冠状动脉重构的血管内超声研究及基质金属蛋白酶和高敏C反应蛋白检测

目的用血管内超声(IVUS)对比研究不同类型冠心病患者的冠状动脉重构(remodeling)特点,探讨冠状动脉重构与临床表现、基质金属蛋白酶(MMPs)及高敏C反应蛋白(hs CRP)的关系。方法在行冠状动脉介入治疗前,应用IVUS研究38例急性冠状动脉综合征(ACS)和18例稳定性心绞痛(SA)患者,测量“罪犯”血管病变处及其近端、远端参考段的外弹力膜(EEM)面积、管腔面积,计算斑块面积和重构指数(RI),定义RI>1.05为正重构,RI<0.95为负重构。识别出高危斑块,检测外周血基质金属蛋白酶2(MMP2)、基质金属蛋白酶9(MMP9)和hs CRP水平。结果ACS组“罪犯”血管处的斑块面积大于SA组[(11.94±4.90)mm2比(9.17±3.36)mm2,P=0.035]。ACS组RI明显大于SA组(0.972±0.222比0.796±0.130,P=0.003)。两组正、负重构分布比率显著不同正重构在ACS组比SA组更常见(34.2%比5.6%,P=0.047),而负重构在SA组更常见(负重构在ACS组和SA组分别为52.6%与88.9%,P=0.003)。ACS组高危斑块发生率多于SA组(76.3%比50.0%,P=0.040)。ACS组患者血清MMP2高于SA组[(250.65±47.97)μg/L比(214.21±47.20)μg/L,P=0.029],前者的血浆MMP9也高于后者[(84.26±9.78)μg/L比(68.46±22.82)μg/L,P=0.038],前者的血清hs CRP亦高于后者[(3.62±3.37)mg/L比(1.48±1.52)mg/L     

冠状动脉重构的血管内超声研究

目的应用血管内超声探讨冠状动脉重构的病变特征及其与临床表现的关系。方法39例急性冠脉综合征患者与45例稳定性心绞痛患者进行冠脉造影及血管内超声检查，对病变进行定性和定量测定。包括外弹力膜血管面积（EEMA）、最小血管内膜腔面积、斑块面积、斑块体积及斑块的性状和重构指数，根据血管内超声斑块的性状分为软斑块和硬斑块（包括纤维斑块、钙化斑块和混合斑块）。重构指数（RI）=病变处EEMA／平均参考血管处EEMA。若RI〉1．0为正性重构，RI〈1．0为负性重构。结果正性重构及负性重构两组年龄、性别及冠心病危险因素等无明显差别，急性冠状动脉综合征的患者更多的表现为正性重构（61．4％vs30．0％，P〈0．01）。稳定性心绞痛的患者更多的表现为负性重构（70．0％vs38．6％，P〈0．01）。与负性重构相比，正性重构一般狭窄程度较轻，但病变部位的血管面积及斑块面积较大[（17．8±7．0）vs（13．6±4．9）mm^2，（12．2±5．5）vs（9．5±4．8）mm^2，P〈0．01），同时正性重构多为偏心性软斑块，发生钙化的较少。结论正性重构及负性重构的病理特征不同，正性重构病变以软斑块及偏心性斑块多见，冠状动脉重构与临床表现及斑块特征有关。     

Evaluation of coronary artery remodeling in patients with acute coronary syndrome and stable angina by multislice computed tomography.

BACKGROUND: Multislice computed tomography (MSCT) was used to evaluate coronary artery remodeling in patients with acute coronary syndrome (ACS) and stable angina (SA). METHODS AND RESULTS: MSCT was performed in 31 patients with ACS and 26 patients with SA and intravascular ultrasound (IVUS) was performed in 28 of these 57 patients. In both the MSCT and IVUS analyses, coronary artery remodeling was assessed by the remodeling index (RI): RI >1.10 was defined as positive coronary artery remodeling (PCAR) and RI <0.95 was defined as negative coronary artery remodeling (NCAR). The RI assessed by MSCT closely correlated with that of IVUS (r=0.86, n=28). The vessel area at the region of maximum luminal narrowing was also comparable between the MSCT and IVUS measurements (r=0.92). PCAR was present in 19 patients (61.3%) with ACS, but in none of the patients with SA (p<0.0001). However, NCAR was present in only 1 patient with ACS (3.2%), but was present in 18 patients (62.9%) with SA. The RI was significantly larger in patients with ACS (1.19+/-0.18) than in those with SA (0.89+/-0.10, p<0.0001). CONCLUSION: MSCT accurately assesses coronary artery remodeling.     

