血小板/淋巴细胞与急性冠状动脉综合征患者非罪犯动脉粥样硬化斑块易损性的相关性-光学相干断层扫描技术研究

目的:通过光学相干断层扫描技术探讨急性冠状动脉综合征(ACS)患者血小板与淋巴细胞比值(PLR)与非罪犯动脉粥样硬化斑块易损性的关系。方法:回顾性纳入74例就诊于首都医科大学附属北京安贞医院,诊断为ACS并接受经皮冠状动脉造影及OCT检查的患者。结果:PLR是易损斑块(TCFA)的危险因素(OR=1.011,95%CI:1.002～1.020,P=0.015)。PLR对TCFA的诊断敏感性为84.0%,特异性为55.1%。高PLR组患者冠状动脉血管内非罪犯脂质斑块的最大脂质核心角度[(162.30±64.31)vs.(133.33±55.29)°,P=0.012]、平均脂质核心角度[(123.51±44.46)vs.(107.11±44.84)°,P=0.049]、脂质斑块长度[4.75(2.93,7.20)vs. 3.40(2.20,5.30)mm,P=0.023]及脂质指数[535.40(303.26,877.19)vs. 344.03(181.93,673.00),P=0.014]均显著高于低PLR组患者,纤维帽厚度[100.00(60.00,157.50)vs. 130.00(80.00,195.00)μm,P=0.031]显著低于低PLR组。高PLR组的纤维斑块数量(P=0.038)、易损斑块发生率(P=0.006)及斑块破裂发生率(P=0.007)均高于低PLR组。同时,PLR与脂质斑块纤维帽厚度(FCT)呈负相关(R=0.205,P=0.020)。结论:高水平PLR可能与ACS患者易损斑块特征有关。PLR水平在评估ACS患者非罪犯动脉粥样硬化斑块的易损性方面具有潜在价值。     

New insights into spotty calcification and plaque rupture in acute coronary syndrome: an optical coherence tomography study

Although recent optical coherence tomography (OCT) studies have focused on spotty calcification, whether there were any characteristics in the concomitant existence of calcification and plaque rupture remains unknown. The aim of the present study was to investigate the characteristics of spotty calcification in acute coronary syndrome (ACS) patients with or without plaque rupture, using OCT. This study enrolled 98 consecutive patients with ACS. OCT image acquisitions were performed in the culprit lesions, and patients were divided into the plaque rupture group (n = 38) and the non-rupture group (n = 60). The frequency of spotty calcification (p = 0.006), thin-capped fibroatheroma (p = 0.012), macrophage infiltration (p = 0.022), and the number of spotty calcification per patient (p < 0.001) were significantly higher and the largest arc and the minimum depth of spotty calcification from the luminal surface were significantly smaller in the rupture group. Moreover, in the rupture group, most of the spotty calcifications in the site nearest to the minimum lumen area were observed in the proximal portion of that site, and tended to be located near the plaque rupture. Multivariate analysis revealed that the presence of spotty calcification (OR 3.19, 95 % CI 1.12–9.76, p = 0.030) and age (OR 1.08, 95 % CI 1.02–1.14, p = 0.008) were independent predictive factors for plaque rupture. This study demonstrates the characteristics of spotty calcification in ACS patients with plaque rupture and the positional relationship between spotty calcification and plaque rupture. These detailed observations could impact on treatment strategies for the prevention of ACS.     

Association of statin therapy with reduced coronary plaque rupture: an optical coherence tomography study

OBJECTIVE: Statin therapy induces plaque regression and may stabilize atheromatous plaques. Optical coherence tomography (OCT) is a high-resolution in-vivo imaging modality that allows characterization of atherosclerotic plaques. We aimed to demonstrate the potential utility of OCT in evaluating coronary plaques in patients with or without statin therapy. METHODS: Patients undergoing cardiac catheterization were enrolled. We identified culprit lesions and performed intracoronary OCT imaging. Plaque lipid pool, fibrous cap thickness, and frequency of thin-cap fibroatheroma were evaluated using previously validated criteria. Macrophage density was determined from optical signals within fibrous caps. Presence of calcification, thrombosis, and rupture was assessed. RESULTS: Forty-eight patients were included (26 on statins, 22 without statins). Baseline characteristics were similar apart from lipid profile. Patients on statin therapy had lower total and low-density lipoprotein cholesterol concentrations (4.45+/-1.35 vs. 5.26+/-0.83 mmol/l, P=0.02; 2.23+/-0.78 vs. 3.26+/-0.62 mmol/l, P<0.001, respectively). Frequencies of lipid-rich plaque (69 vs. 82%), thin-cap fibroatheroma (31 vs. 50%), plaque calcification (15 vs. 5%) and thrombosis (15 vs. 32%), and fibrous cap macrophage density were comparable between statin and nonstatin groups (5.9 vs. 6.3%; all P=NS). Ruptured plaques were, however, significantly less frequent in patients on established statin therapy (8 vs. 36%; P=0.03) with a trend toward increased minimum fibrous cap thickness (78 vs. 49 microm; P=0.07). CONCLUSION: We demonstrated the use of OCT in plaque characterization and found that patients on prior statin therapy have reduced incidence of ruptured plaques and a trend toward thicker fibrous caps. This suggests that statins may stabilize coronary plaques.     

