 且血管造影狭窄<50%的女性接受了 IVUS（n=114 支血管）检查。分析由一个盲法核心实验室进行。16 名患者有 PD（18 支血管中的 14 个破裂和 5 个溃疡）。计算破裂斑块和每个血管中面积最大的斑块的斑块面积、斑块负担百分比、管腔面积狭窄、偏心度和重构指数。
破裂斑块的斑块负担百分比低于同一血管中最大斑块（31.9%比 49.8%，P=0.005），并且很少位于最大斑块所在的位置（1/19）。破裂斑块通常为纤维状，与同一血管中最大斑块相比，偏心度或重构程度并不更高。
在无阻塞性 CAD 的 MI 女性中，IVUS 通常可识别斑块破裂。在这些患者人群中，斑块破裂发生在纤维或纤维脂肪斑块中，与先前对斑块脆弱性的研究预期相反，在这些患者中，通常不会发生偏心、向外重构或软斑块。斑块破裂很少发生在血管中最大斑块的部位。这些发现表明，无血管造影阻塞性 CAD 的 MI 女性中 PD 的病理生理学可能与阻塞性疾病的 MI 不同，需要进一步研究。
