Senguttuvan Nagendra Boopathy, Kumar Sharath, Lee Wang-Soo, Mishra Sundeep, Cho Jun Hwan, Kwon Jee Eun, Hyeon Seong Hyeop, Jeong Yun Sang, Won Hoyoun, Shin Seung Yong, Lee Kwang Je, Kim Tae Ho, Kim Chee Jeong, Kim Sang-Wook
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
All India Institute of Medical Sciences, New Delhi, 110029, India.
PLoS One. 2016 Nov 2;11(11):e0165885. doi: 10.1371/journal.pone.0165885. eCollection 2016.
Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability.
Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score-matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive.
Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification.
There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA).
心脏瓣膜钙化与总体冠状动脉斑块负荷相关，被认为是一个独立的心血管风险和预后因素。本研究的目的是评估瓣膜钙化的存在与斑块形态和/或易损性之间的关系。
采用经胸超声心动图评估280例接受射频血管内超声（虚拟组织学血管内超声，VH-IVUS）检查的冠心病患者的瓣膜钙化情况。对192例患者（每组n = 96）进行倾向评分匹配队列分析。薄帽纤维粥样斑块（TCFA）定义为坏死核心（NC）占斑块面积>10%，斑块负荷>40%，且NC与管腔接触≥3个图像切片。重塑指数（病变/参考血管面积）>1.05被认为是阳性。
患者分为两组：至少一个瓣膜有任何钙化（152例患者）与未检测到瓣膜钙化（128例患者）。倾向评分匹配分析后，两组在年龄、危险因素、临床诊断和血管造影分析方面相似。灰阶IVUS分析显示血管大小、斑块负荷、最小管腔面积和重塑指数相似。通过VH-IVUS，瓣膜钙化患者的NC%和致密钙（DC）%更高（分别为p = 0.024和p = 0.016）。然而，通过倾向评分匹配分析，仅在最大NC部位DC%更高（p = 0.029）。VH-TCFA的发生频率根据瓣膜钙化的复杂性（p = 0.0064）和严重程度（p = 0.013）而更高。
瓣膜钙化与VH-IVUS对TCFAs的评估之间存在显著关系。瓣膜钙化表明动脉粥样硬化疾病的复杂性更高（冠状动脉斑块钙化增加）和冠状动脉斑块更易损（VH-TCFA发生率更高）。