光学相干断层成像对急性冠状动脉综合征患者易损斑块的新认识

血管斑块的稳定性是影响急性冠状动脉综合征发生发展的主要因素,具有超高空间分辨率的光学相干断层成像(OCT)技术在易损斑块识别方面有着独特的优势。本文就近年来OCT在急性冠状动脉综合征患者易损斑块识别方面的临床新进展进行综述。     

Association between food and nutrients intakes and coronary plaque vulnerability in patients with coronary heart disease: An optical coherence tomography study

Background and aimsDietary intakes play important roles in the prevention and treatment of coronary heart disease (CHD). Coronary plaque vulnerability is the key mechanism leading to CHD progression. We aimed to explore the association between dietary intakes and plaque vulnerability via optical coherence tomography (OCT).Methods and resultsA total of 314 CHD patients were included in this study. Dietary intake status was assessed by semi-quantitative food frequency questionnaire and plaque vulnerability was measured by OCT. The results showed that vegetables were negatively associated with macrophage infiltration, thin cap fibroatheroma (TCFA) and thrombus [odds ratio (OR) = 0.48, 0.38, 0.38, 95% confidence interval (95% CI) = 0.24–0.93, 0.17–0.84, 0.15–0.94, all P < 0.05]; fruits were negatively associated with lipid plaque, TCFA, rupture and thrombus (OR = 0.17, 0.11, 0.12, 0.20, 95% CI = 0.07–0.39, 0.04–0.29, 0.05–0.28, 0.08–0.55, all P < 0.05); salt was positively associated with lipid plaque and TCFA (OR = 2.59, 2.83, 95% CI = 1.14–5.90, 1.23–6.51, all P < 0.05). Regarding nutrients intakes, dietary fiber was negatively associated with macrophage infiltration (OR = 0.34, 95% CI = 0.14–0.85, P = 0.021); folate was negatively associated with lipid plaque, TCFA and rupture (OR = 0.22, 0.16, 0.20, 95% CI = 0.09–0.58, 0.06–0.41, 0.08–0.51, all P < 0.05); vitamin C was negatively associated with TCFA, rupture and thrombus (OR = 0.26, 0.22, 0.05, 95% CI = 0.07–0.95, 0.07–0.65, 0.01–0.25, all P < 0.05); sodium was positively associated with lipid plaque, TCFA, rupture and thrombus (OR = 3.43, 3.96, 2.73, 4.84, 95% CI = 1.51–7.80, 1.66–9.45, 1.18–6.27, 1.76–9.28, all P < 0.05).ConclusionSalt and sodium were dietary risk factors for plaque vulnerability, whereas vegetables, fruits, dietary fiber, folate and vitamin C were dietary protective factors for plaque vulnerability.     

Association of coronary plaque composition and arterial remodelling: a optical coherence tomography study

BackgroundConflicting data have been reported about the association between plaque composition and remodelling index (RI). The aim of this study is to evaluate the relationship between plaque morphology obtained by optical coherence tomography (OCT) and arterial remodelling.Methods and resultsOCT and intravascular ultrasound imaging pull back was performed at corresponding sites on 94 lesions in 47 patients. OCT plaque characteristics for lipid content, fibrous cap thickness, thin-cap fibroatheroma (TCFA), plaque rupture, thrombus, calcification and erosion were derived using validated criteria. Compared with intermediate/negative remodelling (RI < 1.0), positive remodelling (RI > 1.0) was associated with presence of higher lipid pool (2.86 ± 0.42 vs. 2.20 ± 0.78; p < 0.001), thin fibrous cap (47.86 ± 25.43 μm vs. 74.41 ± 32.41 μm; p < 0.001), TCFA > 3 mm (82.1% vs. 22.7%; p < 0.0001), plaque rupture and thrombus (42.8% vs. 19.7%; p = 0.024), and higher plaque burden (73.70 vs. 70.70; p = 0.048). No difference was observed in the presence of calcification and plaque erosions.ConclusionsCoronary lesions with positive remodelling show higher incidences of vulnerable plaque and plaque rupture across the lesion length. This potentially explains the correlation between unstable coronary syndromes and positive remodelling.     

