糖尿病患者冠状动脉粥样硬化病变的虚拟组织学血管内超声研究

目的 使用虚拟组织学血管内超声(virtual histology intravascular ultrasound,VH-IVUS)评价2型糖尿病患者冠状动脉粥样硬化斑块的组织成分和形态特征.方法 在2008年9月至2009年3月,前瞻性连续收集冠状动脉造影提示的、三支主要血管中直径狭窄≥50%的原位粥样斑块病变,进行灰阶血管内超声以及二维和体积法VH-IVUS分析.根据患者临床资料分为糖尿病(DM)组22例(39个病变)和非DM组46例(69个病变).结果 在最小管腔面积处,DM组斑块的坏死核心(19.4%±1.2%比15.1%±1.1%,P=0.015)和钙化成分(15.2%±1.6%比10.7%±1.1%,P=0.016)较非DM组更多,而纤维组织(56.7%±2.3%比64.8%±1.8%,P=0.007)更少;同样,体积法VH-IVUS发现DM组的坏死核心体积(21.3%±1.3%比16.5%±1.1%,P=0.008)和钙化组织体积(16.6%±1.4%比11.3%±1.1%,P=0.003)更大,而纤维组织体积(55.1%±2.1%比63.9%±1.8%,P=0.003)更小.此外,DM组薄帽纤维粥样硬化斑块的发生率(69.2%)较非DM组(42.O%)更高(P=0.009).然而,斑块重构系数和正性重构发生率在两组差异均无统计学意义.结论 相对于非DM患者,DM患者冠状动脉狭窄性粥样斑块的坏死和钙化组织含量更多,易损斑块也更多见.     

左主干冠状动脉病变的血管内超声研究

目的 血管内超声评价非严蕈钙化性左主干病变的形态特点,探讨开口和非开口部位形成狭窄的不同机制.方法 2004年10月至2007年10月,共入选造影确诊或可疑的狭窄病变并行血管内超声检查的153例(开口47例,非开口106例)非严重钙化性左主干病变,定性和定量分析血管内超声图像;负性重构定义为重构指数＜0.95.结果 左主干参考节段平均管腔直径和血管(外弹力膜)直径为(4.1±0.8)mm和(5.3士0.8)mm.开口病变的纤维性、钙化性和软斑块分别为70.2%、19.2%和8.5%,而非开口病变为35.8%、43.4%和3.8%,两者差异有统计学意义(P=0.01).总体来说,31.1%病例的最小管腔面积＜6 mm2,其中开口组29.5%,非开口组31.9%(P=0.87).最小管腔面积在两组相似,但非开口组的斑块面积[(13.3±5.4)mm2比(10.8±4.5)mm2,P=0.007]和斑块负荷(61.9%±14.5%比54.8%±15.9%,P=0.020)均显著大于开口组,斑块负荷＞50%的比例更高(84.8%比61.3%,P=0.002).开口病变的重构系数显著低于非开口病变(0.9±0.2比1.0.±0.2,P=0.000),而且负性重构更多见(74.5%和34.9%,P=0.000).logistic回归分析发现,病变部位(OR=4.9,P=0.004)、斑块面积(OR=1.2,P=0.01)和斑块负荷(OR=0.003,P=0.000)是左主干发生重构的独立预测因素.结论 负性重构现象在左主干开口病变中更常见,可能是其狭窄形成的机制之一.狭窄程度不确定的冠状动脉左主干病变需要血管内超声精确评价.     

基于多层螺旋CT血管造影技术评估不同重构模式的症状性颈动脉斑块特征

目的探讨多层螺旋CT血管造影(CT angiography, CTA)技术比较不同重构模式的症状性颈动脉斑块形态学及成分构成的相关特征。方法回顾性分析2016年1月～2020年10月在北京朝阳医院京西院区因症状性颈动脉就诊,并经CTA检查筛出颈动脉存在惟一责任斑块的患者129例,根据不同的重构模式分为正性重构组61例和负性重构组68例,比较2组斑块相关指标的差异。结果 2组斑块长度和斑块溃疡比例比较,无统计学差异(P0.05)。与负性重构组比较,正性重构组斑块负荷(0.62±0.26 vs 0.47±0.06,P=0.000)、斑块偏心指数(0.77±0.02 vs 0.68±0.03,P=0.016)和斑块脂质成分体积[434.50(226.80,704.90)mm~3vs 226.25(157.50,391.48)mm~3,P=0.000]更大,差异有统计学意义。结论多层螺旋CTA技术可快速准确评价斑块的形态和成分构成,对危险斑块的筛出具有重要的临床意义。     

