Konishi Takao, Kashiwagi Yusuke, Funayama Naohiro, Yamamoto Tadashi, Murakami Hironori, Hotta Daisuke, Tanaka Shinya
Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan.
Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Heart Vessels. 2019 Aug;34(8):1266-1279. doi: 10.1007/s00380-019-01363-8. Epub 2019 Feb 21.
Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD) and with an increased risk for myocardial infarction, stroke or death due to cardiovascular disease. Optical frequency-domain imaging (OFDI) is a useful modality for evaluating the characteristics of atherosclerotic plaque. The purpose of the study was to use OFDI to investigate the association of OSA with coronary plaque characteristics in patients undergoing percutaneous coronary intervention (PCI). We retrospectively analyzed OFDI data for coronary artery plaques from 15 patients with OSA and 35 non-OSA patients treated between October 2015 and October 2018. Plaque morphology was evaluated for 70 lesions, including 21 from patients with OSA and 49 from non-OSA patients. Compared with the non-OSA group, patients with OSA had significantly higher prevalences of thinned cap fibroatheroma (TCFA) (67% vs. 35%, P = 0.014) and microchannels (86% vs. 55%, P = 0.014); a significantly higher mean lipid index (1392 ± 982 vs. 817 ± 699, P = 0.021), macrophage grade (8.4 ± 6.4 vs. 4.8 ± 4.5, P = 0.030), and maximum number of microchannels (1.5 ± 1.0 vs. 0.7 ± 0.7, P = 0.001); and a significantly lower mean minimum fibrous cap thickness (69.4 ± 28.7 vs. 96.1 ± 51.8 μm, P = 0.008). This OFDI analysis suggests that OSA is associated with unstable plaque characteristics in patients with CAD. More intensive medical management for stabilization of coronary atherosclerotic plaque is required in patients with OSA.
阻塞性睡眠呼吸暂停（OSA）与冠状动脉疾病（CAD）相关，并且会增加心肌梗死、中风或心血管疾病导致死亡的风险。光学频域成像（OFDI）是评估动脉粥样硬化斑块特征的一种有用方法。本研究的目的是使用OFDI来研究接受经皮冠状动脉介入治疗（PCI）的患者中OSA与冠状动脉斑块特征之间的关联。我们回顾性分析了2015年10月至2018年10月期间接受治疗的15例OSA患者和35例非OSA患者的冠状动脉斑块的OFDI数据。对70处病变的斑块形态进行了评估，其中21处来自OSA患者，49处来自非OSA患者。与非OSA组相比，OSA患者薄帽纤维粥样瘤（TCFA）的患病率显著更高（67%对35%，P = 0.014）以及微通道的患病率显著更高（86%对55%，P = 0.014）；平均脂质指数显著更高（1392±982对817±699，P = 0.021）、巨噬细胞分级显著更高（8.4±6.4对4.8±4.5，P = 0.030）以及微通道的最大数量显著更高（1.5±1.0对0.7±0.7，P = 0.001）；并且平均最小纤维帽厚度显著更低（69.4±28.7对96.1±51.8μm，P = 0.008）。这项OFDI分析表明，OSA与CAD患者不稳定的斑块特征相关。OSA患者需要更强化的药物治疗以稳定冠状动脉粥样硬化斑块。