Association between serum adipsin and plaque vulnerability determined by optical coherence tomography in patients with coronary artery disease

BackgroundEarly identification of vulnerable plaques is important for patients with coronary artery disease (CAD) to reduce acute coronary events and improve their prognosis. We sought to examine the relationship between adipsin, an adipokine secreted from adipocytes, and plaque vulnerability in CAD patients.MethodsA total of 103 plaques from 99 consecutive patients who underwent coronary angiography were assessed by optical coherence tomography. The serum level of adipsin was measured using enzyme-linked immunosorbent assay (ELISA). The accuracy of adipsin for detecting thin-cap fibroatheroma (TCFA) was determined by the area under the receiver operating characteristic curve (AUC).ResultsOf the 99 patients, 49 were classified into the low adipsin group and 50 into the high adipsin group according to the median level of serum adipsin (2.43 µg/mL). The plaques from the high adipsin group exhibited a greater lipid index (2,700.0 vs. 1,975.9° × mm, P=0.015) and an increased proportion of TCFAs (41.2% vs. 21.2%, P=0.028) compared with the low adipsin group. Serum adipsin was found to be negatively correlated with fibrous cap thickness (ρ=−0.322, P=0.002), while it was positively correlated with average lipid arc (ρ=0.253, P=0.015), maximum lipid arc (ρ=0.211, P=0.044), lipid core length (ρ=0.241, P=0.021), lipid index (ρ=0.335, P=0.001), and vulnerability score (ρ=0.254, P=0.014). Furthermore, adipsin had a significant association with TCFAs (OR: 1.290, 95% CI: 1.048–1.589, P=0.016) in the multivariate analysis, while having a moderate diagnostic accuracy for TCFAs (AUC: 0.710, 95% CI: 0.602–0.817, P<0.001).ConclusionsOur findings suggest that serum adipsin is significantly and positively correlated with the incidence of TCFAs. The application of adipsin as a biomarker may offer improvement in the diagnosis of vulnerable plaques and clinical benefits for CAD patients.     

红细胞分布宽度在急性冠脉综合征患者非罪犯病变斑块进展中的预测作用

目的评估红细胞分布宽度(RDW)等指标在预测急性冠脉综合征(ACS)患者非罪犯病变斑块进展中的价值方法入选2008年8月1日至2013年8月1日住解放军总医院心脏介入中心行经皮冠状动脉介入治疗(PCI)术的ACS患者421例。根据三维定量冠状动脉造影(3D-QCA)分析斑块进展与否,将所有患者分为两组:进展组(n=109)和非进展组(n=312)。比较两组患者相关临床资料、传统危险因素的差异,并通过logistic回归分析探讨RDW和其他危险因素与非罪犯斑块进展之间的关系。结果与非进展组相比,进展组患者RDW显著增高[(13.08±0.73)%vs(12.89±0.71)%,P=0.020]。RDW四分位分组分析斑块进展结果也表明,随RDW的升高,非罪犯病变血管斑块进展在各组中听占的比例也呈升高趋势,且两两比较差异均具有统计学意义(P0.05)。经校正后的多因素回归分析显示RDW(OR=1.385,P=0.045)和糖尿病(OR=1.809.P=0.026)是病变进展的独立危险因素。结论 RDW能够在一定程度上预测ACS患者非罪犯病变斑块的进展。     

Inflammatory markers and plaque morphology: an optical coherence tomography study

Background

OCT with its unique image resolution is the ideal method to detect culprit lesion characteristics in different clinical presentations. The identification of inflammatory markers related to plaque characteristics may be of clinical importance.

Methods

Thirty-two patients with acute coronary syndromes (ACS) and fourteen patients with stable angina pectoris (SAP) were enrolled in this study. Culprit lesion morphology was assessed by optical coherence tomography (OCT) in patients with ACS and SAP. The possible relations between serum levels of high sensitivity-C reactive protein (hs-CRP) and interleukin-18 (IL-18) with plaque characteristics were investigated in those patients.

