Challa Karthik K, Kansal Mayank M, Frazin Leon, Nikanorov Alex, Kohler Robert, Martinsen Brad J, Vidovich Mladen I
Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.
Division of Cardiology, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.
Catheter Cardiovasc Interv. 2018 May 1;91(6):1092-1100. doi: 10.1002/ccd.27247. Epub 2017 Aug 24.
Coronary arteries are exposed to several complex biomechanical forces during the cardiac cycle. These biomechanical forces potentially contribute to both native coronary artery disease, development of atherosclerosis and eventual stent failure. The aim of the present study was to characterize and define coronary artery axial rotation and the effect of stent implantation on this biomechanical factor.
Intravascular ultrasound (IVUS) images were obtained from porcine coronary arteries and analyzed in ultrasound analysis software used to evaluate myocardial strain and torsion in echocardiography. In this study the software was utilized for a novel application to evaluate coronary artery rotation and time-to-peak (TTP) rotation in porcine coronary arteries. Clockwise (CW) and counterclockwise (CCW) rotation of coronary arteries during the cardiac cycle and (TTP) rotation were measured.
A total of 11 (4 LAD, 4 LCX, 3 RCA) coronary artery segments were independently analyzed pre- and post-stent implantation for a total of 22 IVUS runs. CW and CCW rotation and TTP varied widely within coronary artery segments and between different coronary arteries. Stent implantation impacted degree, direction and TTP of coronary rotation. Measurement reliability was assessed and the intraclass correlation coefficient for maximum average CCW was 0.990 (95% confidence interval 0.980-0.996, P < 0.0001), indicating excellent agreement.
Coronary arteries display wide spectrum of CW and CCW rotation during the cardiac cycle. Coronary stents impact the degree and direction of coronary artery rotation. The implications of these findings on development of atherosclerosis and stent failure require further investigation.
在心动周期中，冠状动脉会受到多种复杂的生物力学力作用。这些生物力学力可能在原发性冠状动脉疾病、动脉粥样硬化的发展以及最终的支架失效中都起到作用。本研究的目的是描述和定义冠状动脉的轴向旋转以及支架植入对这一生物力学因素的影响。
从猪冠状动脉获取血管内超声（IVUS）图像，并在用于评估超声心动图中心肌应变和扭转的超声分析软件中进行分析。在本研究中，该软件被用于一项新的应用，以评估猪冠状动脉的旋转和峰值时间（TTP）旋转。测量心动周期中冠状动脉的顺时针（CW）和逆时针（CCW）旋转以及（TTP）旋转。
共对11个（4个左前降支、4个左旋支、3个右冠状动脉）冠状动脉节段在支架植入前后进行了独立分析，共进行了22次IVUS检查。冠状动脉节段内以及不同冠状动脉之间，CW和CCW旋转以及TTP差异很大。支架植入影响冠状动脉旋转的程度、方向和TTP。评估了测量可靠性，最大平均CCW的组内相关系数为0.990（95%置信区间0.980 - 0.996，P < 0.0001），表明一致性极佳。
在心动周期中，冠状动脉呈现出广泛的CW和CCW旋转范围。冠状动脉支架会影响冠状动脉旋转的程度和方向。这些发现对动脉粥样硬化发展和支架失效的影响需要进一步研究。
