Dohi Tomotaka, Maehara Akiko, Moreno Pedro R, Baber Usman, Kovacic Jason C, Limaye Atul M, Ali Ziad A, Sweeny Joseph M, Mehran Roxana, Dangas George D, Xu Ke, Sharma Samin K, Mintz Gary S, Kini Annapoorna S
Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA.
Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
Eur Heart J Cardiovasc Imaging. 2015 Jan;16(1):81-7. doi: 10.1093/ehjci/jeu169. Epub 2014 Sep 4.
To evaluate the relationship between lipid content and plaque morphometry as well as the process of lesion progression and regression in patients with significant coronary artery disease.
The present study, using data from the YELLOW trial, was conducted in patients having significant coronary lesions (fractional flow reserve <0.8) who underwent serial intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) at baseline and after 7 weeks. For each coronary plaque (≥50% plaque burden that was ≥5 mm in length), we evaluated plaque characteristics and the extent of lipid-rich plaque [LRP, defined as the 4 mm long segment with the maximum lipid-core burden index (maxLCBI4 mm)] on NIRS. Among 66 patients (age 63.0 ± 10.1 years; 82% statin use at baseline), 94 plaques were identified. The extent of LRP at baseline was positively correlated with IVUS plaque burden (r = 0.317, P = 0.002). A large LRP (maxLCBI4 mm ≥500) was present only in plaques with a large plaque burden (≥70%). Multivariate analysis demonstrated that plaque burden was the best predictor of the extent of LRP (P < 0.001). In lesions with a large plaque burden and a large amount of LRP at baseline, a reduction in LRP was seen in all lesions in patients receiving intensive statin therapy (P = 0.004) without a significant change in plaque burden.
Coronary lesions containing a large amount of LRP also had a large plaque burden. Short-term regression of LRP (without a change in plaque burden) was observed mainly in plaques with a large plaque burden and a large amount of LRP at baseline.
http://www.clinicaltrials.gov. Unique identifier: NCT01567826.
评估冠状动脉疾病患者脂质含量与斑块形态学之间的关系，以及病变进展和消退过程。
本研究利用黄色试验的数据，对有显著冠状动脉病变（血流储备分数<0.8）的患者进行，这些患者在基线和7周后接受了系列血管内超声（IVUS）和近红外光谱（NIRS）检查。对于每个冠状动脉斑块（斑块负荷≥50%且长度≥5 mm），我们在NIRS上评估斑块特征和富含脂质斑块[LRP，定义为脂质核心负荷指数（maxLCBI4 mm）最大的4 mm长节段]的范围。在66例患者（年龄63.0±10.1岁；基线时82%使用他汀类药物）中，共识别出94个斑块。基线时LRP的范围与IVUS斑块负荷呈正相关（r = 0.317，P = 0.002）。仅在斑块负荷大（≥70%）的斑块中存在大的LRP（maxLCBI4 mm≥500）。多变量分析表明，斑块负荷是LRP范围的最佳预测指标（P < 0.001）。在基线时斑块负荷大且LRP量大的病变中，接受强化他汀类治疗的患者所有病变的LRP均有降低（P = 0.004），而斑块负荷无显著变化。
含有大量LRP的冠状动脉病变也有大的斑块负荷。主要在基线时斑块负荷大且LRP量大的斑块中观察到LRP的短期消退（斑块负荷无变化）。
