联合 IVUS 和 NIRS 检测纤维脂肪斑：人体冠状动脉的组织病理学验证。
Combined IVUS and NIRS detection of fibroatheromas: histopathological validation in human coronary arteries.
机构信息
Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
Cardiovascular Research Foundation, New York, New York.
出版信息
JACC Cardiovasc Imaging. 2015 Feb;8(2):184-94. doi: 10.1016/j.jcmg.2014.09.021. Epub 2015 Jan 7.
OBJECTIVES
This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).
BACKGROUND
NIRS-detected, lipid-rich plaques (LRPs) and IVUS-detected attenuated plaques are considered to be vulnerable.
METHODS
IVUS-attenuated plaque and NIRS-LRP (yellow or tan block chemogram) were compared with histopathology in 1,943 sections of 103 coronary arteries from 56 autopsied hearts.
RESULTS
IVUS-superficial attenuation and NIRS-LRP showed a similar high specificity of approximately 95%, whereas IVUS-superficial attenuation alone had a poor sensitivity (vs. NIRS-LRP) in detecting FAs (36% vs. 47%; p = 0.001). Compared with FA sections with superficial attenuation, FA sections without superficial attenuation had a smaller plaque burden (57.1% vs. 67.7%), a larger arc of calcium (79.7° vs. 16.8°), and a lower prevalence of a ≥20% histological necrotic core (28% vs. 50%) or late FA (14% vs. 37%; all p < 0.05). Compared with FA sections with NIRS-LRP, FA sections without NIRS-LRP showed a smaller plaque burden (58.0% vs. 63.3%) and a lower prevalence of a ≥20% necrotic core (27% vs. 46%). Conversely, non-FAs with NIRS-LRP (vs. non-FAs without LRP) showed a larger plaque burden (55.1% vs. 46.3%), a greater prevalence of a ≥20% histological lipid pool (34% vs. 5%), and mostly pathological intimal thickening (50%) or fibrocalcific plaque (33%). When sections showed either IVUS attenuation or NIRS-LRP, the sensitivity for predicting a FA was significantly higher compared with IVUS attenuation alone (63% vs. 36%; p < 0.001) or NIRS-LRP alone (63% vs. 47%; p < 0.001). When sections showed both IVUS attenuation and NIRS-LRP, the positive predictive value improved compared with IVUS attenuation alone (84% vs. 66%; p < 0.001) or NIRS-LRP alone (84% vs. 65%; p < 0.001).
CONCLUSIONS
NIRS-LRP was more accurate than IVUS for predicting plaque containing a necrotic core or a large lipid pool, and the combination was more accurate than either alone.
目的
本研究旨在评估灰阶血管内超声（IVUS）和近红外光谱（NIRS）检测组织学纤维脂肪瘤（FA）的能力。
背景
NIRS 检测到的富含脂质斑块（LRP）和 IVUS 检测到的衰减斑块被认为是易损斑块。
方法
将 103 例尸检心脏 1943 个节段的 IVUS 衰减斑块和 NIRS-LRP（黄色或棕褐色块化学图谱）与组织病理学进行比较。
结果
IVUS 浅层衰减和 NIRS-LRP 具有相似的高特异性（约 95%），而单独的 IVUS 浅层衰减在检测 FA 时敏感性较差（36%比 47%；p=0.001）。与浅层衰减的 FA 节段相比，无浅层衰减的 FA 节段斑块负荷较小（57.1%比 67.7%），钙弧较大（79.7°比 16.8°），组织学坏死核心≥20%的发生率较低（28%比 50%）或晚期 FA 发生率较低（14%比 37%；均 p<0.05）。与有 NIRS-LRP 的 FA 节段相比，无 NIRS-LRP 的 FA 节段斑块负荷较小（58.0%比 63.3%），坏死核心≥20%的发生率较低（27%比 46%）。相反，有 NIRS-LRP 的非 FA 斑块（与无 LRP 的非 FA 斑块相比）斑块负荷较大（55.1%比 46.3%），组织学脂质池≥20%的发生率较高（34%比 5%），主要为病理性内膜增厚（50%）或纤维钙化斑块（33%）。当节段显示 IVUS 衰减或 NIRS-LRP 时，预测 FA 的敏感性明显高于单独使用 IVUS 衰减（63%比 36%；p<0.001）或单独使用 NIRS-LRP（63%比 47%；p<0.001）。当节段同时显示 IVUS 衰减和 NIRS-LRP 时，阳性预测值与单独使用 IVUS 衰减（84%比 66%；p<0.001）或单独使用 NIRS-LRP（84%比 65%；p<0.001）相比有所提高。
结论
NIRS-LRP 比 IVUS 更能准确预测含有坏死核心或大脂质池的斑块，联合使用比单独使用更准确。
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