不同血流储备分数冠状动脉临界病变的血管内超声特征研究

目的:探讨不同血流储备分数(FFR)冠状动脉(冠脉)临界病变的血管内超声(IVUS)特征。方法:对92例患者的冠脉临界病变行FFR检查,根据不同FFR值将患者分为3组:缺血组(FFR0.75,24例),临界组(0.75≤FFR≤0.80,31例),非缺血组(FFR0.80,37例)。应用gray-IVUS测量3组病变血管外弹力膜横截面积(EEM-CSA)、平均参考血管EEM-CSA、最小管腔面积(MLA)、病变长度、斑块负荷、管腔容积、总斑块体积以及斑块体积百分比(PAV);应用iMAP-IVUS定量分析3组间斑块组织学性质。比较3组间的临床资料与IVUS测量值是否有统计学差异。结果:3组间MLA[(2.6±0.3) mm~2∶(2.8±0.5) mm~2∶(3.3±0.9) mm~2,P0.001]、病变长度[(22.8±7.9) mm∶(21.7±6.7) mm∶(17.3±6.2) mm,P0.001]、斑块负荷[(76.1±9.5)%∶(73.4±7.5)%∶(67.8±9.3)%,P0.001]、斑块体积[(187.1±78.3) mm~3∶(178.4±67.8) mm~3∶(136.6±68.3) mm~3,P=0.015]及PAV[(61.2±7.5)%∶(57.7±6.4)%∶(52.9±7.6)%,P=0.021]具有显著统计学差异;但在组间析因分析中,缺血组和临界组的所有gray-IVUS参数均无显著统计学差异。iMAP-IVUS分析3组的斑块纤维成分[(43.7±8)%∶(44.4±6.5)%∶(48.7±6.4)%,P=0.127]、脂质成分[(13.7±2.5)%∶(11.6±2.6)%∶(11.7±2.8)%,P=0.091]无显著统计学差异,而坏死成分[(37.6±5.6)%∶(32.9±6.6)%∶(29.2±5.1)%,P=0.020]和钙化成分[(3.2±1.4)%∶(2.9±1.4)%∶(2.4±1.2)%,P=0.033]具有统计学差异;组间析因分析中,缺血组和临界组斑块坏死成分和钙化成分仍有统计学差异(均P0.05)。结论:FFR0.75与FFR临界值的冠脉临界病变的形态特征在gray-IVUS上相似,但前者在iMAP-IVUS中的坏死及钙化成分更高。基于iMAP-IVUS的结果,FFR0.75可能仍然是冠脉临界病变行血运重建的合理界值。     

急性冠状动脉综合征患者冠状动脉病变的血管内超声评价

目的采用血管内超声显像(IVUS)技术评价急性冠状动脉综合征(ACS)患者的冠状动脉病变特点.方法对45例ACS患者和28例稳定型心绞痛(SAP)患者的罪犯血管行IVUS检查,对病变部位IVUS图像进行定量和定性分析.定量测定指标包括病变部位和参照节段的血管面积(EEMcsa)、管腔面积(Lcsa,)和斑块面积(EEMcsa-Lcsa),斑块负荷=(EEMcsa-Lcsa)/EEMcsa×100%.血管重构指数(RI)定义为病变部位EEMcsa与参照节段平均EEMcsa的比值,RI＞1.0者为正性重构,RI＜1.0者为负性重构.结果与SAP患者相比,ACS组病变部位的EEMcsa[(15.4±4.6)mm2比(11.8±3.7)mm2,P=0.001],斑块面积[(11.9±4.1)mm2比(8.0±3.0)mm2,P＜0.001]和斑块负荷[(77.1±10.8)%比(65.0±12.0)%,P＜0.001]均显著高于前者,正性重构较SAP患者更常见(68%比38%,P=0.02),其RI(1.05±0.11)也高于SAP(0.98±0.14),P=0.025.ACS组病变以软斑块为主,占73%,明显高于SAP患者的28%(P=0.001),更多斑块破裂(38%比11%,P=0.012)和血栓形成(24%比0%,P=0.005).与负性重构病变比较,正性重构病变中软斑块占的比例较高(70%比34%,P=0.004),钙化较少[(18±37)°比(45±52)°,P=0.017].结论ACS患者冠状动脉病变的常见形态特征为软斑块,斑块破裂,血栓形成和正性重构.冠状动脉的重构形式与病变的组成有关.     

