Zhou Pengyu, Wang Yuting, Sun Jie, Yu Yannan, Mossa-Basha Mahmud, Zhu Chengcheng
Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Radiology, University of Washington, Seattle, WA, United States.
Front Cardiovasc Med. 2021 Oct 27;8:742935. doi: 10.3389/fcvm.2021.742935. eCollection 2021.
Statin therapy is an essential component of cardiovascular preventive care. In recent years, various vessel wall MRI (VW-MRI) techniques have been used to monitor atherosclerosis progression or regression in patients with extracranial or intracranial large-artery atherosclerosis. We aimed to perform a systematic review and meta-analysis on the effects of statin therapy on plaque evolution as assessed by VW-MRI. Prospective studies investigating carotid and intracranial atherosclerotic plaques in patients on statin therapy monitored by serial VW-MRI were systematically identified in the literature. The plaque burden and lipid-rich necrotic core (LRNC) volume of carotid plaque and the imaging features of intracranial plaques were extracted and summarized. For studies investigating carotid artery wall volume and LRNC volume, combined estimates were derived by meta-analysis. The study identified 21 studies of carotid plaque and two studies of intracranial plaque. While 16 studies investigating carotid plaques that included 780 patients by High-resolution VW-MRI were included in the meta-analysis. There was no significant change in carotid wall volume from baseline to 12 months. A significant change in LRNC volume was observed at > 12 months compared with baseline (Effect = -10.69, 95% CI = -19.11, -2.28, < 1), while no significant change in LRNC volume at 3-6 months or 7-12 months after statin therapy initiation in 6 studies. Increases in fibrous tissue and calcium and reduction in neovascularization density of the plaque were seen in 2/3 studies (including 48/59 patients), 1/3 studies (including 17/54 patients), and 2/2 studies (including 71 patients) after statin therapy, respectively. Two studies with 257 patients in intracranial atherosclerosis showed that statins could effectively decrease wall volume and plaque enhancement volume. Collective data indicated that statins could potentially stabilize carotid plaques by significantly reducing LRNC with 1 year of therapy as shown on serial carotid VW-MRI. There was no significant decrease in wall volume, which nonetheless indicated that plaque composition changes might be more sensitive to response monitoring than wall volume. It is likely that more sensitive, clinically relevant, and preferably quantitative indicators of therapeutic effects on intracranial vessel plaque morphology will be developed in the future.
他汀类药物治疗是心血管预防保健的重要组成部分。近年来，各种血管壁磁共振成像（VW-MRI）技术已被用于监测颅外或颅内大动脉粥样硬化患者的动脉粥样硬化进展或消退情况。我们旨在对他汀类药物治疗对VW-MRI评估的斑块演变的影响进行系统评价和荟萃分析。通过对文献进行系统检索，纳入前瞻性研究，这些研究采用连续VW-MRI监测接受他汀类药物治疗患者的颈动脉和颅内动脉粥样硬化斑块。提取并总结颈动脉斑块的斑块负荷和富含脂质的坏死核心（LRNC）体积以及颅内斑块的影像学特征。对于研究颈动脉壁体积和LRNC体积的研究，通过荟萃分析得出合并估计值。该研究共纳入21项关于颈动脉斑块的研究和2项关于颅内斑块的研究。其中，16项通过高分辨率VW-MRI研究颈动脉斑块的研究（共780例患者）被纳入荟萃分析。从基线到12个月，颈动脉壁体积无显著变化。与基线相比，在>12个月时观察到LRNC体积有显著变化（效应=-10.69，95%CI=-19.11，-2.28，P<0.01），而在他汀类药物治疗开始后的3-6个月或7-12个月，6项研究中LRNC体积无显著变化。在2/3的研究（包括48/59例患者）、1/3的研究（包括17/54例患者）和2/2的研究（包括71例患者）中，他汀类药物治疗后分别观察到斑块纤维组织和钙增加以及新生血管密度降低。两项针对257例颅内动脉粥样硬化患者的研究表明，他汀类药物可有效降低血管壁体积和斑块强化体积。汇总数据表明，如连续颈动脉VW-MRI所示，他汀类药物通过1年治疗显著减少LRNC，可能使颈动脉斑块稳定。血管壁体积虽无显著减少，但这表明斑块成分变化可能比血管壁体积对反应监测更敏感。未来可能会开发出对颅内血管斑块形态治疗效果更敏感、与临床相关且最好是定量的指标。
