Liu Feng-Ju, Chen Qing, Cheng Yi
Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Quant Imaging Med Surg. 2024 Jan 3;14(1):316-324. doi: 10.21037/qims-23-621. Epub 2023 Nov 13.
The risk factors for coronary and carotid plaque development are consistent. Coronary plaque rupture is a major cause of adverse cardiovascular events. Ultrasound can evaluate vulnerable carotid plaques and provide information for predicting vulnerable coronary plaques identified by optical coherence tomography (OCT). This study aimed to investigate the predictive role of non-invasive carotid ultrasound in OCT diagnosis of atherosclerotic vulnerable plaque.
A total of 70 participants, including 35 patients with and 35 without vulnerable coronary plaque, were enrolled in this case-control study at Beijing Anzhen Hospital from 2016 to 2021. The data of 70 patients with suspected coronary heart disease who had undergone OCT examination during percutaneous coronary intervention (PCI) surgery and completed carotid ultrasound examination within 3 days before PCI were analyzed retrospectively. According to the OCT diagnostic criteria for vulnerable plaques, the patients were divided into the vulnerable-plaque group and the stable-plaque group. Univariate and binary logistic regression analyses assessed risk factors for vulnerable coronary plaque. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive power of carotid plaque features.
The univariate analysis demonstrated that the differences in high-sensitivity C-reactive protein levels and carotid plaque characteristics (irregular fibrous cap, heterogeneous plaque, hypoechoic plaque, plaque calcification, and a plaque thickness of greater than 3 mm) between the two groups were statistically significant. The logistic multivariate regression analysis revealed that an irregular fibrous cap of a carotid plaque [odds ratio (OR) =4.819; 95% confidence interval (CI): 1.106-22.867; P=0.048] and a hypoechoic plaque (OR =9.632; 95% CI: 2.138-43.384; P<0.05) were independent risk factors for predicting vulnerable plaques of the coronary artery.
Noninvasive carotid ultrasound is feasible and clinically valuable for predicting vulnerable and asymptomatic coronary plaques defined by OCT. With this method, adverse events can be diagnosed and treated in advance.
冠状动脉和颈动脉斑块形成的危险因素是一致的。冠状动脉斑块破裂是不良心血管事件的主要原因。超声可评估易损颈动脉斑块，并为预测光学相干断层扫描（OCT）识别的易损冠状动脉斑块提供信息。本研究旨在探讨非侵入性颈动脉超声在OCT诊断动脉粥样硬化易损斑块中的预测作用。
2016年至2021年，在北京安贞医院进行的这项病例对照研究共纳入70名参与者，其中35例有易损冠状动脉斑块，35例无易损冠状动脉斑块。回顾性分析70例疑似冠心病患者的数据，这些患者在经皮冠状动脉介入治疗（PCI）手术期间接受了OCT检查，并在PCI前3天内完成了颈动脉超声检查。根据OCT对易损斑块的诊断标准，将患者分为易损斑块组和稳定斑块组。单因素和二元逻辑回归分析评估冠状动脉易损斑块的危险因素。采用受试者操作特征（ROC）曲线分析来确定颈动脉斑块特征的预测能力。
单因素分析表明，两组之间高敏C反应蛋白水平和颈动脉斑块特征（不规则纤维帽、不均匀斑块、低回声斑块、斑块钙化以及斑块厚度大于3mm）的差异具有统计学意义。逻辑多因素回归分析显示，颈动脉斑块的不规则纤维帽[比值比（OR）=4.819；95%置信区间（CI）：1.106-22.867；P=0.048]和低回声斑块（OR =9.632；95%CI：2.138-43.384；P<0.05）是预测冠状动脉易损斑块的独立危险因素。
非侵入性颈动脉超声对于预测由OCT定义的易损和无症状冠状动脉斑块是可行的且具有临床价值。通过这种方法，可以提前诊断和治疗不良事件。
