Falcão Breno A A, Falcão João Luiz A A, Morais Gustavo R, Silva Rafael C, Lopes Augusto C, Soares Paulo R, Mariani José, Kalil-Filho Roberto, Edelman Elazer R, Lemos Pedro A
Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Arq Bras Cardiol. 2015 Oct;105(4):390-8. doi: 10.5935/abc.20150098. Epub 2015 Aug 18.
Vascular remodeling, the dynamic dimensional change in face of stress, can assume different directions as well as magnitudes in atherosclerotic disease. Classical measurements rely on reference to segments at a distance, risking inappropriate comparison between dislike vessel portions.
to explore a new method for quantifying vessel remodeling, based on the comparison between a given target segment and its inferred normal dimensions.
Geometric parameters and plaque composition were determined in 67 patients using three-vessel intravascular ultrasound with virtual histology (IVUS-VH). Coronary vessel remodeling at cross-section (n = 27.639) and lesion (n = 618) levels was assessed using classical metrics and a novel analytic algorithm based on the fractional vessel remodeling index (FVRI), which quantifies the total change in arterial wall dimensions related to the estimated normal dimension of the vessel. A prediction model was built to estimate the normal dimension of the vessel for calculation of FVRI.
According to the new algorithm, "Ectatic" remodeling pattern was least common, "Complete compensatory" remodeling was present in approximately half of the instances, and "Negative" and "Incomplete compensatory" remodeling types were detected in the remaining. Compared to a traditional diagnostic scheme, FVRI-based classification seemed to better discriminate plaque composition by IVUS-VH.
Quantitative assessment of coronary remodeling using target segment dimensions offers a promising approach to evaluate the vessel response to plaque growth/regression.
血管重塑是指面对压力时血管尺寸的动态变化，在动脉粥样硬化疾病中，其可呈现不同的方向和幅度。传统测量方法依赖于对远处节段的参照，存在对不同血管部分进行不恰当比较的风险。
探索一种基于给定目标节段与其推断的正常尺寸之间比较的血管重塑量化新方法。
对67例患者使用带有虚拟组织学的三血管血管内超声（IVUS-VH）测定几何参数和斑块成分。使用经典指标和基于分数血管重塑指数（FVRI）的新型分析算法评估横截面（n = 27,639）和病变（n = 618）水平的冠状动脉血管重塑，该指数量化了与血管估计正常尺寸相关的动脉壁尺寸的总变化。建立预测模型以估计血管的正常尺寸用于计算FVRI。
根据新算法，“扩张性”重塑模式最不常见，约一半的病例存在“完全代偿性”重塑，其余病例检测到“负性”和“不完全代偿性”重塑类型。与传统诊断方案相比，基于FVRI的分类似乎能更好地通过IVUS-VH区分斑块成分。
使用目标节段尺寸对冠状动脉重塑进行定量评估为评估血管对斑块生长/消退的反应提供了一种有前景的方法。