急性冠状动脉综合征梗死相关血管病变斑块组织成分的相关危险因素分析

目的:评价急性冠状动脉综合征(ACS)患者梗死相关血管病变(罪犯病变)斑块组织成分的相关危险因素。方法:对55例ACS患者行冠状动脉造影(55支罪犯血管)同时进行血管内超声虚拟组织成像(IVUS-VH)检查,根据诊断不同分为不稳定性心绞痛组(UAP组)40例,急性心肌梗死组(AMI组)15例。分析最小管腔面积处和病变最大坏死核处的最小管腔面积、斑块负荷,IVUS-VH分析坏死核面积百分比(NC%)、致密钙化面积百分比(DC%)、纤维脂肪组织面积百分比(FF%)、纤维组织面积百分比(FI%),计算重构指数。酶联免疫吸附(ELISA)法检测血清金属基质蛋白酶-9(MMP-9)、氧化低密度脂蛋白(ox-LDL)和超敏C反应蛋白(hs-CRP)水平。结果:AMI组和UAP组最小管腔面积处的NC%分别为(27.90±9.72)%和(19.41±11.53)%(t=-2.533,P=0.014);最大坏死核处的NC%分别为(39.09±8.82)%和(31.99±12.35)%(t=-2.032,P=0.047);两组比较差异均有统计学意义。AMI组和UAP组的MMP-9水平分别为(14.63±2.71)μg/L和(12.65±2.72)μg/L(t=-2.411,P=0.019);ox-LDL水平分别为(196.21±25.89)μg/L和(159.57±33.39)μg/L(t=-3.832,P=0.001);hs-CRP水平分别为(1.57±1.93)mg/L和(0.31±0.33)mg/L(t=-2.514,P=0.024);两组比较差异均有统计学意义。斑块组织成分与MMP-9、ox-LDL、hs-CRP水平不相关。罪犯病变最大坏死核处和最小管腔面积处的最小管腔面积分别为(5.25±2.15)mm~2和(3.45±1.07)mm~2(t=-6.348,P=0.001);NC%分别为(33.93±11.85)%和(21.73±11.62)%(t=-8.752,P=0.001),两者比较差异均有统计学意义。结论:(1)在ACS患者中,AMI患者较UAP患者的罪犯病变坏死核组织成分面积大,血清MMP-9、ox-LDL和hs-CRP水平高。(2)在同一罪犯病变中最小管腔面积处并不具有最大坏死核组织。(3)血清MMP-9、ox-LDL和hsCRP水平与斑块组织成分无关。     

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。     

血管内超声评估冠状动脉管腔狭窄伴外弹力膜扩张性血管重构的临床研究

目的:应用血管内超声评估冠状动脉(冠脉)管腔狭窄伴外弹力膜扩张性血管重构的临床研究.方法:103例急性冠状动脉综合症(ACS)患者,男68例,女35例,年龄平均(60±11)岁;常规冠脉造影,血管内超声检测103处靶病变和参考血管处动脉粥样斑块形态学参数.将重构指数＞1为正重构组(n=67),重构指数≤1为负重构组(n=36);计算靶病变处管腔面积与平均参考段的管腔面积的比值(称为管腔狭窄比值).比较分析重构分组之间的斑块形态学特点,比较两组在病变处与参考段之间的差异;并进行管腔狭窄、外弹力膜扩张与斑块负荷的相关性分析.结果:103例患者中有5例ACS患者靶病变的管腔面积与平均参考血管的管腔面积相同,1例患者未见参考血管段的病变.102例存在参考血管段病变患者的资料统计显示,靶病变处与近端和远端参考段比较,斑块负荷的明显增加[依次为(71.76±9.17)%,(39.76±12.54)%,(32.38±13.97)%];管腔面积缩小[依次为(3.81±1.09)mm2,(8.91±2.43)mm2,(9.03±2.16)mm2];靶病变处与远端参考段比较,病变处外弹力膜(EEM)面积缩小[(14.71±2.89)mm2 vs(28.37±4.48)mm2],差异有统计学意义(P均＜0.001).管腔狭窄比值与斑块负荷呈负相关性(r=-0.84,P＜0.001)而与管腔面积呈正相关性(r=0.70,P=0.007);重构指数与其他参数未见相关性.结论:ACS患者冠状动脉存在着管腔狭窄伴外弹力膜扩张的双向重构,管腔狭窄比值可能是评估重构的重要指标.     

