Impact of metabolic syndrome on coronary plaque vulnerability in Japanese women with acute coronary syndrome.

BACKGROUND: Previous study has demonstrated that metabolic syndrome (MetS) can predict cardiovascular mortality in men, but the prediction was weak for women. In the present study predictors for multiple complex coronary lesions were investigated to clarify the impact of MetS in Japanese women with acute coronary syndrome (ACS). METHODS AND RESULTS: Subjects were Japanese women with ACS (n=81) who underwent emergency coronary angiography and B-mode carotid ultrasonography. They were divided into 2 groups based on the number of complex plaques. Although the MetS prevalence identified using the Japanese criteria was similar between the 2 groups, using the modified ATP III criteria it was more in patients with multiple coronary lesions than in those with a single coronary lesion (p<0.02). The prevalence of diabetes mellitus (DM) in the multiple group was higher than that in the single group (p<0.008). Significant independent predictors for multiple complex coronary lesions were DM (odds ratio (OR) 4.78, p<0.03) and carotid artery remodeling (OR 8.81, p<0.02). Among the components of MetS, a low level of high-density lipoprotein-cholesterol (<50 mg/dl) was a significant independent predictor (p<0.007). CONCLUSIONS: DM and carotid artery remodeling are useful markers for coronary vulnerability in Japanese women. Gender-specific pathophysiological differences may exist for components of MetS.     

Clinical implications of carotid artery remodeling in acute coronary syndrome: ultrasonographic assessment of positive remodeling

OBJECTIVES: We investigated the relationship between ultrasonographic features of the carotid artery and the angiographic features of coronary plaques in acute coronary syndrome (ACS). BACKGROUND: The carotid intima-media thickness (IMT) may be a marker of advanced coronary artery disease. METHODS: Consecutive ACS patients (N = 125) underwent B-mode ultrasonography within one week of the acute coronary event. Using a 7.5-MHz linear array transducer, the common carotid IMT, interadventitial diameter, and luminal diameter were examined. Carotid plaques were also assessed. Then patients were divided into two groups based on the number of complex plaques identified by coronary angiography. RESULTS: The carotid IMT of 75 patients with multiple complex coronary plaques was significantly larger than that of 50 patients with solitary plaques (p < 0.0003). The prevalence of soft and hard carotid plaques was higher in the group with multiple coronary plaques than in those with single plaques (28% vs. 12%, p < 0.04 and 13% vs. 0%, p < 0.008, respectively). Additionally, the carotid interadventitial diameter was larger in the patients with multiple plaques than in those with single plaques (7.93 +/- 0.97 mm vs. 7.48 +/- 0.88 mm, p < 0.01), and a significant correlation was observed between the carotid IMT and interadventitial diameter (R = 0.54, p < 0.0001). CONCLUSIONS: In ACS, multiple complex coronary plaques are associated with positive carotid remodeling, suggesting that plaque vulnerability may be a systemic phenomenon.     

