Alfonso F, Macaya C, Goicolea J, Hernandez R, Segovia J, Zamorano J, Bañuelos C, Zarco P
Cardiopulmonary Department, San Carlos, University Hospital, Madrid, Spain.
J Am Coll Cardiol. 1994 Mar 15;23(4):879-84. doi: 10.1016/0735-1097(94)90632-7.
The aim of this study was to elucidate determinants of coronary compliance in patients with coronary artery disease.
Intravascular ultrasound potentially enables in vivo evaluation of coronary artery compliance.
Twenty-seven patients (mean age [+/- SD] 57 +/- 11 years, three women) undergoing coronary angioplasty were studied with intravascular ultrasound imaging. A mechanical intravascular ultrasound system (4.8F, 20 MHz) was used. A total of 58 different coronary segments (proximal to the target angiographic lesion) were studied. Of these, 35 were located in the left anterior descending, 9 in the left main, 8 in the left circumflex and 6 in the right coronary arteries. During intravascular ultrasound imaging, 22 segments (38%) appeared normal, but 36 (62%) had plaque (24 fibrotic, 3 lipidic and 9 calcified). Systolic-diastolic changes in area (delta A) and pressure (delta P) with respect to vessel area (A) were used to study normalized compliance (Normalized compliance = [delta A/A]/delta P [mm Hg-1 x 10(3)]).
Lumen area and plaque area were 12.6 +/- 5.7 and 3 +/- 3 min2, respectively. Plaque was concentric (more than two quadrants) at 10 sites, but the remaining 26 plaques were eccentric. Compliance was inversely related to age (r = -0.34, p < 0.05) but was not related to other clinical variables. Compliance was greater in the left main coronary artery (3.9 +/- 2.1 vs. 1.8 +/- 1.2 mm Hg-1, p < 0.05) and in coronary segments with normal findings on ultrasound imaging (2.9 +/- 1.9 vs. 1.6 +/- 1.1 mm Hg-1, p < 0.01). Moreover, at diseased coronary segments compliance was lower in calcified plaques than in other types of plaques (1.2 +/- 0.7 vs. 2.3 +/- 1.6 mm Hg-1, p < 0.01) but was similar in concentric and eccentric plaques (1.6 +/- 1.5 vs. 1.6 +/- 0.9 mm Hg-1). Plaque area (r = -0.38, p < 0.01) was inversely correlated with compliance. On multivariate analysis, only age and plaque area were independently related to compliance.
Intravascular ultrasound may be used to evaluate compliance in patients with coronary artery disease. Compliance is reduced with increasing age and is mainly determined by the arterial site and by the presence, size and characteristics of plaque on intravascular ultrasound imaging.
本研究旨在阐明冠心病患者冠状动脉顺应性的决定因素。
血管内超声有可能对冠状动脉顺应性进行体内评估。
对27例接受冠状动脉血管成形术的患者（平均年龄[±标准差]57±11岁，3名女性）进行血管内超声成像研究。使用机械血管内超声系统（4.8F，20MHz）。共研究了58个不同的冠状动脉节段（靶血管造影病变近端）。其中，35个位于左前降支，9个位于左主干，8个位于左旋支，6个位于右冠状动脉。在血管内超声成像过程中，22个节段（38%）表现正常，但36个（62%）有斑块（24个纤维化，3个脂质化，9个钙化）。用相对于血管面积（A）的面积变化（ΔA）和压力变化（ΔP）来研究标准化顺应性（标准化顺应性 = [ΔA/A]/ΔP [mmHg-1×10(3)]）。
管腔面积和斑块面积分别为12.6±5.7和3±3mm2。10个部位的斑块为同心性（超过两个象限），但其余26个斑块为偏心性。顺应性与年龄呈负相关（r = -0.34，p < 0.05），但与其他临床变量无关。左主干冠状动脉的顺应性更高（3.9±2.1 vs. 1.8±1.2mmHg-1，p < 0.05），血管内超声成像表现正常的冠状动脉节段顺应性也更高（2.9±1.9 vs. 1.6±1.1mmHg-1，p < 0.01）。此外，在病变冠状动脉节段，钙化斑块的顺应性低于其他类型斑块（1.2±0.7 vs. 2.3±1.6mmHg-1，p < 0.01），但同心性和偏心性斑块的顺应性相似（1.6±1.5 vs. 1.6±0.9mmHg-1）。斑块面积（r = -0.38，p < 0.01）与顺应性呈负相关。多因素分析显示，只有年龄和斑块面积与顺应性独立相关。
血管内超声可用于评估冠心病患者的顺应性。顺应性随年龄增长而降低，主要由动脉部位以及血管内超声成像上斑块的存在、大小和特征决定。