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.     

血管内超声、64层螺旋CT及定量冠状动脉造影对不稳定性心绞痛患者冠状动脉病变的评价

目的 应用血管内超声(rvos)探讨不稳定性心绞痛(UAP)低、中及高危组患者动脉粥样硬化斑块的特点,评价定量冠状动脉造影(QCA)和64层螺旋CT(MDCT)的诊断价值.方法 采用IVUS、MDCT和QCA分析61例UAP患者(低危组17例,中危组33例,高危组11例)71支病变血管.分析比较3组患者斑块的形态学特点.根据IVUS斑块回声的强度,将斑块分为软斑块、纤维斑块、钙化斑块、混合斑块,计算最小面积处斑块负荷,并分为≤50%、51%～74%及≥75%3类病变.以IVUS结果为标准,评价QCA计算血管狭窄程度的可信性,MDCT诊断3类病变的敏感性和特异性,及对斑块成分诊断的可靠性.结果 QCA可估计低危组和中危组患者的斑块负荷(低危组r=0.768,P<0.01;中危组r=0.721,P<0.01).高危组患者血管重构明显(冠状动脉重构指数=1.21±0.31),QCA低估了IVUS的斑块负荷[分别为(67±14)%、(75±16)%,r=0.551,P<0.01].MDCT对冠状动脉病变有较高的阴性预测值(87.8%-96.3%),但无法区分典型粥样硬化斑块内的纤维帽(kappa=0.245)及脂质核(kappa=0.235).3组患者IVUS斑块特点分析结果表明,随着危险度程度的增加,软斑块比例、血管正性重构程度、血管外弹力膜面积、最小管腔面积、斑块负荷、斑块破裂及血栓发生率逐渐增加.结论 QCA可以相对准确地评价UAP低危和中危组患者的冠状动脉狭窄程度,同时会低估高危组患者的病变程度.MDCT对于冠心病的诊断有非常高的阴性预测值可用于排除冠心病,但是无法可靠地区分粥样硬化斑块内的纤维帽及脂质核.IVUS检查显示软斑块、正性血管重构和最小管腔面积<4mm~2者可能为UAP高危组患者.     

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.     

Impact of preinterventional arterial remodeling on in-stent neointimal hyperplasia and in-stent restenosis after coronary stent implantation.

BACKGROUND: Patterns of arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting. METHODS AND RESULTS: Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09+/-0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84+/-0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (P&M CSA) at pre-intervention and NIH CSA at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group (9.2+/-2.9 mm2 vs 6.2+/-1.8 mm2, 3.3+/-1.2 mm2 vs 1.5+/-0.9 mm2; p = 0.001, p = 0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62+/-15 mm3 vs 75 +/-20 mm3; p = 0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46+/-15 mm3 vs 26+/-10 mm3; p = 0.001). A significant positive correlation was found between pre-interventional RI and follow-up NIH CSA (r = 0.25, p = 0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs 18.2%, 28.8% vs 15.2%; p = 0.032, 0.035, respectively). CONCLUSION: Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR.     