颈动脉内中膜厚度、颈动脉斑块总积分及P选择素水平与急性冠状动脉综合征患者冠状动脉病变的关系

目的分析颈动脉内中膜厚度(IMT)、颈动脉斑块总积分(Crouse积分)及P选择素(PS)水平与急性冠状动脉综合征(ACS)患者冠状动脉狭窄程度及6个月主要不良心脏事件(MACE)的关系。方法选择2012年6月至2013年1月在河北联合大学附属医院心内科以胸痛入院的282例患者,所有患者入院后均行冠状动脉造影检查,根据造影结果、心电图及心肌酶结果将入选人群分为非冠心病患者78例(对照组)、不稳定型心绞痛患者117例(UAP组)及急性心肌梗死患者87例(AMI组)。所有患者入院时行PS测定,入院后72 h内完成颈动脉血管超声检查测定IMT并计算Crouse积分,根据冠状动脉造影结果行Gensini评分,评价狭窄程度。随访6个月,追踪患者MACE的发生。应用SPSS 13.0进行统计分析,比较各组间颈动脉IMT、Crouse积分及PS水平的差异。结果对照组与ACS组比较,IMT[(0.90±0.29)mm比(1.38±0.25)mm]、Crouse积分(3.88±1.45比8.98±2.92)及PS水平[(14.79±3.15)ng/L比(42.21±11.71)ng/L]差异均有统计学意义(均为P<0.01);与对照组比较,UAP组和AMI组的IMT[(1.33±0.18)mm和(1.44±0.31)mm]、Crouse积分[(8.29±2.78)mm和(9.92±2.86)mm]及PS水平[(38.95±10.31)ng/L和(46.57±12.09)ng/L]均明显增高,且UAP组和AMI组间比较差异亦有统计学意义(均为P<0.01);冠状动脉单支病变、双支病变和三支病变的ACS患者的IMT[(1.18±0.26)mm、(1.39±0.17)mm和(1.57±0.17)mm]、Crouse积分(6.13±1.89、9.15±1.84和11.99±2.11)及PS水平[(32.51±8.96)ng/L、(43.76±9.64)ng/L和(50.79±9.65)ng/L],两两比较差异均有统计学意义(均为P<0.01);ACS患者的IMT、Crouse积分及PS水平与冠状动脉Gensini评分呈显著正相关(r=0.83、0.75和0.84,均为P<0.01)。MACE组与无MACE组比较,IMT[(1.56±0.19)mm比(1.28±0.29)mm]、Crouse积分(11.93±2.61比7.68±2.86)及PS水平[(52.28±8.45)ng/L比(36.47±13.41)ng/L]差异均有统计学意义(均为P<0.01)。结论 IMT、Crouse积分及PS水平检测可作为ACS的预测因子,并有助于ACS患者的冠状动脉病变严重程度及预后评估。     

Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease

Objective. Epicardial adipose tissue (EAT) is recognized as a novel risk factor for coronary artery disease (CAD), and its contribution is thought to be stronger in non-obese patients than in obese patients. However, the prognostic impact of the progression of EAT accumulation after comprehensive management for atherosclerotic risk factors remains unclear. This study aimed to investigate whether an increase of the EAT volume during follow-up predicts future acute coronary syndrome (ACS) events in non-obese CAD patients. Methods. This study consisted of 517 non-obese CAD patients (368 men; age, 66 ± 10 years) who underwent serial multidetector computed tomography (MDCT) examinations to evaluate coronary atherosclerosis progression. The MDCT examination was used to assess the severity of stenosis, plaque characteristics, and EAT volume. All patients received comprehensive management to reduce CAD risk factors after the first MDCT examination. The MDCT examination was repeated at 6–24 months, and patients were followed-up for more than 1 year or until the occurrence of ACS events. Results. Of 517 patients, 159 (31%) patients were classified into increase of EAT volume during follow-up, 91 (18%) into decrease of EAT volume during follow-up, and 267 (51%) patients into constant of EAT volume during follow-up. The prevalence of obstructive plaques and MDCT-derived vulnerable features of coronary plaques were significantly elevated in patients with increase of EAT volume during follow-up. In contrast, no significant changes were observed in the other 2 groups. During the follow-up period of 4.1 ± 1.8 years (median 4.4 years) after the second MDCT examination, ACS occurred in 43 (8.3%) patients. Multivariate Cox regression analysis showed that the presence of low-attenuation plaque (hazard ratio [HR]; 1.78, p = 0.04) and napkin-ring sign (HR; 3.74, p < 0.001) at second MDCT examination, and changes of EAT volume per 10 ml (HR; 1.34, p = 0.004) were associated with future ACS events. Conclusion. Patients with increase of EAT volume during follow-up despite comprehensive management for CAD risks had an increased prevalence of obstructive plaques and plaques with high-risk features, which could be associated with unfavorable ACS outcomes in non-obese CAD patients.     

