Demirkıran Ahmet, Çakır Ozan, Atıcı Adem, Aslanger Emre, Akdeniz Cansu, Umman Berrin, Umman Sabahattin, Bugra Zehra, Sezer Murat
Department of Cardiology, Istanbul University Faculty of Medicine, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2017 Oct;45(7):606-613. doi: 10.5543/tkda.2017.94493.
The histological characteristics of plaque may affect the hemodynamic outcome of a given coronary stenosis. In particular, the potential effect of volumetric calcium content and the topographical distribution in the lesion segment on physiological outcome has not yet been investigated. The aim of this study was to identify any potential correlation between patterns of calcification and the fractional flow reserve (FFR) and the coronary remodeling index (RMI).
A total of 26 stable angina pectoris and 34 acute coronary syndrome patients without persistent ST-segment elevation constituted the study population. FFR was used to assess 70 intermediate coronary stenosis lesions. After obtaining hemodynamic measurements, quantitative grayscale and virtual histology-intravascular ultrasound analyses were performed. The depth, length, and circumferential distribution of calcification of the lesions were also recorded.
Within the analyzed segment (area of interest, lesion segment), FFR was correlated with maximal thickness of deep calcification (r=-0.285; p=0.021) and calcification angle (r=-0.396; p=0.001). In lesions with a calcification angle >180°, the mean FFR value was significantly lower compared with those <180° (0.64±0.17 vs. 0.78±0.08; p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437; p<0.001) and deep (r=0.425; p<0.001) calcification. RMI was correlated with maximal thickness of superficial (r=-0.357; p=0.003) and deep (r=0.417; p<0.001) calcification. RMI was also correlated with FFR (r=-0.477; p<0.001).
This study demonstrated that the geometry, location, and amount of calcification of a plaque could affect hemodynamic and anatomical outcome measures in functionally significant stenoses by affecting vessel wall compliance.
斑块的组织学特征可能会影响特定冠状动脉狭窄的血流动力学结果。特别是，病变节段中钙含量的体积以及地形分布对生理结果的潜在影响尚未得到研究。本研究的目的是确定钙化模式与血流储备分数（FFR）和冠状动脉重构指数（RMI）之间是否存在任何潜在关联。
共有26例稳定型心绞痛患者和34例无持续性ST段抬高的急性冠状动脉综合征患者构成了研究人群。使用FFR评估70处中度冠状动脉狭窄病变。在获得血流动力学测量值后，进行了定量灰度和虚拟组织学-血管内超声分析。还记录了病变钙化的深度、长度和周向分布。
在分析节段（感兴趣区域，病变节段）内，FFR与深部钙化的最大厚度（r = -0.285；p = 0.021）和钙化角度（r = -0.396；p = 0.001）相关。在钙化角度>180°的病变中，平均FFR值显著低于<180°的病变（0.64±0.17对0.78±0.08；p = 0.024）。RMI与浅表（r = -0.437；p<0.001）和深部（r = 0.425；p<0.001）钙化的最大角度相关。RMI与浅表（r = -0.357；p = 0.003）和深部（r = 0.417；p<0.001）钙化的最大厚度相关。RMI也与FFR相关（r = -0.477；p<0.001）。
本研究表明，斑块钙化的几何形状、位置和数量可通过影响血管壁顺应性来影响功能上有意义的狭窄的血流动力学和解剖学结果指标。