Results

Plaque rupture and thin-cap fibroatheroma (TCFA) were detected more frequently in ACS patients compared with SAP patients, (78.6% vs. 14.3%, p < 0.001, 92.9% vs. 14.3%, p < 0.001, respectively). Higher levels of serum hs-CRP and IL-18 were found in patients with plaque rupture vs. those with no plaque rupture (median value: 19.2 mg/L vs. 1.6 mg/L, p < 0.001 and 219.5 pg/ml vs. 127.5 pg/ml, p = 0.001 respectively), and TCFA vs. those without TCFA (median value: 15.2 mg/L vs. 1.6 mg/L, p = 0.004 and 209.0 pg/ml vs.153.2 pg/ml, p = 0.03 respectively). Serum hs-CRP was the only independent predictor of plaque rupture (p = 0.02, odds ratio 1.1, 95% confidence interval 1.0 to 1.2). A cut-off value of hs-CRP > 4.5 mg/L could detect ruptured plaque with a sensitivity of 91.7% and a specificity of 77.8%.

Conclusions

OCT detected plaque rupture and TCFA more frequent in ACS patients compared with SAP. Elevated hs-CRP and IL-18 were positively related to plaque instability and rupture.     

光学相干断层成像在急性冠脉综合征预测中的应用

光学相干断层成像（OCT）是现有临床影像诊断技术中分辨率最高的成像技术,它可以识别斑块类型特征,也可以识别体内巨噬细胞以及血清学炎性生物标记物（外周血白细胞,超敏C反应蛋白）.本文讨论了OCT检测易损斑块,巨噬细胞对于预测急性冠脉综合征的研究进展.     

In-vivo comparison of coronary plaque characteristics using optical coherence tomography in women vs. men with acute coronary syndrome

OBJECTIVE: Women with acute coronary syndromes (ACS) have worse outcomes than men. Data on sex differences of culprit plaque characteristics are lacking. Intravascular optical coherence tomography (OCT) is a high-resolution imaging technique capable of in-vivo plaque characterization. The aim of this study was to compare culprit plaque characteristics in women and men presenting with ACS. METHODS: Patients undergoing coronary angiography after ACS were enrolled. We performed OCT imaging on the culprit lesions. Previously validated criteria for OCT plaque characterization were used: lipid was quantified on cross-sectional image and lipid-rich plaque was defined as > or = 2 involved quadrants; fibrous cap thickness was measured at the thinnest point and thin-cap fibroatheroma was defined as lipid-rich plaque with fibrous cap thickness less than 65 microm. RESULTS: Forty-two patients (33 men and nine women) were included. No significant sex differences were found in baseline characteristics. Lipid-rich plaques were identified in majority of patients. No significant difference, however, was seen in the frequency of lipid-rich plaques, thin-cap fibroatheroma or minimum fibrous cap thickness (79 vs. 89%; 45 vs. 67%; 53.8 vs. 45.4 microm, respectively; P=NS) between men and women. Incidence of calcification, thrombus and plaque disruption were also similar. CONCLUSIONS: No significant sex difference was seen in culprit plaque characteristics determined by OCT imaging in patients who presented with ACS.     

光学相干断层成像下青年女性急性冠状动脉综合征患者的斑块特征分析

目的:通过使用光学相干断层成像(OCT)分析青年女性急性冠状动脉综合征(ACS)患者冠状动脉斑块特征。方法:纳入北京安贞医院2014年12月至2018年1月,因ACS入院行OCT且年龄≤40岁的29例青年女性患者,通过冠状动脉造影及OCT对患者冠状动脉的狭窄程度及斑块特征进行分析,探讨青年女性患者的冠状动脉斑块特点。结果:29例青年女性患者的造影中,25例(86. 2%)累及LAD,其中18例(86. 2%)为单支病变。对29例青年女性患者的29处靶血管进行OCT检查,结果显示:26例(89. 7%)病变为TCFA病变,15例(51. 7%)病变观察到巨噬细胞聚集,6例(20. 7%)观察到微通道,9例(31. 0%)病变处合并斑块侵蚀,1例(3. 4%)合并斑块破裂。结论:青年女性ACS患者多同时合并多种危险因素,且其斑块易损性高,其发生冠状动脉事件的病理学基础可能为斑块侵蚀而非斑块破裂。     

Difference in plaque characteristics of coronary culprit lesions in a cohort of Egyptian patients presented with acute coronary syndrome and stable coronary artery disease: An optical coherence tomography study

Aims

This study was designed to utilize frequency-domain optical coherence tomography (FD-OCT) for assessment of plaque characteristics and vulnerability in patients with acute coronary syndrome (ACS) compared to stable coronary artery disease (SCAD).