Relationships between vascular factors and plaque morphology in patients with acute coronary syndrome

Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound（lVUS） was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors（sPE,t-PA, MCP-1, IL-8,1L-6,sVCAM-1, and sCD40L） was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction （AMI） and ustable angina （UA） patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-lsPE, sVCAM-I-sCD40L, sCD40L-sPE, IL-6-ILS,ILS-MCP1, and MCPI-sVCAM-1; CRP （18.868±4.907mg/L vs 5.806±3.553 mg/L）and IL-6 （19.5 pg/ml [9.2 - 44.6 pg/ml]vs 5.3 pg/ml [2.3- 13.4 pg/ml]）were elevated in the vulnerable plaque group（P 〈0.05）. sCD40L（473.82± 126.11 vs 237.94± 34.78 pg/ml）,sPE （107.21±39.90 vs 49.06 ±5.61ug/L） and MCP-1（132.42 ± 17.85 vs 127.17±13.27 pg/ml） were increased in the plaque rupture group（P 〈 0.05）;There was correlation between tPA and plaque morphology（P 〈 0.05）. Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis ofAMI, sCD40L, MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.     

急性冠状动脉综合征患者胆固醇代谢标志物与罪犯血管斑块易损性的相关性研究

目的:探讨急性冠状动脉综合征(ACS)患者胆固醇代谢标志物与罪犯血管虚拟组织学-血管内超声特点的相关性。方法:入选4周内未接受过调脂治疗的ACS的患者共55例,根据血管虚拟组织学-血管内超声检查确定有无薄帽纤维粥样硬化斑块(TCFA),将患者分为两组,比较两组患者斑块组分及胆固醇代谢标志物水平的差异。结果:TCFA(+)组罪犯病变斑块的纤维脂质、坏死核心、钙化成分较TCFA(-)组显著增高,[分别为18.55(12.20,46.77)vs.12.60(4.31,16.39)mm~3,P=0.002;44.88(35.06,68.82)vs.25.97(15.23,28.98)mm~3,P=0.000;3.20(1.03,4.70)vs.1.30(0.80,2.50)mm~3,P=0.015]。谷固醇与罪犯病变斑块的坏死体积、钙化体积成正相关。结论:胆固醇吸收标志物水平可能与冠状动脉斑块的易损性呈正相关。     

颈动脉粥样斑块对冠心病的预测价值

目的探讨颈动脉粥样斑块对冠心病的预测价值。方法对39例行冠状动脉造影术者同时做颈动脉超声检查,将冠状动脉造影结果与颈动脉超声结果进行对比分析。结果颈动脉粥样斑块形成者与正常者冠脉造影阳性率分别为74%和25%(P<0.01),双侧和单侧颈动脉斑块形成者冠脉造影阳性率分别为92%和20%(P<0.05),颈动脉粥样斑块对冠心病诊断的敏感度、特异度、诊断价值分别为81%、67%和74%。结论颈动脉粥样斑块对冠心病有较高的预测价值,双侧颈动脉粥样斑块较单测者预测性更高。     

Coronary plaque instability in severe acute respiratory syndrome

In his second week of severe acute respiratory syndrome (SARS) illness, a patient developed an unusually complicated course of acute coronary syndrome. One day after initial stabilization of a non-ST-elevated anterior myocardial infarction (MI), he sustained an ST-elevated anterior MI. Eight hours after emergency coronary intervention to the culprit lesion, he developed another ST-elevated MI in the inferior territory. Acute inflammation and cytokine storm in the immunopathological phase of SARS may play a role in coronary plaque instability. Physicians should be alert to this potentially fatal complication and adopt appropriate vigilant and aggressive management strategies.     