IVUS radiofrequency analysis in the evaluation of the polymeric struts of the bioabsorbable everolimus‐eluting device during the bioabsorption process

Background : In the ABSORB study cohort A the changes in the amount of dense calcium and necrotic core have not been reported in comparison to the prestenting phase; this evaluation could be useful to better clarify the bioabsorption process. Aim of this study was therefore to evaluate the dynamic changes in plaque size and plaque tissue composition observed between 6 months and 2 years follow‐up, and to compare these findings to the prestenting phase. Methods : Angiography, intravascular ultrasound and derived parameters (virtual histology, palpography, and echogenicity) were serially assessed postprocedure, at 6 months and at 2 years in 20 patients. In a subset of 8 patients the same measurements were also recorded in the prestenting phase. Results : In the total population a reduction of 18% in the plaque area was observed between 6 month and 2 year follow‐up (7.56 ± 2.32 mm² at 6 months vs. 6.16 ± 2.10 mm² at 2 year follow‐up; P < 0.01). In the subgroup of eight patients who underwent IVUS during the pre‐stenting phase, the plaque area at 2 year follow‐up was not significantly different when compared to the prestenting plaque area (7.29 ± 2.29 mm² at prestenting vs. 7.48 ± 1.45 mm² at 2 year follow‐up, P = NS). Necrotic core area was reduced by 24% between the 6 month and 2 year follow‐up (0.97 ± 0.66 mm² at 6 months vs. 0.74 ± 0.53 mm² at 2 year follow‐up; P = NS), whilst dense calcium was reduced by 14% from 6 month to 2 year follow‐up (0.83 ± 0.50 mm² at 6 months vs 0.72 ± 0.64 mm² at 2 year follow‐up; P = NS). Whilst the necrotic core at 2 years follow‐up was not significantly different when compared to the pre‐stenting phase (0.62 ± 0.42 mm² prestenting vs 1.07 ± 0.56 mm² at 2 year follow‐up; P = NS), the area of dense calcium was significantly higher at follow‐up compared to prestenting (0.35 ± 0.35 mm² pre‐stenting vs. 0.84 ± 0.66 mm² at 2 year follow‐up; P < 0.05). Conclusions : The reduction in the necrotic core component between 6 month and two year follow‐up could be related to a synergistic effect of the bio‐absorption process and the anti‐inflammatory action of everolimus. © 2010 Wiley‐Liss, Inc.     

Coronary artery distensibility and compensatory vessel enlargement--a novel parameter influencing vascular remodeling?

Vascular remodeling implies the concept of compensatory vessel enlargement to preserve luminal dimensions during atheromatous plaque development. However, negative remodeling, i.e. vessel shrinkage in response to plaque accumulation has also been described. So far, the factors influencing positive or negative remodeling are uncertain. We hypothesized that vascular distensibility, a measure of vessel compliance, is related to compensatory enlargement. In 58 patients undergoing intravascular ultrasound interrogation of a de novo lesion prior to coronary intervention, the cross-sectional vessel area (VA), lumen area (LA) and plaque area (PA = VA minus LA) were measured at end diastole and end systole at the lesion site and at the proximal and distal reference segments. Positive remodeling was defined to be present when the VA at the lesion was > 1.05 times larger than that at the proximal reference (group A), negative remodeling when the VA at the lesion was < 0.95 of the reference site (group C) and in-between was considered to be intermediate (group B). Vessel compliance was measured by calculating vascular distensibility. Results showed a similar LA at the lesion site in all groups (4.18 ± 2.18 vs. 4.36 ± 1.19 vs. 3.74 ± 1.81 mm², NS) while VA and PA were significantly larger in group A (17.19 ± 5.08 vs. 14.22 ± 3.66 and 12.45 ± 4.82 mm², p = 0.005 and 13 ± 4.55 vs. 9.95 ± 3.58 and 8.7 ± 3.83, p = 0.003, respectively). Vascular distensibility at the proximal reference segment was significantly greater in group A (3.55 ± 2.67 vs. 1.25 ± 1.03 and 0.85 ± 0.73 mmHg⁻¹, p < 0.001) with a positive correlation between remodeling and distensibility (R = 0.52, p < 0.001). In a multiple regression model including clinical and lesional factors, distensibility was the only predictor of remodeling. In conclusion, these results suggest that compensatory vessel enlargement occurs to a greater degree in patients with increased coronary artery distensibility, which appears to be a predictor for positive remodeling. Received: 14 September 2000, Returned for revision: 30 October 2000, Revision received: 8 January 2001, Accepted: 24 January 2001     

Virtual Histology Intravascular Ultrasound Analysis of Attenuated Plaque and Ulcerated Plaque Detected by Gray Scale Intravascular Ultrasound and the Relation Between the Plaque Composition and Slow Flow/No Reflow Phenomenon During Percutaneous Coronary Intervention

Objective

This study aimed to assess the plaque characteristics of attenuated and ulcerated plaques in virtual‐histology intravascular ultrasound (VH‐IVUS) and the incidence of slow flow/no reflow during percutaneous coronary intervention (PCI).

