不对称二甲基精氨酸与光学相干断层成像评估的支架内再狭窄组织特征的相关性。
Association between asymmetric dimethylarginine and in-stent restenosis tissue characteristics assessed by optical coherence tomography.
机构信息
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan, ROC.
Division of Cardiology, Chia-Yi & Wan-Qiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
出版信息
Int J Cardiol. 2019 Aug 15;289:131-137. doi: 10.1016/j.ijcard.2019.05.003. Epub 2019 May 3.
BACKGROUND
Impaired bioavailability of endothelium-derived nitric oxide (NO) and endothelial dysfunction may play a pivotal role in the pathogenesis of in-stent restenosis (ISR) after coronary stenting. We aimed to investigate the relation between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and the ISR lesions tissue characteristics assessed by optical coherence tomography (OCT).
METHODS AND RESULTS
Forty-five patients with symptomatic ISR lesions (17 bare metal stents, 28 drug-eluting stents, medium implantation duration: 58.0 months) were evaluated by OCT for in-stent tissue characteristics and calcification. We defined neoatherosclerosis as the presence of lipid or calcified neointima in ISR lesions, and 12 (26.7%), 33 (73.3%) ISR lesions were classified as with homogenous neointima and neoatherosclerosis respectively. The patients with neoatherosclerosis have significantly higher plasma ADMA levels compared to those of patients with homogenous neointima (1.12 ± 0.21 μmol/l versus 0.83 ± 0.08 μmol/l, p < 0.001). Furthermore, the plasma ADMA level of ISR lesions with intra-stent calcification (n = 24, 53.3%) was also significantly higher than those of ISR lesions without (n = 21, 46.7%; p < 0.001). There was a highly significant association between plasma ADMA level and intra-stent relative calcium index (mean calcium arc × calcium length)/(360 × analyzed length) (p < 0.001, r = 0.702). In multivariate analyses adjusted for age, sex, diabetes, eGFR, plasma ADMA level remained the only significant predictor for the presence of neoatherosclerosis (p = 0.008) and intra-stent calcification (p < 0.001). In contrast, plasma ADMA level correlated with intra-stent relative lipid core index (mean lipid core arc × lipid core length)/(360 × analyzed length) only in subgroup without intra-stent calcification (p = 0.004, r = 0.596, multivariate-adjusted p = 0.022).
CONCLUSIONS
Increased plasma ADMA levels were associated with the development of in-stent neoatherosclerosis and calcification.
背景
血管内皮衍生的一氧化氮（NO）生物利用度受损和内皮功能障碍可能在冠状动脉支架置入后支架内再狭窄（ISR）的发病机制中起关键作用。我们旨在研究内源性一氧化氮合酶抑制剂不对称二甲基精氨酸（ADMA）与光学相干断层扫描（OCT）评估的 ISR 病变组织特征之间的关系。
方法和结果
45 例有症状的 ISR 病变患者（17 例裸金属支架，28 例药物洗脱支架，中位植入时间：58.0 个月）通过 OCT 评估支架内组织特征和钙化情况。我们将新内膜中的脂质或钙化定义为 ISR 病变中的新动脉粥样硬化，并将 12 例（26.7%）、33 例（73.3%）ISR 病变分别归类为具有同质新内膜和新动脉粥样硬化。与同质新内膜患者相比，新动脉粥样硬化患者的血浆 ADMA 水平明显升高（1.12±0.21μmol/L 比 0.83±0.08μmol/L，p<0.001）。此外，支架内钙化的 ISR 病变患者（n=24，53.3%）的血浆 ADMA 水平也明显高于无支架内钙化的 ISR 病变患者（n=21，46.7%；p<0.001）。血浆 ADMA 水平与支架内相对钙指数（平均钙弧×钙长度）/（360×分析长度）之间存在高度显著相关性（p<0.001，r=0.702）。在调整年龄、性别、糖尿病、eGFR 等因素的多变量分析中，血浆 ADMA 水平仍然是新动脉粥样硬化（p=0.008）和支架内钙化（p<0.001）存在的唯一显著预测因素。相反，在没有支架内钙化的亚组中，血浆 ADMA 水平与支架内相对脂质核心指数（平均脂质核心弧×脂质核心长度）/（360×分析长度）相关（p=0.004，r=0.596，多变量调整后 p=0.022）。
结论
血浆 ADMA 水平升高与支架内新动脉粥样硬化和钙化的发展有关。
Zotero 插件