斑块稳定性与炎症反应在急性冠状动脉综合征中作用的研究

目的 探讨冠状动脉（冠脉）粥样斑块稳定性和炎症反应在急性冠状动脉综合征（ACS）中的作用。方法 对28例ACS和13例稳定性心绞痛（SA）患者“罪犯”冠脉进行血管内超声（IVUS）检查,同时测定外周血清高敏C反应蛋白（hs-CRP）、基质金属蛋白酶-9（MMP-9）、组织型基质金属蛋白酶抑制剂-1（TIMP-1）、可溶性CD40L（sCD40L）含量。结果 ACS患者冠脉病变处以软斑块为主71．4％（20／28）,SA患者冠脉病变处以硬斑块为主76．9％（10／13）,差异有统计学意义（P=0．004）。与sA组比较,ACS组病变处斑块面积大（P=0．004）、斑块负荷重（P=0．048）、以正性重构为主（P=0．013）。ACS组血清hs—CRP、MMP-9、sCIMOL含量均高于SA组,TIMP-1含量在ACS组和SA组之间差异无统计学意义（P=0．234）,ACS组hs-CRP与MMP-9（r=0．671,P=0．000）、sCIMOL（r=0．494,P=0．008）呈正相关。结论 冠脉“罪犯”病变处结构性易损斑块是ACS发作基础,CIMOL和MMP-9参与的炎症反应导致斑块功能性不稳定和不同临床表现。     

Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study

OBJECTIVES: We examined the association between the features of the culprit lesion in coronary artery disease (CAD) and clinical presentation as shown by intravascular ultrasound (IVUS). BACKGROUND: The association between coronary remodeling pattern and clinical presentation of CAD is unclear. METHODS: We analyzed 125 selected patients who underwent preintervention IVUS. Acute myocardial infarction (AMI) and unstable angina pectoris (UAP) were categorized as an acute coronary syndrome (ACS), and stable angina pectoris (SAP) and old myocardial infarction (OMI) as stable CAD. Coronary remodeling patterns and plaque morphology of the culprit lesion obtained by IVUS were analyzed in terms of their association with clinical presentation or angiographic morphology. RESULTS: Angiographically complex lesions were associated with ACS and OMI. In patients with a complex lesion, positive remodeling was observed more frequently than in those with a simple lesion. In AMI and UAP, positive remodeling was observed more frequently than in SAP and OMI (82% vs. 78% vs. 33% vs. 40%, respectively, p < 0.0001). The remodeling ratio was greater in AMI and UAP than in SAP and OMI (1.26 +/- 0.15 vs. 1.11 +/- 0.10 vs. 0.94 +/- 0.11 vs. 0.96 +/- 0.13, respectively, p < 0.0001). Furthermore, within ACS, the remodeling ratio was greater in AMI than in UAP (1.26 +/- 0.15 vs. 1.11 +/- 0.10, respectively, p < 0.05), whereas the frequency of positive remodeling was not different. CONCLUSIONS: Positive remodeling was more frequently observed in ACS than in stable CAD. Moreover, the degree of positive remodeling was greater in AMI than in UAP. These results may reflect the impact of remodeling types and its degree in the culprit lesion of CAD on clinical presentation.     

