Yamamoto Myong Hwa, Yamashita Kennosuke, Matsumura Mitsuaki, Fujino Akiko, Ishida Masaru, Ebara Seitarou, Okabe Toshitaka, Saito Shigeo, Hoshimoto Koichi, Amemiya Kisaki, Yakushiji Tadayuki, Isomura Naoei, Araki Hiroshi, Obara Chiaki, McAndrew Thomas, Ochiai Masahiko, Mintz Gary S, Maehara Akiko
From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.).
Circ Cardiovasc Imaging. 2017 Sep;10(9). doi: 10.1161/CIRCIMAGING.117.006347.
Optical coherence tomographic (OCT) morphologies associated with lesion progression are not well studied. The aim of this study was to determine the morphological change for untreated lesion progression using both OCT and intravascular ultrasound (IVUS).
We used baseline and 8-month follow-up 3-vessel OCT and IVUS to assess 127 nonculprit lesions (IVUS plaque burden ≥40%) in 45 patients with stable angina after target lesion treatment. Lesion progression was defined as an IVUS lumen area decrease >0.5 mm. A layered pattern was identified as a superficial layer that had a different optical intensity and a clear demarcation from underlying plaque. Lesion progression was observed in 19% (24/127) lesions, and its pattern was characterized into 3 types: type I, new superficial layered pattern at follow-up that was not present at baseline (n=9); type II, a layered pattern at baseline whose layer thickness increased at follow-up (n=7); or type III, no layered pattern at baseline or follow-up (n=8). The increase of IVUS plaque+media area was largest in type I and least in type III (1.9 mm [1.6-2.1], 1.1 mm [0.9-1.4], and 0.3 mm [-0.2 to 0.8], respectively; =0.002). Type III, but not types I or II, showed negative remodeling during follow-up (IVUS vessel area; from 14.3 mm [11.4-17.2] to 13.5 mm [10.4-16.7]; =0.02). OCT lipidic plaque was associated with lesion progression (odds ratio, 13.6; 95% confidence interval, 3.7-50.6; <0.001).
Lesion progression was categorized to distinct OCT morphologies that were related to changes in plaque mass or vessel remodeling.
与病变进展相关的光学相干断层扫描（OCT）形态尚未得到充分研究。本研究的目的是使用OCT和血管内超声（IVUS）来确定未经治疗的病变进展的形态学变化。
我们使用基线和8个月随访时的三支血管OCT和IVUS，对45例稳定型心绞痛患者在靶病变治疗后的127处非罪犯病变（IVUS斑块负荷≥40%）进行评估。病变进展定义为IVUS管腔面积减少>0.5平方毫米。分层模式被确定为具有不同光学强度且与下层斑块有清晰分界的表层。19%（24/127）的病变观察到有病变进展，其模式分为3种类型：I型，随访时出现新的表层分层模式，基线时不存在（n=9）；II型，基线时存在分层模式，随访时层厚度增加（n=7）；或III型，基线或随访时均无分层模式（n=8）。IVUS斑块+中膜面积的增加在I型中最大，在III型中最小（分别为1.9平方毫米[1.6-2.1]、1.1平方毫米[0.9-1.4]和0.3平方毫米[-0.2至0.8]；P=0.002）。III型，而非I型或II型，在随访期间显示负性重塑（IVUS血管面积；从14.3平方毫米[11.4-17.2]降至13.5平方毫米[10.4-16.7]；P=0.02）。OCT脂质斑块与病变进展相关（比值比，13.6；95%置信区间，3.7-50.6；P<0.001）。
病变进展可分为不同的OCT形态，这些形态与斑块质量或血管重塑的变化有关。
