Kubiak Grzegorz M, Pociask Elżbieta, Wańha Wojciech, Dobrolińska Magdalena, Gąsior Paweł, Smolka Grzegorz, Ochała Andrzej, Gąsior Zbigniew, Wojakowski Wojciech, Roleder Tomasz
Department of Cardiac Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
Krakow Cardiovascular Research Institute, Jagiellonian University Medical College, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2018;14(2):157-166. doi: 10.5114/aic.2018.76407. Epub 2018 Jun 19.
Coronary artery bypass grafting (CABG), although widely used for a long time in diffuse coronary artery disease (CAD), has serious limitations associated with graft aging and its degeneration.
The relationship between saphenous vein graft (SVG) plaque morphology assessed by optical coherence tomography (OCT) and clinical findings has not been elucidated yet.
We compared the morphology of SVG in stenotic vs. non-stenotic lesions using OCT imaging in 29 patients hospitalized in our center within the OCTOPUS registry.
Stenotic lesions were characterized by higher incidence of thin-cap fibroatheroma (TCFA) (33% vs. 0%, = 0.0048), thrombus (28% vs. 0%, = 0.0008), lipid-rich plaque (LRP) (75% vs. 35%, = 0.0013) and plaque within the SVG valve (19% vs. 0%, = 0.0114) as compared to non-stenotic lesions. Patients with intimal tearing or rupture (ITR) were older (75.8% vs. 68.9 years, = 0.047) and had lower left ventricular ejection fraction (LVEF) (32.0% vs. 49.7%, = 0.001) and glomerular filtration rate (GFR) (36.0 vs. 73.6 ml/min/1.73 m, = 0.010). Patients with calcified lesions vs. those without had lower high-density lipoprotein (HDL) cholesterol (33.2 vs. 44.1 mg/dl, = 0.018), similarly to those with ruptured plaque vs. those without (28.3 vs. 41.7 mg/dl, = 0.047).
Presence of ITR was associated with advanced age, decreased LVEF and renal insufficiency. Decreased concentration of HDL was associated with higher occurrence of calcified and ruptured plaque.
冠状动脉旁路移植术（CABG）虽然长期广泛应用于弥漫性冠状动脉疾病（CAD），但与移植血管老化及其退变相关的严重局限性。
光学相干断层扫描（OCT）评估的大隐静脉移植血管（SVG）斑块形态与临床结果之间的关系尚未阐明。
在我们中心登记的章鱼研究中，我们使用OCT成像比较了29例住院患者狭窄性病变与非狭窄性病变中SVG的形态。
与非狭窄性病变相比，狭窄性病变的特征是薄帽纤维粥样瘤（TCFA）发生率更高（33%对0%，P = 0.0048）、血栓发生率更高（28%对0%，P = 0.0008）、富含脂质斑块（LRP）发生率更高（75%对35%，P = 0.0013）以及SVG瓣膜内斑块发生率更高（19%对0%，P = 0.0114）。内膜撕裂或破裂（ITR）患者年龄更大（75.8岁对68.9岁，P = 0.047），左心室射血分数（LVEF）更低（32.0%对49.7%，P = 0.001），肾小球滤过率（GFR）更低（36.0对73.6 ml/min/1.73 m²，P = 0.010）。有钙化病变的患者与无钙化病变的患者相比，高密度脂蛋白（HDL）胆固醇更低（33.2对44.1 mg/dl，P = 0.018），有破裂斑块的患者与无破裂斑块的患者相比情况类似（28.3对41.7 mg/dl，P = 0.047）。
ITR的存在与高龄、LVEF降低和肾功能不全相关。HDL浓度降低与钙化和破裂斑块的更高发生率相关。
