炎症介导急性冠脉综合征患者心脏代谢指数与易损斑块之间的关系。

Inflammation mediates the relationship between cardiometabolic index and vulnerable plaque in patients with acute coronary syndrome.

作者信息

Yan Haihao, Lv Sai, Pi Haiyao, Yu Haixu, Yin Weijun, Wang Yaran, Lan Yonghao, Liu Wei

机构信息

Department of Cardiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.

出版信息

Lipids Health Dis. 2025 May 28;24(1):194. doi: 10.1186/s12944-025-02608-4.

DOI:10.1186/s12944-025-02608-4

PMID:40437601

Abstract

BACKGROUND

As a novel indicator reflecting metabolic status and visceral adiposity distribution, the cardiometabolic index (CMI) has gained attention in cardiovascular risk stratification. This investigation employed optical coherence tomography (OCT) to examine potential associations between CMI and vulnerable plaque, as well as the role of inflammation.

METHODS

This study conducted a cross-sectional analysis of 270 acute coronary syndrome (ACS) patients who had OCT imaging evaluation. Patients were categorized based on CMI tertiles, with CMI calculated using the formula [waist (cm)/height (cm)]×[triglycerides (mmol/L)/HDL-C (mmol/L)]. OCT was used to assess plaque events in culprit lesions and plaque components in non-culprit lesions, and inflammatory markers were measured. A mediation analysis framework was implemented to investigate inflammatory pathways in CMI-vulnerable plaque relationships.

RESULTS

CMI tertiles were linked to vulnerable plaque traits: thin-cap fibroatheromas (TCFA), macrophages (Tertiles1 vs. Tertiles2 vs. Tertiles3, TCFA: 10.0% vs. 20.0% vs. 26.7%, P = 0.016; macrophages: 17.8% vs. 28.9% vs. 36.7%, P = 0.019). Multivariate regression demonstrated CMI elevation independently predicted a higher prevalence of TCFA (OR:1.40, 95%CI: 1.25-2.89, P = 0.003), more macrophage infiltration (OR:1.61, 95% CI:1.09-2.37, P = 0.017), reduced FCT (β:-30.65, 95% CI:-50.72-10.57, P = 0.003), and enlarged maximum lipid arc (β:20.78, 95% CI:6.55-35.01, P = 0.004). Moreover, CMI was positively related to hsCRP, WBC, and neutrophils. Mediation analysis revealed that hsCRP mediated about 17.0% of the association between CMI and minimum FCT [Indirect effect=-5.21, 95% CI=(-12.70, -1.27), P = 0.016].

CONCLUSIONS

CMI is a key forecaster of vulnerable plaque in patients with ACS. Systemic inflammation is associated with the relationship between CMI and vulnerable plaque features, suggesting a potential mechanistic link.

摘要

背景

作为反映代谢状态和内脏脂肪分布的新型指标，心脏代谢指数（CMI）在心血管风险分层中受到关注。本研究采用光学相干断层扫描（OCT）来检测CMI与易损斑块之间的潜在关联以及炎症的作用。

方法

本研究对270例接受OCT成像评估的急性冠状动脉综合征（ACS）患者进行了横断面分析。患者根据CMI三分位数进行分类，CMI使用公式[腰围（cm）/身高（cm）]×[甘油三酯（mmol/L）/高密度脂蛋白胆固醇（mmol/L）]计算。OCT用于评估罪犯病变中的斑块情况和非罪犯病变中的斑块成分，并检测炎症标志物。采用中介分析框架来研究CMI与易损斑块关系中的炎症途径。

结果

CMI三分位数与易损斑块特征相关：薄帽纤维粥样斑块（TCFA）、巨噬细胞（三分位数1与三分位数2与三分位数3相比，TCFA：10.0%对20.0%对26.7%，P = 0.016；巨噬细胞：17.8%对28.9%对36.7%，P = 0.019）。多因素回归显示CMI升高独立预测更高的TCFA患病率（OR：1.40，95%CI：1.25 - 2.89，P = 0.003）、更多的巨噬细胞浸润（OR：1.61，95%CI：1.09 - 2.37，P = 0.017）、更小的纤维帽厚度（β：-30.65，95%CI：-50.72 - 10.57，P = 0.003）以及更大的最大脂质弧（β：20.78，95%CI：6.55 - 35.01，P = 0.004）。此外，CMI与高敏C反应蛋白（hsCRP）、白细胞（WBC）和中性粒细胞呈正相关。中介分析显示hsCRP介导了CMI与最小纤维帽厚度之间约17.0%的关联[间接效应=-5.21，95%CI=（-12.70，-1.27），P = 0.016]。