Rasheed Q, Nair R N, Sheehan H M, Hodgson J M
University Hospital of Cleveland, Ohio, USA.
Int J Card Imaging. 1995 Jun;11(2):89-95. doi: 10.1007/BF01844706.
Little information is available regarding the in vivo composition of angina producing culprit atherosclerotic lesions in various anginal syndromes. In this study we used intracoronary ultrasound to determine the composition of culprit lesions in various subsets of anginal syndromes and correlated this composition with the patient's clinical presentation. One hundred and forty six patients referred for angioplasty or atherectomy were classified as having either chronic stable angina (angina which was clinically unchanged for > 2 months), crescendo angina (an accelerating pattern of frequent or prolonged anginal episodes), severe rest angina (abrupt onset of prolonged angina) or post-infarction angina (angina within 2 weeks of acute myocardial infarction). Intracoronary ultrasound imaging of the culprit lesion was performed before intervention. Lesions were classified as soft, mixed fibrous without calcium, mixed fibrous with calcium or calcified. Analysis of the ultrasound images revealed that the majority of culprit lesions were soft in severe rest (71%) and post-infarction angina (73%) whereas, the majority of culprit lesions were mixed fibrous or calcified in chronic stable (69%) and crescendo (53%) angina (X2 = 22.73, p = 0.007). In addition, the frequency of intralesional calcium in chronic stable or crescendo angina was significantly higher than that in severe rest or stable angina. We conclude that the composition of culprit lesions in various anginal subsets are different. The lesion morphology in crescendo angina frequently resembles that in chronic stable angina; while those in severe rest and post-infarction angina are frequently similar. These findings may have implications for medical or interventional treatment of patients with angina.
关于各种心绞痛综合征中导致心绞痛的罪犯动脉粥样硬化病变的体内成分，目前可用信息较少。在本研究中，我们使用冠状动脉内超声来确定各种心绞痛综合征亚组中罪犯病变的成分，并将该成分与患者的临床表现相关联。146例因血管成形术或旋切术而转诊的患者被分类为患有慢性稳定型心绞痛（临床上超过2个月无变化的心绞痛）、恶化型心绞痛（频繁或延长的心绞痛发作呈加速模式）、严重静息型心绞痛（长时间心绞痛突然发作）或梗死后心绞痛（急性心肌梗死后2周内出现的心绞痛）。在干预前对罪犯病变进行冠状动脉内超声成像。病变被分类为软斑块、无钙化的混合纤维斑块、有钙化的混合纤维斑块或钙化斑块。超声图像分析显示，在严重静息型心绞痛（71%）和梗死后心绞痛（73%）中，大多数罪犯病变为软斑块，而在慢性稳定型心绞痛（69%）和恶化型心绞痛（53%）中，大多数罪犯病变为混合纤维斑块或钙化斑块（X2 = 22.73，p = 0.007）。此外，慢性稳定型或恶化型心绞痛中病变内钙化的频率显著高于严重静息型或梗死后心绞痛。我们得出结论，各种心绞痛亚组中罪犯病变的成分不同。恶化型心绞痛的病变形态常类似于慢性稳定型心绞痛；而严重静息型和梗死后心绞痛的病变形态常相似。这些发现可能对心绞痛患者的药物或介入治疗具有启示意义。
