Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland.
Department of Social and Preventive Medicine, Clinical Trials Unit, Institute of Social and Preventive Medicine, Bern University Hospital, 3012 Bern, Switzerland.
Eur Heart J Cardiovasc Imaging. 2021 Jun 22;22(7):824-834. doi: 10.1093/ehjci/jez318.
We assessed morphological features of near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
IVUS-NIRS and OCT were performed in the two non-infarct-related arteries (non-IRAs) in patients undergoing percutaneous coronary intervention for treatment of an acute coronary syndrome. A lesion was defined as the 4 mm segment with the maximum amount of lipid core burden index (maxLCBI4mm) of each LRP detected by NIRS. We divided the lesions into three groups based on the maxLCBI4mm value: <250, 250-399, and ≥400. OCT analysis and IVUS analysis were performed blinded for NIRS. We measured fibrous cap thickness (FCT) by using a semi-automated method. A total of 104 patients underwent multimodality imaging of 209 non-IRAs. NIRS detected 299 LRPs. Of those, 41% showed a maxLCBI4mm <250, 39% a maxLCBI4mm 251-399, and 19% a maxLCBI4mm ≥400. LRPs with a maxLCBI4mm ≥400, as compared with LRPs with a maxLCBI4mm 250-399 and <250, were more frequently thin-cap fibroatheroma (TCFA) (42.1% vs. 5.1% and 0.8%; P < 0.001) with a smaller minimum FCT (80 μm vs. 110 μm and 120 μm; P < 0.001); a higher IVUS-derived percent atheroma volume (53% vs. 53% and 44%; P < 0.001) and a higher remodelling index (1.08 vs. 1.02 and 1.01; P < 0.001). MaxLCBI4mm correlated with OCT-derived FCT (r = 0.404; P < 0.001) and was the best predictor for TCFA with an optimal cut-off value of 401 (area under the curve = 0.882; P < 0.001).
LRPs with increasing maxLCBI4mm exhibit OCT and IVUS features of presumed plaque vulnerability including TCFA morphology, increased plaque burden, and positive remodelling.
我们通过光学相干断层扫描（OCT）和血管内超声（IVUS）评估近红外光谱（NIRS）检测到的富含脂质斑块（LRP）的形态特征。
对接受经皮冠状动脉介入治疗急性冠状动脉综合征的患者的两条非梗死相关动脉（非 IRA）进行 IVUS-NIRS 和 OCT 检查。根据 NIRS 检测到的每个 LRP 的脂质核心负荷指数（LCBI）最大值（maxLCBI4mm），将病变定义为 4mm 段。我们根据 maxLCBI4mm 值将病变分为三组：<250、250-399 和≥400。OCT 分析和 IVUS 分析对 NIRS 结果进行了盲法评估。我们使用半自动方法测量纤维帽厚度（FCT）。共对 209 条非 IRA 进行了多模态成像，NIRS 检测到 299 个 LRP。其中，41%的 maxLCBI4mm <250，39%的 maxLCBI4mm 251-399，19%的 maxLCBI4mm≥400。与 maxLCBI4mm 250-399 和<250 的 LRP 相比，maxLCBI4mm≥400 的 LRP 更常出现薄帽纤维粥样斑块（TCFA）（42.1%比 5.1%和 0.8%；P<0.001），FCT 最小（80μm 比 110μm 和 120μm；P<0.001）；IVUS 检测到的动脉粥样斑块体积百分比（53%比 53%和 44%；P<0.001）和重构指数（1.08 比 1.02 和 1.01；P<0.001）更高。MaxLCBI4mm 与 OCT 衍生的 FCT 相关（r=0.404；P<0.001），并且是 TCFA 的最佳预测因子，最佳截断值为 401（曲线下面积=0.882；P<0.001）。
maxLCBI4mm 逐渐增加的 LRP 具有 OCT 和 IVUS 特征，提示斑块易损性，包括 TCFA 形态、斑块负荷增加和正性重构。
