Matsuzawa Yasushi, Hibi Kiyoshi, Saka Kenichiro, Konishi Masaaki, Akiyama Eiichi, Nakayama Naoki, Ebina Toshiaki, Kosuge Masami, Iwahashi Noriaki, Maejima Nobuhiko, Tamura Kouichi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan,
Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Ther Clin Risk Manag. 2019 Feb 15;15:285-291. doi: 10.2147/TCRM.S184457. eCollection 2019.
Thinning of the fibrous cap of atherosclerotic plaque is a major component of plaque vulnerability. The high resolution of optical coherence tomography (OCT) provides an accurate measurement of fibrous-cap thickness. Endothelial dysfunction is associated with inflammation and enhanced local expression of matrix metalloproteinases. We investigated the association between endothelial dysfunction and OCT-derived thin-cap fibroatheroma (TCFA) in patients with acute coronary syndromes (ACS).
Seventy-four patients with ACS, who underwent both OCT examinations of the culprit lesion before percutaneous coronary intervention and peripheral endothelial function assessment as assessed by logarithmic value of reactive hyperemia index (Ln_RHI), were enrolled. Age-, sex-, hypertension-, and diabetes-matched non-coronary artery disease (non-CAD) patients were also enrolled (n=15).
Ln_RHI levels were significantly lower in ACS patients compared with non-CAD patients (0.56±0.26 vs 0.74±0.22, =0.01). Furthermore, the Ln_RHIs of ACS patients with TCFA (n=44) were significantly lower than those of ACS patients without TCFA (n=30) (0.50±0.24 vs 0.65±0.26, =0.01). There was a weak but significant positive correlation between Ln_RHI and fibrous-cap thickness (Spearman's =0.25, =0.03). Multivariate logistic regression analysis identified lower Ln_RHI as an independent factor associated with TCFA in ACS patients (OR per 0.1 increase in Ln_RHI: 0.78 [95% CI: 0.62-0.98], =0.03).
Advanced endothelial dysfunction significantly correlates with a thin fibrous cap of coronary plaques in patients with ACS.
动脉粥样硬化斑块纤维帽变薄是斑块易损性的主要组成部分。光学相干断层扫描（OCT）的高分辨率可准确测量纤维帽厚度。内皮功能障碍与炎症及基质金属蛋白酶局部表达增强有关。我们研究了急性冠状动脉综合征（ACS）患者内皮功能障碍与OCT衍生的薄帽纤维粥样斑块（TCFA）之间的关联。
纳入74例ACS患者，这些患者在经皮冠状动脉介入治疗前对罪犯病变进行了OCT检查，并通过反应性充血指数的对数值（Ln_RHI）评估了外周内皮功能。还纳入了年龄、性别、高血压和糖尿病匹配的非冠状动脉疾病（非CAD）患者（n = 15）。
与非CAD患者相比，ACS患者的Ln_RHI水平显著降低（0.56±0.26 vs 0.74±0.22，P = 0.01）。此外，患有TCFA的ACS患者（n = 44）的Ln_RHI显著低于没有TCFA的ACS患者（n = 30）（0.50±0.24 vs 0.65±0.26，P = 0.01）。Ln_RHI与纤维帽厚度之间存在微弱但显著的正相关（Spearman相关系数= 0.25，P = 0.03）。多因素逻辑回归分析确定较低的Ln_RHI是ACS患者中与TCFA相关的独立因素（Ln_RHI每增加0.1的比值比：0.78 [95% CI：0.62 - 0.98]，P = 0.03）。
在ACS患者中，严重的内皮功能障碍与冠状动脉斑块的薄纤维帽显著相关。
