Nakajima Akihiro, Araki Makoto, Minami Yoshiyasu, Soeda Tsunenari, Yonetsu Taishi, McNulty Iris, Lee Hang, Nakamura Sunao, Jang Ik-Kyung
Cardiology Division and.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Am J Cardiol. 2022 Feb 1;164:27-33. doi: 10.1016/j.amjcard.2021.10.026. Epub 2021 Nov 21.
Recently, layered plaque, an optical coherence tomography equivalent of healed plaque, has been gaining attention. However, detailed layered plaque characteristics including the burden of plaque layer have not been investigated. Patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of culprit lesion were included. Layer index, a product of the mean layer arc and layer length, was correlated with the pattern of layer and culprit pathology. In addition, layer index was compared between culprit and nonculprit plaques. Finally, predictors for greater layer index were identified using general linear modeling. In 349 patients, 99 culprit plaques had layered phenotype (28.4%), whereas among 465 nonculprit plaques, 165 had layered pattern (35.5%). Layer index was greater in multilayer pattern versus single-layer pattern (1,688.5 vs 996.6, p <0.001), interrupted layer phenotype versus intact layer phenotype (1,276.5 vs 646.8, p <0.001), rupture versus erosion at culprit lesion (1,191.0 vs 861.8, p <0.001), and culprit versus nonculprit plaque (1,475.6 vs 983.4, p <0.001). The general linear modeling revealed that multilayer pattern (regression coefficient b [B] 7.332, p <0.001), interrupted layer phenotype (B 4.624, p <0.001), culprit lesion (B 2.792, p = 0.001), lipid-rich plaque (B 1.953, p = 0.032), and culprit plaque rupture (B: 1.943, p = 0.008) were the significant predictors for greater layer index. In conclusion, layer index (burden of layered plaque) was greater in multilayer pattern, interrupted layer phenotype, at culprit plaque, lipid-rich plaque, and in cases with culprit plaque rupture.
最近，分层斑块，一种光学相干断层扫描中相当于愈合斑块的表现，已受到关注。然而，包括斑块层负担在内的详细分层斑块特征尚未得到研究。纳入了对罪犯病变进行干预前光学相干断层扫描成像的急性冠状动脉综合征患者。层指数，即平均层弧长与层长度的乘积，与层的模式及罪犯病变病理相关。此外，还比较了罪犯斑块和非罪犯斑块的层指数。最后，使用一般线性模型确定了层指数较高的预测因素。在349例患者中，99个罪犯斑块具有分层表型（28.4%），而在465个非罪犯斑块中，165个具有分层模式（35.5%）。多层模式的层指数高于单层模式（1688.5对996.6，p<0.001），中断层表型高于完整层表型（1276.5对646.8，p<0.001），罪犯病变处破裂高于糜烂（1191.0对861.8，p<0.001），罪犯斑块高于非罪犯斑块（1475.6对983.4，p<0.001）。一般线性模型显示，多层模式（回归系数b[B]7.332，p<0.001）、中断层表型（B 4.624，p<0.001）、罪犯病变（B 2.792，p = 0.001）、富含脂质斑块（B 1.953，p = 0.032）和罪犯斑块破裂（B: 1.943，p = 0.008）是层指数较高的显著预测因素。总之，多层模式、中断层表型、罪犯斑块、富含脂质斑块以及罪犯斑块破裂时的层指数（分层斑块负担）较高。