急性冠状动脉综合征与稳定性冠心病斑块组织成分的比较

目的 应用血管内超声虚拟组织成像技术评价稳定性冠心病(SCAD)患者与急性冠状动脉综合征(ACS)患者冠状动脉斑块成分的差别,为探讨有效的易损斑块检测方法提供证据.方法 入选210例冠心病患者,根据临床表现分为ACS组和SCAD组.对所有直径＞2.5 mm的血管内狭窄超过50%的病变行血管内超声检查,共评价346处原位病变.应用虚拟组织学软件分析斑块成分并进行组间比较.结果 在ACS与SCAD患者间,总的冠状动脉粥样硬化斑块成分比例差异无统计学意义(纤维组织51.2%±12.5%比52.6%±9.6%,纤维脂肪组织11.3%±10.6%比12.9%±9.4%,钙化组织15.1%±8.9%比20.5%±12.5%,坏死成分23.1%±9.8%比20.4%±6.8%,均P＞0.05).两组问罪犯病变成分比例差异也无统计学意义(纤维组织49.1%±11.2%比50.3%±9.7%,纤维脂肪组织10.2%±9.5%比12.7%±9.5%,钙化组织15.4%±8.9%比17.4%±24.8%,坏死成分24.0%±11.5%比19.7%±5.3%,均P＞0.05).ACS患者中,高密度脂蛋白胆固醇＞1.04 mmol/L者与≤1.04 mmol/L者比较,斑块纤维脂肪成分较多(15.6%±9.6%比7.4%±5.9%,P＜0.05),而坏死成分较少(19.4%±8.6%比28.6%±11.2%,P＜0.05).结论 SCAD与ACS患者冠状动脉粥样硬化斑块中各种成分的比例无明显差别.因此,评价斑块的易损性不仅要看各种成分所占的比例,更重要的是关注不同成分在斑块内的空间分布以及与血管腔的关系.     

Coronary angioplasty in acute coronary syndrome

PTCA is a widely used technique in patients post-acute myocardial infarction (AMI) as well as in unstable angina (UA). The precise timing of its application and some aspects of the indication nowadays remains a matter of controversy. Primary PTCA is not generally considered to be the initial treatment of AMI. In contrast, immediate PTCA after thrombolysis has been proposed attempting to decrease the incidence of early reocclusion, improve myocardial salvage, decrease the incidence of postinfarction angina and improve survival. Nevertheless, three recent controlled studies (TAMI, TIMI II and ECSG) have demonstrated that an "aggressive" strategy with obligatory, invasive intervention following thrombolysis does not provide any advantage in terms of survival, rate of reocclusion or improved ventricular function and is, in fact, likely to be harmful. Emergent coronary arteriography after AMI should be reserved for unstable patients with continued or recurrent ischemia in the CCU. In elective basis it should be indicated in all patients with spontaneous or provocable ischemia prior to hospital discharge. If high grade coronary stenoses are identified, the patient should be considered for PTCA or surgical revascularization. In our own experience with coronary arteriography 24 hours to 15 days after intravenous thrombolysis with SK, PTCA is anatomically feasible in 44% of all the patients and in 60% of those showing a patent vessel. However, when indicated because of postinfarction angina or a positive stress test, PTCA was performed only in 22%, some of them presenting with a totally occluded vessel. In case of stenosis lesser than 100% the dilation success rate is slightly lower than that of out entire series (84% vs 88%), but the incidence of acute occlusion is significantly higher (10% vs 6%), particularly in patients with angiographic evidence of intracoronary thrombi. The incidence of "non-significant" (less than 70%) stenosis spontaneously increases when the coronary arteriography is performed late during hospitalization (34% vs 17% when the patient is studied in the first 24-48 hours).(ABSTRACT TRUNCATED AT 250 WORDS)     

