Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Heart. 2018 Sep;104(17):1439-1446. doi: 10.1136/heartjnl-2017-312579. Epub 2018 Mar 1.
Coronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.
33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12-18 months (n=520 segments).
Lipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (-0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: -3.03, 95% CI (-5.81 to -0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).
Epicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.
ACTRN12612000594820, Post-results.
已经证明，冠状动脉舒张功能与动脉粥样硬化斑块进展均与不良心血管事件相关。然而，这些因素与冠状动脉斑块脂质负担之间的关系尚不清楚。本实验重点研究了使用双模态血管内超声（IVUS）和近红外光谱（NIRS）成像技术，检测舒张功能障碍（内皮依赖性（沙丁胺醇）和内皮非依赖性（硝酸甘油））与动脉粥样硬化斑块进展和脂质负担的自然史之间的关系。
33 例稳定型胸痛或急性冠状动脉综合征患者接受了冠状动脉舒张功能和冠状动脉内斑块 IVUS 和 NIRS 成像的连续评估。在基线和 12-18 个月的间隔时间（n=520 个节段）测量了节段性大血管反应（%变化节段管腔容积（ΔSLV））、斑块负担（斑块体积百分比（PAV））、脂质核心（富含脂质斑块（LRP）和脂质核心负担指数（LCBI））。
在研究期间发展为富含脂质斑块的脂质阴性冠状动脉节段，其内皮依赖性功能受损（-0.24±2.96％对 5.60±1.47％，P=0.04）和内皮非依赖性功能受损（13.91±4.45％对 21.19±3.19％，P=0.036）。多变量分析显示，内皮依赖性功能预测 ΔLCBI（β系数：-3.03，95％CI（-5.81 至-0.25），P=0.033），而内皮非依赖性功能预测 ΔPAV（β系数：0.07，95％CI（0.04 至 0.10），P<0.0001）。
无论临床表现如何，心外膜冠状动脉舒张功能都是未来动脉粥样硬化进展和成分的决定因素。
ACTRN12612000594820，Post-results。