Background

The attenuated and ulcerated plaques are thought as embolic prone plaque; however, the plaque characteristics are unclear.

Methods

Subjects were 119 patient's 121 lesions undergoing VH‐IVUS before coronary stenting. These lesions were divided into the 15 lesions showing attenuated plaque, 24 lesions showing ulcerated plaque, and 82 lesions revealing neither attenuated nor ulcerated plaque (the control group).

Results

Fibro‐fatty tissue in the attenuation group was significantly larger than the control group (27.5 ± 9.5% vs 13.9 ± 8.2%, P < 0.01, 3.5 ± 1.9 mm² vs 1.6 ± 1.2 mm², P < 0.01). Necrotic core in ulceration group was significantly larger than the control group (20.7 ± 9.0% vs 15.9 ± 9.0%, P < 0.05, 2.5 ± 1.3 mm² vs 1.7 ± 1.0 mm², P < 0.01). Dense calcium in ulceration group was significantly larger than the control group (12.3 ± 6.4% vs 8.3 ± 7.1%, P < 0.05, 1.4 ± 0.7 mm² vs 0.9 ± 0.8 mm², P < 0.01). In the ulceration group, the necrotic core area of acute coronary syndrome was significantly larger than the stable angina pectoris (3.0 ± 1.4 mm² vs 1.8 ± 1.0 mm², P < 0.05). The incidence of slow flow/no reflow was significantly higher in the attenuation and ulceration group than the control group (20.0% [3/15], 20.8% [4/24] vs 4.9% [4/82], P < 0.05, 0.05).

Conclusion

The attenuated plaque had significantly larger fibro‐fatty tissue. The ulcerated plaque had significantly larger necrotic core and dense calcium. The lesions with the attenuated and the ulcerated plaque had more frequent slow flow/no reflow during PCI. (J Interven Cardiol 2013;26:295–301)

     

Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap

Objectives

This study assessed the incidence and course of healing of uncovered plaque ruptures (PR) following primary percutaneous coronary intervention.

Virtual histology by intravascular ultrasound study on degenerative aortocoronary saphenous vein grafts

Data of virtual histology (VH) acquired by intravascular ultrasound (IVUS) on saphenous vein graft (SVG) lesions is lacking. This study sought to report the VH IVUS findings in degenerative aortocoronary SVG lesions and correlate various types of plaque compositions (fibrous, fibro-fatty, dense calcium, and necrotic core) with different clinical and lesion characteristics. Virtual histology IVUS was performed on SVG in 38 symptomatic patients with a history of coronary artery bypass grafting, who underwent percutaneous coronary intervention on either native vessels or SVG. Measurements were made at the image slice with the smallest lumen. A total of 54 SVG lesions were analyzed; the mean graft age was 13.7 ± 4.0 years. The mean vessel size was 5.0 ± 1.0 mm; plaque area was 13.4 ± 7.3 mm², and plaque burden was 63.0% ± 15.0%. Fibrous tissue represented the major plaque component (62.1% ± 17.1%). Lesions with a plaque burden of ≥70% were associated with positive remodeling, larger vessel size, higher percentage of fibro-fatty tissue, but lower percentage of dense calcium. Plaque burden was found to be positively correlated with remodeling index (r = 0.37, P = 0.01) and % fibro-fatty tissue (r = 0.49, P < 0.001) but negatively correlated with % dense calcium (r= −0.31, P = 0.03). The severity of SVG atherosclerosis paralleled with a proportional increase in fibro-fatty tissue. Unstable plaques in SVG were associated with positive remodeling, lipid-rich atheroma, and less calcium deposition, similar to the VH IVUS findings in native coronary arteries.     

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。