Hodgson J M, Reddy K G, Suneja R, Nair R N, Lesnefsky E J, Sheehan H M
Division of Cardiology, University Hospitals of Cleveland, Ohio 44106.
J Am Coll Cardiol. 1993 Jan;21(1):35-44. doi: 10.1016/0735-1097(93)90714-c.
This study was designed to establish the relation between ultrasound-derived atheroma morphology and the clinical, procedural and angiographic features of patients presenting for coronary angioplasty.
Intracoronary ultrasound imaging provides accurate dimensional information regarding arterial lumen and wall structures. Atheroma composition may also be assessed by ultrasound; however, only limited studies have been performed in patients.
In 65 patients a diagnostic ultrasound imaging catheter or a combination imaging-angioplasty balloon catheter was used during coronary angioplasty to image both the lesion and the vessel segment just proximal to it (reference segment). Ultrasound images were analyzed for lumen, total vessel and plaque areas and were classified into five morphologic subtypes (soft, fibrous, calcific, mixed plaque and concentric subintimal thickening). These data were compared with angiographic morphologic features, procedural results and clinical angina pattern (stable vs. unstable).
Morphologic analysis of the ultrasound images obtained from the lesion correlated well with the clinical angina syndrome. Compared with patients with stable angina, patients with unstable angina had more soft lesions (74% vs. 41%), fewer calcified and mixed plaques (fibrotic, soft or calcific components in one or more combinations [25% vs. 59%]) and fewer intralesional calcium deposits (16% vs. 45%) (all p < 0.01). There was no correlation between ultrasound and angiographic lesion morphologic characteristics for either the reference segment or the lesion. Ultrasound demonstrated greater sensitivity than angiography for identifying unstable lesions (74% vs. 40%). Dimensional analysis demonstrated a large plaque burden in the reference segments (45 +/- 15% of total vessel area). Postangioplasty plaque burden was also high (62 +/- 9%). There was a significant, but only fair correlation between lumen area determined by angiography and ultrasound for both the reference segment (r = 0.70, p < 0.001) and the postangioplasty lesion (r = 0.63, p < 0.05).
Morphologic plaque classification by ultrasound is closely correlated to clinical angina but has little relation to established angiographic morphologic characteristics. Intracoronary ultrasound imaging during angioplasty identifies a large residual plaque burden in both the reference segment and the lesion. In the future, determination of plaque composition by intracoronary ultrasound may be important in selecting or modifying interventional therapeutic options.
本研究旨在确定超声检测的动脉粥样硬化形态与接受冠状动脉血管成形术患者的临床、手术及血管造影特征之间的关系。
冠状动脉内超声成像可提供有关动脉管腔和管壁结构的准确尺寸信息。动脉粥样硬化成分也可通过超声评估；然而，针对患者的研究较少。
在65例患者的冠状动脉血管成形术中，使用诊断性超声成像导管或成像-血管成形术联合球囊导管对病变及其近端血管节段（参考节段）进行成像。对超声图像进行管腔、血管总面积及斑块面积分析，并分为五种形态学亚型（软斑块、纤维斑块、钙化斑块、混合斑块及同心性内膜下增厚）。将这些数据与血管造影形态学特征、手术结果及临床心绞痛类型（稳定型与不稳定型）进行比较。
从病变处获取的超声图像的形态学分析与临床心绞痛综合征密切相关。与稳定型心绞痛患者相比，不稳定型心绞痛患者有更多的软斑块（74%对41%）、更少的钙化斑块和混合斑块（一种或多种组合的纤维、软或钙化成分[25%对59%]）以及更少的病变内钙沉积（16%对45%）（所有p<0.01）。参考节段或病变的超声与血管造影病变形态学特征之间均无相关性。超声在识别不稳定病变方面比血管造影表现出更高的敏感性（74%对40%）。尺寸分析显示参考节段有较大的斑块负荷（占血管总面积的45±15%）。血管成形术后斑块负荷也较高（62±9%）。血管造影和超声测定的参考节段管腔面积（r=0.70，p<0.001）及血管成形术后病变管腔面积（r=0.63，p<0.05）之间存在显著但仅为中等程度的相关性。
超声对斑块的形态学分类与临床心绞痛密切相关，但与既定的血管造影形态学特征关系不大。血管成形术中冠状动脉内超声成像显示参考节段和病变处均有较大的残余斑块负荷。未来，冠状动脉内超声测定斑块成分对于选择或调整介入治疗方案可能具有重要意义。