Correlation of lipoprotein (a) levels and plaque morphology in very young acute coronary syndrome patients using optical coherence tomography

IntroductionLevels of lipoprotein (LP) (a) are useful marker for risk stratification of cardiovascular disease. This genetic biomarker is suggestive of patient predisposition to acute coronary event. The present study was to study correlation of LP(a) levels and plaque morphology in very young patients (<35 years) with acute coronary syndrome (ACS).MethodsA prospective, single-center, observational study consisting of very young patients with ACS and fit for optical coherence tomography (OCT) guided invasive coronary angiography was conducted at tertiary-care centre. LP(a) levels were compared between healthy controls and very young ACS patients. Correlation of LP(a) levels and plaque characteristics in very young ACS patients was done using OCT imaging.ResultsOut of enrolled 80 subjects, 40 were very young ACS and 40 were matched healthy controls. In very young patients, plaque rupture and erosion were mechanism of ACS in 67.5% and 32.5% patients, respectively. Mean levels of LP(a) were 28.10 ± 13.96 nmol/l in healthy controls and 47.19 ± 29.85 nmol/l in very young patients with ACS (p = 0.022). Among very young ACS patients, patients with LP(a) levels<75 nmol/l and ≥75 nmol/l had mean thin cap fibroatheroma thickness of 117.08 ± 52.542 μm and 95.00 ± 36.286 μm, respectively (p = 0.2355).ConclusionHigher levels of LP(a) were seen in younger patients with ACS compared with matched healthy individuals. Plaque rupture was the commonest mechanism of ACS in very young ACS patients. Patients with high LP(a) levels had lesser thickness of fibrous cap in OCT imaging compared with low levels of LP(a).     

Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome

Background and aimsThis study aimed to assess possible association of detailed abdominal fat profiles with coronary plaque characteristics in patients with acute coronary syndrome (ACS).Methods and resultsIn 60 patients with ACS, culprit arteries were evaluated at 1-mm intervals (length analyzed: 66 ± 28 mm) by grayscale and integrated backscatter intravascular ultrasound (IB-IVUS) before percutaneous coronary intervention. Standard IVUS indexes (as a volume index: volume/length), plaque components (as percent tissue volume) and fibrous cap thickness (FCT) were assessed by IB-IVUS. Plain abdominal computed tomography was performed to evaluate subcutaneous adipose tissue (SAT) area, visceral adipose tissue (VAT) area, and VAT/SAT ratio. While SAT area only correlated with vessel volume (r = 0.27, p = 0.04), VAT area correlated positively with vessel (r = 0.30, p = 0.02) and plaque (r = 0.33, p = 0.01) volumes and negatively with FCT (r = −0.26, p = 0.049), but not with percent plaque volume and plaque tissue components. In contrast, higher VAT/SAT ratio significantly correlated with higher percent lipid (r = 0.34, p = 0.008) and lower percent fibrous (r = −0.34, p = 0.007) volumes with a trend toward larger percent plaque volume (r = 0.19, p = 0.15), as well as thinner FCT (r = −0.53, p < 0.0001). In the multiple regression analysis, higher VAT/SAT ratio was independently associated with higher percent lipid with lower percent fibrous volumes (p = 0.03 for both) and thinner fibrous cap thickness (p = 0.0001).ConclusionCoronary plaque vulnerability, defined as increased lipid content with thinner fibrous cap thickness, appears to be more related to abnormal abdominal fat distribution, or so-called hidden obesity, compared with visceral or subcutaneous fat amount alone in patients with ACS.     

光学相干断层成像判断冠状动脉不稳定斑块

光学相干断层成像是近年出现的一项光学成像技术,其原理是基于光学干涉现象.该项技术与血管内超声相比具有更高的分辨率,本文根据光学相干断层成像在心血管疾病领域的研究进展,总结了该项技术对冠状动脉不稳定斑块方面的研究现状.     

Assessment of coronary arterial plaque by optical coherence tomography

The purpose of this study was to analyze the ability of optical coherence tomography (OCT) to identify coronary arterial plaque diagnosed by histologic examination. We examined 166 sections from 108 coronary arterial segments of 40 consecutive human cadavers (24 men and 16 women; mean age 74 +/- 7 years). The plaque type was classified as fibrous (n = 43), fibrocalcific (n = 82), or lipid-rich (n = 41). The accuracy of OCT and intravascular ultrasound (IVUS) in characterizing the plaque type was studied, with the histologic consensus diagnosis serving as the gold standard. OCT, as well as IVUS, had high sensitivity and specificity for characterizing the different types of atherosclerotic plaque. OCT had a higher sensitivity for characterizing lipid-rich plaques than IVUS (85% vs 59%, p = 0.03). In conclusion, the high resolution of OCT permitted evaluation of lipid-rich plaques more accurately than IVUS.