血管内超声分析斑块组成与冠状动脉重构之间的关系

目的 本研究的目的旨在应用血管内超声显像(IVUS)技术探讨斑块组成与冠状动脉重构之间的关系.方法 对77例冠心病患者(男性53例,平均年龄58±10岁)的罪犯血管采用ClearView或Galaxy2 (美国波士顿科学公司)血管内超声显像仪进行IVUS检查,其中31例为稳定性心绞痛,46例为急性冠状动脉综合征.对病变进行定性和定量测定.根据斑块组成回声的不同,分为软斑块、纤维斑块、钙化斑块和混合斑块,后三者统称为硬斑块.重构指数(RI)=病变处血管横截面积/平均参考血管面积.若RI＞1.0为正性重构;RI＜1.0为负性重构.比较不同重构形式病变的特性.结果 77处病变中,45处(58%)发生正性重构,32处(42%)发生负性重构.比较两组患者的临床表现,正性重构的患者更多的表现为急性冠状动脉综合征(74%比43%, P=0.006).与负性重构相比,正性重构病变部位的斑块面积和血管面积较大,斑块组成更多为软斑块(71%比34%, P＝0.001),发生钙化的较少(21%比54%, P＝0.003),钙化范围也较小[(18±37)°比(40±50)°, P＝0.027].进行多因素回归分析后,斑块组成和临床表现在两组患者中的差别仍具有统计学意义.结论冠状动脉重构与临床表现及斑块组成有关,正性重构病变软斑块较多见且钙化较少.     

急性冠脉综合征病变的血管内超声研究

目的 探讨急性冠脉综合征(ACS)冠状动脉粥样斑块病变的血管内超声(IVUS)特点.方法 应用IVUS观察35例稳定型心绞痛(SA)和49例急性冠脉综合征(包括急性心肌梗死和不稳定型心绞痛)患者冠脉病变处的粥样硬化斑块的特征.结果 ACS组患者冠脉病变处以软斑块为主69.4% (34/49),SA患者冠脉病变处以硬斑块为主77.1% ( 27/35),差异有统计学意义(P＜0.05),其中ACS组不稳定斑块和斑块破裂,血栓形成病变占总病变的57.2%,与SA组(8.6%)相比具有显著差异性(P＜0.01);同时两组患者斑块面积、斑块负荷、偏心指数相比差异亦具有显著性(P＜0.01);ACS患者主要以正性重构为主(59.2%),而SA患者主要以负性重构为主(57.1%),二者均有统计学差异(P＜0.01).结论 ACS组软斑块及斑块破裂、血栓形成、血管正性重构发生率明显高于SA组,IVUS检查是在体观察粥样斑块的良好手段,并可以指导治疗策略.     

Relationship between high sensitive C-reactive protein and coronary plaque component in patients with acute coronary syndrome: Virtual Histology study

OBJECTIVES: Elevated circulating C-reactive protein (CRP)is commonly observed in patients with acute coronary syndrome(ACS), suggesting enhanced inflammation in vulnerable plaques. However, few data are available on the relationship between the levels of CRP and the histological composition of coronary plaque. We investigated the relationship between plasma high sensitive CRP level and coronary plaque component with Virtual Histology intravascular ultrasound (VH-IVUS). METHODS: Twenty eight patients with ACS and 37 patients with non-ACS were enrolled in the study. Plasma high sensitve CRP levels were measured before catheterization. A total of 125 lesions (ACS; 24 culprit lesions, 30 non-culprit lesions, non-ACS; 34 culprit lesions, 37 non-culprit lesions)underwent IVUS volumetric investigation, and the volume of plaque and media were calculated. Spectral analysis of IVUS radiofrequency data was performed with VH software, and plaque and media were classified into fibrous, fibro-fatty, dense calcium, and necrotic core elements. RESULTS: Although the plasma high sensitive CRP level in patients with ACS was higher than that in those with non-ACS (0.26 +/- 0.2 vs 0.15 +/- 0.17 mg/dl, p < 0.05), necrotic core volume was not different between the two groups(11.7 +/- 7.3 vs 12.3 +/- 7.2mm3/cm, p = 0.71). There was a positive correlation between high sensitve CRP and necrotic core volume in patients with ACS, not only in culprit lesions (p = 0.0004, r2 = 0.564) but also in non-culprit lesions (p = 0.0008, r2 = 0.473), whereas patients with non-ACS showed no correlations. CONCLUSIONS: IVUS spectral analysis revealed that elevated plasma high sensitve CRP level was correlated with necrotic core volume in patients with ACS, both in culprit and non-culprit lesions, suggesting enhanced vascular inflammation.     

Relationship between coronary artery remodeling and plaque composition in culprit lesions: an intravascular ultrasound radiofrequency analysis.