急性冠状动脉综合征患者血管因子与冠状动脉斑块特征的相关性研究

目的探讨急性冠状动脉综合征（ACS）患者血管因子与冠状动脉斑块特征的相关性。方法选择56例ACS患者,年龄（60±11）岁,男37例,女19例,发病时取血,应用液相蛋白芯片结合流式细胞分析方法测定7种血管因子：可溶的P选择素（sPE）、组织血纤维蛋白溶酶原激活物（tPA）、单核细胞趋化蛋白1（MCP-1）、白细胞介素（IL）-8、IL-6、可溶的血管细胞间黏附分子1（sVCAM-1）和可溶的黏附分子40配体（sCD40L）,以及相应的炎症因子;常规冠状动脉造影,并用血管内超声（IVUS）检测56个靶病变处动脉粥样斑块形态学及性质特征。分析急性心肌梗死（AMI）与不稳定性心绞痛（UA）患者、易损斑块与非易损斑块组发生斑块破裂时的血管因子改变以及斑块形态学指标与血管因子的相关性。结果存在密切相关的血管因子有sVCAM-1和sPE、sVCAM-1和sCIMOL、sCD40L和sPE、IL-6和IL-8、IL-8和MCP1、以及MCP1和sVCAM-1;易损斑块组的高敏C反应蛋白（hs-CRP）为（18．9±4．9）mg／L,IL-6为[19.5ng／L（9．2—44．6ng／L）],明显高于非易损斑块组[hs-CRP：（5.8±3．6）mg／L,IL-6：5.3ng／L（2．3—13．4ng／L）,均P〈0．05];与非斑块破裂组比较,斑块破裂组的sCD40L[（474±126）ng／L比（238±35）ng／L],sPE[（107．2±39．9）ng／L比（49．1±5．6）μg／L]和MCP-1[（132±18）ng／L比（127±13）ng／L]明显升高（均P〈0．05）;tPA与斑块形态之间存在一定的相关性（均P〈0．05）。sCIMOL、MCP—1,sPE和TC水平升高是发生斑块破裂的独立危险因素（均P〈0．05）。结论炎症反应作为中间过程,IL-6和CRP标志易损斑块的生物特点,对AMI可能有一定的诊断意义,而sCIMOL、MCP-1和sPE可能是另一个潜在的反映ACS严重发作的标志。     

Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome

Background and aimsMetabolic syndrome (MetS) is associated with increased incidence of diabetes and cardiovascular diseases in patients initially free from these diseases. However, its prognostic value in patients with established coronary artery diseases remains controversial. Therefore, we aimed to illustrate the prevalence and investigate the impact of MetS in patients with multivessel coronary artery disease (MVD) and acute coronary syndrome (ACS).Methods and resultsThis was a large registry of consecutive patients with ACS referred to primary percutaneous coronary intervention (PCI) and those with MVD were eligible for this analysis. MetS was defined based on modified Adult Treatment Panel III definition. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction and stroke. A total of 2532 patients were included in the current analysis and 993 (39.2%) of them had MetS. The prevalence of MetS increased from 2010 to 2016 (p _{for trend} = 0.005). In patients over 60 years old, the prevalence of MetS decreased with aging (p _{for trend} = 0.002). Female subjects had a higher prevalence than their male counterparts (61.5% verse 32.9% and p < 0.001). Over a median follow-up of 2.3 years, MetS was not significantly associated with MACE (adjusted 95% CI from 0.92 to 1.54).ConclusionMetS was frequently observed in patients with MVD and ACS. Patients with MetS were more likely to be young and female. However, it was not an independent predictor for MACE after primary PCI in those patients.     

Relationship between plaque morphology of carotid artery and aortic valve calcification

Aortic and mitral valvular calcifications are found to be associated with atherosclerotic risk factors and are largely accepted as part of a generalized atherosclerotic process. As well as the severity of stenosis, embologenic properties of plaques are also responsible for ischemic potentials of atherosclerotic plaques in carotid arteries. In this study, the authors aimed to define the characteristics of plaque morphology in patients with and without aortic valvular calcification (AVC) and to show the association between AVC and carotid plaque characteristics. Carotid plaque morphology in 182 consecutive patients with AVC was compared with plaque characteristics in 170 patients without AVC. Risk factors for atherosclerosis, age, and gender were similar in patients with and without AVC. The presence of carotid atherosclerosis, complex atheromas, and carotid artery stenosis was significantly higher in patients with AVC when compared with those without AVC (p < 0.001, p < 0.001, and p < 0.05, respectively). Unstable plaques (Types I and II) were also found to be more common in the patients with AVC than in those without AVC (p < 0.001). This study demonstrated the strong correlation between AVC and carotid atheromas. The plaques in patients with AVC are more unstable in morphology than in those without AVC, and this may explain the higher stroke incidence in these patients.