BACKGROUND: The relationship between coronary artery remodeling and culprit plaque composition in vivo has not been fully evaluated by spectral analysis of intravascular ultrasound (IVUS) radiofrequency (RF) data. METHODS AND RESULTS: IVUS RF analyses were performed for 56 consecutive de novo culprit lesions of 52 patients undergoing percutaneous coronary intervention. Remodeling of culprit lesions was determined using the remodeling index (RI), calculated as the external elastic membrane area of the minimum lumen area (MLA) site divided by that of the proximal reference site. Positive remodeling was defined as RI >1.05, intermediate remodeling as 0.95< or = RI < or =1.05 and negative remodeling as RI <0.95. Among the 56 lesions, positive remodeling was detected in 24, intermediate remodeling in 16, and negative remodeling in 16. At MLA sites, positive remodeling lesions had a larger percentage of the fibrofatty component than negative remodeling lesions (22.5+/-10.3% vs 10.4+/-6.6%, p=0.0001), whereas the latter contained a larger percentage of the dense calcium component than the former (2.8+/-2.9% vs 8.4+/-7.0%, p=0.016). CONCLUSIONS: Culprit plaques with positive remodeling have a large lipid burden, whereas those with negative remodeling contain a large amount of calcium.     

Correlation between morphologic characteristics and local temperature differences in culprit lesions of patients with symptomatic coronary artery disease.

OBJECTIVES: The purpose of this study was to investigate the possible correlation between morphologic and functional characteristics of culprit lesions (CL) in patients with acute coronary syndromes (ACS) and chronic stable angina (CSA). BACKGROUND: Intravascular ultrasound (IVUS) provides morphologic assessment and intracoronary thermography (ICT) evaluates the local inflammatory activation of CL. METHODS: Eighty-one consecutive patients, 48 with ACS and 33 with CSA, were enrolled. Ratio of lesion to reference external elastic membrane area, indicated by IVUS, was defined as positive remodeling index (pRi) (> or =1) or negative remodeling index (nRi) (<1). We also investigated the existence of ruptured plaque (rp) in the CL. By ICT temperature difference (DeltaT) between the CL and the proximal vessel wall was measured. RESULTS: Patients with ACS had greater remodeling index than patients with CSA (1.15 +/- 0.18 vs. 0.90 +/- 0.12; p < 0.01), as well as increased DeltaT (0.08 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.01). Patients with pRi had higher DeltaT than patients with nRi (0.07 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.001). In patients with nRi there was no difference in DeltaT between ACS and CSA (p = 0.22). Patients with rp had increased DeltaT compared with patients without rp (0.09 +/- 0.03 degrees C vs. 0.05 +/- 0.02 degrees C; p < 0.01). Multivariate analysis showed that DeltaT was independently correlated with the presence of rp, pRi, and ACS. CONCLUSIONS: The present study showed that culprit lesions with plaque rupture and positive arterial remodeling have increased thermal heterogeneity, although in certain patients a discrepancy between morphogic and functional characteristics was observed. A combination of morphologic and functional examination may offer additional diagnostic and prognostic information.     

Association between plasma inflammatory markers and morphology of coronary artery lesion in patients with coronary artery disease

The atherosclerotic plaque vulnerability may be related to inflammation,immunity,metabolism and blood clotting.One of the key factors affecting plaque stability is inflammatory reaction.This study was to investigate the relationship between vulnerability of coronary artery plaque evaluated with coronary angiography (CAG),intravascular ultrasound (IVUS) and the levels of plasma inflammatory markers.Methods Fifty-eight consecutive patients with acute coronary syndrome who had coronary lesion of a single vessel were divided into 3 groups based on angiographic morphology of the lesions:type Ⅰ lesion group (n =16),type Ⅱ lesion group (n =25) and type Ⅲ lesion group (n =17).The control group consisted of 17 patients with stable angina.Plasma levels of high sensitivity C reaction protein (hs-CRP),matrix metalloproteinase (MMP,including MMP-2 and MMP-9),CD40 ligand (CD40L) and pregnancy associated plasma protein-A (PAPP-A) were measured by ELISA.A subgroup of 28 patients (including 18 ACS patients and 10 stable angina control patients) who underwent IVUS study,were analyzed.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than those in other groups (all P＜0.05).In type Ⅱ lesion group,linear correlation analyses showed significant positive correlation between levels of hs-CRP and MMP-2 (r=0.508);MMP-2 and MMP-9,CD40L,PAPP-A (r=0.647,0.704 and 0.751,respectively);MMP-9 and CD40L,PAPP-A (r=0.491 and 0.639,respectively);CD40L and PAPP-A (r=0.896).IVUS subgroup analysis showed that the area of plaques and plaque burden in culprit lesion,the incidence of high-risk plaques,remodeling index (RI) and positive remodeling percentage in ACS patients were significantly greater than those in control subgroup (P=0.000,0.037,0.028,0.015 and 0.040,respectively).Compared with control subgroup,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated (P=0.033,0.000,0.000 and 0.027,respectively).Conclusions CAG and IVUS combined with study on plasma levels of inflammation mediators are helpful in judging the vulnerability of coronary artery plaques.(J Geriatr Cardiol 2008;5:207-211)     

Biomarkers, age, and coronary artery remodeling in patients with acute coronary syndrome

To investigate the relationship between age and coronary artery remodeling in patients with acute coronary syndrome (ACS), 56 patients with ACS were identified by intravascular ultrasound (IVUS). Remodeling index (RI) (37 cases of RI > or =1 vs 19 cases of RI <1) and dimidiate age groups (27 patients younger than 60 years vs 29 patients 60 years or older) were compared, and the relationships among biomarkers, age, and arterial remodeling were analyzed. There was a significant difference in age between positive and negative remodeling groups (55+/-13 vs 62+/-10 years; P=.038); RI and triglyceride level showed a statistical correlation (r=0.32; P=.02) and a significant inverse correlation between age and RI (r=-0.47; P<.001). The multivariable linear regression analysis demonstrated that age was an independent predictor of RI (Bate -0.37; 95% confidence interval, 0.93-1.08; P=.04). Age may be an important factor of arterial remodeling. Low-density lipoprotein or triglyceride level may be associated with attenuated coronary vascular remodeling with aging.     

Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography.

OBJECTIVES: The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT). BACKGROUND: Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain. METHODS: Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined. RESULTS: We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 +/- 5.9 mm2 vs. 9.1 +/- 4.8 mm2 vs. 13.5 +/- 10.7 mm2, p = 0.02; and 1.4 +/- 0.3 vs. 1.0 +/- 0.4 vs. 1.2 +/- 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina. CONCLUSIONS: We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.     

Serial intravascular ultrasonic study of outcomes of coronary culprit lesions with plaque rupture following bare metal stent implantation in patients with angina pectoris

Coronary culprit lesions with plaque rupture (PR) have been treated with different coronary interventions. However, it is unknown whether the presence of PR affects the restenotic process after coronary intervention. One hundred forty-two patients undergoing coronary bare metal stent implantation were enrolled in the present retrospective analysis. Case selection was based on availability of intravascular ultrasound (IVUS) and quantitative coronary angiographic examinations at baseline (before and after intervention) and at follow-up. Serial comparative analyses included qualitative and quantitative features of the culprit lesion and reference segments. PR was defined as an intraplaque cavity in communication with the lumen in the presence of a residual, disrupted cap. Patients were categorized according to the presence/absence of PR. Pre-interventional IVUS detected PR in 54 patients (38%). Baseline patient demographics were similar between the +PR and -PR groups. Quantitative IVUS analysis showed higher rates of positive remodeling and larger vessel and plaque areas in the +PR compared with -PR lesions (p <0.001 for all). At follow-up (7.2 +/- 2.6 months), no statistically significant difference was observed between the 2 groups in quantitative coronary angiographic or IVUS measurements. In conclusion, culprit lesions with PR exhibited larger plaque mass and higher rates of positive remodeling at preintervention IVUS examination. However, when treated with bare metal stents, the absence/presence of preintervention PR was not found to affect the rate or severity of in-stent restenosis in these culprit lesions.     

Relationship between interleukin-18 levels and characterization of atherosclerotic plaque and percutaneous coronary intervention

Background lnterleuldn-18(IL- 18) plays a key role in the development,progression and outcome of coronary artery disease and its complications.However,its variability relation to the characterization of atherosclerotic plaque and percutaneous coronary intervention are still unknown.Methods Fifty four patients with coronary artery disease [22 patients with stable angina (SA) and 32 patients with acute coronary syndrome (ACS)] were enrolled in this study.All patients underwent percutaneous coronary intervention (PCI).The stability of the plaques at the criminal vessels was assessed with analogical IVUS.Serum IL-18 levels were measured at the time points of 5 rain before PCI,and Oh,6h,24h and lmonth after PCI in all patients.Results ACS group consisted mainly of lipidic unstable plaques while SA group of fibrous stable plaques.Moreover,compared with those in SA group,eccentricity index (EI) and remodeling index (RI) were significantly higher in ACS group.Positive remodeling was seen in ACS group while negative or no remodeling in SA group.Further,serum IL-18 levels were significantly elevated in patients with ACS than those in SA group before PCI,increased at Oh,6h,24h after PCI (P＜0.05)and were not significant different at 1 month after PCI from those before PCI.Conclusions There is significant difference in the composition and structural characteristics of atherosclerotic plaques between ACS and UA groups.PCI triggersd and enhances the inflammatory response in a short time.Serum levels of IL- 18 are the predictors of progression of unstable plaque in atherosclerosis.Post-operative complications of PCI might be reduced by inhibiting IL- 18.(J Geriatr Cardiol 2008;5:21-24)     

Anti-inflammatory and cardioprotective effects of n-3 polyunsaturated fatty acids and plant sterols in hyperlipidemic individuals

Recent studies have indicated that positive remodeling is strongly associated with development of acute coronary syndrome (ACS). The aim of this study was to compare plaque composition of vascular remodeling patterns by an established in vivo tissue characterization method using integrated backscatter (IB)-intravascular ultrasound (IVUS). The study population consisted of 41 consecutive patients who received IVUS prior to percutaneous coronary intervention. Remodeling index (RI) was calculated as the external elastic membrane (EEM) area at the minimal lumen area (MLA) site divided by average EEM area at the proximal and distal reference sites. The patients were divided into two groups based on RI: positive remodeling (PR) defined as RI>1 and non-PR as RI相似文献   

冠状动脉斑块形态学与血浆炎症介质的关系

目的从冠状动脉（冠脉）斑块的影像学、血浆炎症介质水平等方面综合评价冠脉斑块易损性。方法将冠脉造影显示为单支病变的58例患者,按造影结果分为Ⅰ型病变组（16例）、Ⅱ型病变组（25例）、Ⅲ型病变组（17例）及对照组（17例）。其中行血管内超声（IVUS）检查的28例患者分为急性冠脉综合征（ACS）组和稳定性心绞痛组2个亚组。采用酶联免疫吸附法测定血浆高敏C反应蛋白（hs-CRP）、金属基质蛋白酶（MMP,包括MMP-2、MMP-9）、CD40配体（CD40L）和妊娠相关蛋白-A（PAPP—A）水平。结果Ⅱ型病变组血浆MMP-2、MMP-9和PAPP—A水平显著高于Ⅰ型病变组（P〈0．05）、Ⅲ型病变组（P〈0．05）和对照组（P〈0．001）;线性相关分析显示,Ⅱ型病变组hs—CRP与MMP-2显著正相关（r=0．508）;MMP-2与MMP-9、CD40L、PAPP—A显著正相关（r=0．647、0．704、0．751）;MMP-9与CD40L、PAPP—A显著正相关（r=0．491、0．639）;CD40L与PAPP—A（r=0．896）显著正相关。IVUS亚组分析表明,ACS组的“罪犯”病变斑块面积、斑块负荷、高危斑块发生率、重构指数和正重构均显著大于对照组（P=0．000、0．037、0．028、0．015和0．040）;ACS组血浆hs—CRP、MMP-2、MMP-9和PAPP-A水平也显著升高（P：0．033、0．000、0．000和0．027）。结论冠脉造影、IVUS检查结合检测血浆炎症介质水平更有助于判断冠脉斑块的易损性。     

Relation between local temperature and C-reactive protein levels in patients with coronary artery disease: effects of atorvastatin treatment

Although previous studies have shown systemic inflammatory activation the relation with the local plaque inflammatory activation has not been extensively studied. The present study investigated the relation between local and systemic inflammatory activation in patients with coronary artery disease and the impact of atorvastatin treatment. We included 215 patients undergoing percutaneous coronary intervention; of them 140 were treated with atorvastatin. Patients with stable angina (SA) and acute coronary syndromes (ACS) were included. Systemic inflammation was assessed by serum C-reactive protein (CRP), soluble adhesion molecules levels and local plaque inflammatory activation by coronary thermography. Temperature difference (DeltaT) was assigned as the difference between the proximal vessel wall temperature from the maximal temperature at the culprit plaque. Patients with ACS (n=78) had increased DeltaT compared to patients with SA (n=137) (0.16+/-0.10 degrees C versus 0.08+/-0.07 degrees C, P<0.001). Patients treated with atorvastatin had lower DeltaT compared to untreated patients (0.10+/-0.07 degrees C versus 0.15+/-0.10 degrees C, P<0.01). DeltaT was less in the treated group compared to the untreated group in patients with SA and ACS (ACS: 0.13+/-0.08 degrees C versus 0.20+/-0.11 degrees C, P<0.01, SA: 0.08+/-0.06 degrees C versus 0.13+/-0.08 degrees C, P=0.03). Although a correlation was found between CRP levels and DeltaT (R=0.29, P<0.01), in certain groups a discrepancy between CRP levels and DeltaT was observed. In 25% of patients with low DeltaT CRP levels were >1mg/dl and in 35.5% of patients with high DeltaT CRP was <2mg/dl. The correlation between soluble adhesion molecules and DeltaT did not reach statistical significance. Although there is a correlation between widespread and local inflammatory activation in patients with coronary artery disease, a discrepancy between culprit plaque and systemic inflammatory activation is observed. Atorvastatin has a parallel effect on systemic and local inflammatory process in patients with coronary artery disease.     

Association of plaque characterization by intravascular ultrasound virtual histology and arterial remodeling

Positive remodeling is more often observed in lesions of patients who have acute coronary syndromes or vulnerable (rupture-prone) plaques. However, there are few data that correlate plaque morphology, composition, and arterial remodeling in vivo. We evaluated coronary plaque characterization of lesions with positive remodeling using intravascular ultrasound (IVUS) radiofrequency data analysis. Seventy-seven nonbifurcation native coronary lesions (in 50 patients) were imaged in vivo using 30-MHz IVUS transducers. Lesions were classified into 4 plaque types, fibrous, fibrofatty, dense calcium, and necrotic core, by using processing of the radiofrequency signal validated in vitro. The remodeling index was calculated as the lesion external elastic membrane area divided by the proximal reference external elastic membrane area. Lesions were divided into 2 groups: positive remodeling (remodeling index>1.0, 26 lesions) and intermediate/negative remodeling (remodeling index相似文献   

Arterial remodeling correlates positively with serological evidence of inflammation in patients with chronic stable angina pectoris

Positive coronary artery remodeling is associated with unstable coronary syndromes. Serum inflammatory markers, including high-sensitivity CRP (hsCRP), can predict future risk of acute coronary events in patients with stable coronary artery disease. We sought to elucidate the relationship of specific serum inflammatory markers with intravascular ultrasound (IVUS) estimation of coronary artery remodeling in patients with stable coronary artery disease. Thirty-one sequential patients at our institution undergoing IVUS-assisted percutaneous coronary intervention (PCI) with stable coronary artery disease were enrolled. Automated IVUS pullback and offline analysis were performed in all patients. Images were analyzed for vessel wall area (VWA) and lumen area (LA), at the culprit lesion and at a proximal reference site, and the remodeling index (RI) was calculated. Positive and negative remodeling were defined as a RI of > 1.05 and < 0.95, respectively. ELISA essays were performed for soluble VCAM-1, ICAM-1 and E-selectin. The distribution of data followed a lognormal distribution. By defining arterial remodeling as simply positive or negative, significant differences were identified for log E-selectin only (1.80 +/- 0.04 versus 1.62 +/- 0.05, respectively; p = 0.02). The RI correlation coefficient was 0.38 (p = 0.04) for log sVCAM-1 and 0.42 (p = 0.02) for log sICAM-1. The log E-selection and RI correlation coefficient, although weaker at 0.32, showed a trend toward significance (p = 0.08). There was no significant correlation between log hsCRP and RI (p = 0.42). Using step-wise multivariate analysis, log sVCAM-1 only remained an independent predictor of the RI (p = 0.03). Positive coronary artery remodeling correlates with serological markers of inflammation in patients with stable coronary artery disease.