Insights Into Echo-Attenuated Plaques, Echolucent Plaques, and Plaques With Spotty Calcification
Insights Into Echo-Attenuated Plaques, Echolucent Plaques, and Plaques With Spotty Calcification
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DOI：
10.1016/j.jacc.2014.02.576
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发表时间：
2014-06-03
影响因子：
24
通讯作者：
Maehara, Akiko
中科院分区：
文献类型：
--
作者：
Pu, Jun;Mintz, Gary S.;Maehara, Akiko
三种血管内超声（IVUS）特征与冠状动脉疾病不稳定性相关：回声衰减、斑块内回声带和点状钙化。本研究的目的是研究在相对较大的一系列死后人类冠状动脉样本中负责这些IVUS特征的底物。背景回声衰减、斑块内回声带和点状钙化的确切机制和病理相关性尚不清楚。方法采用改良的美国心脏协会分级法，比较IVUS与近红外光谱对62例患者尸检151例冠状动脉标本中2294条血管段的脂质核心斑块和组织病理学的检测结果。结果IVUS检测到18.3%的节段回声减弱斑块，10.5%的节段回声增强斑块，14.4%的节段点状钙化斑块。组织病理学上，91.4%的回声减弱斑块对应于纤维粥样瘤（FA）伴核心坏死（NC）或病理性内膜增厚伴脂质池；几乎所有浅表回声衰减的节段均提示FA伴晚期NC的存在。与回声减弱斑块相比，超声斑块表明存在相对较小的脂质或NC(厚度：0.51 mm[四分位数间距（IQR）： 0.35至0.64 mm] vs. 0.70mm [IQR: 0.54至0.92 mm] [p < 0.001]；弧度：74.5度[IQR: 59.0度至101.0度]vs. 90度[IQR: 70.0度至112.0度][p < 0.001])，尽管82.8%的浅表回声区显示含nc的FA。IVUS点状钙化，尤其是体表部位的点状钙化（72.6%），常与伴有钙沉积的FA相关，与纤维钙化斑块相比，FA背景下的钙弧度更小（37.5度[IQR: 23.0度至53.0度]vs. 59.0度[IQR: 46.0度至69.0度]；p < 0.001）。IVUS和近红外光谱的比较显示，回声衰减斑块包含近红外光谱衍生的脂质核心斑块的可能性最高，其次是回声斑块和点状钙化。本研究表明，回声衰减斑块，特别是表面回声衰减，是识别高风险斑块（即含有大NC的FA）最可靠的IVUS特征。[J] .中华医学会心脏科杂志，2014;33 (3):391 - 391
Objectives Three intravascular ultrasound (IVUS) signatures have been associated with coronary artery disease instability: echo attenuation, an intraplaque echolucent zone, and spotty calcification. The aim of this study was to investigate the substrates responsible for these IVUS signatures in a relatively large series of post-mortem human coronary samples.Background The exact mechanisms and pathological correlates underlying echo attenuation, an intraplaque echolucent zone, and spotty calcification remain poorly understood.Methods IVUS was compared with near-infrared spectroscopic detection of lipid core plaque and histopathology in 2,294 vessel segments from 151 coronary specimens from 62 patients at necropsy using the modified American Heart Association classification.Results IVUS detected echo-attenuated plaques in 18.3% of segments, echolucent plaques in 10.5% of segments, and spotty calcification in 14.4% of segments. Histopathologically, 91.4% of echo-attenuated plaques corresponded to either a fibroatheroma (FA) with a necrotic core (NC) or pathological intimal thickening with a lipid pool; almost all segments with superficial echo attenuation indicated the presence of an FA with an advanced NC. Echolucent plaques indicated the presence of a relatively smaller lipid or NC compared with echo-attenuated plaques (thickness: 0.51 mm [interquartile range (IQR): 0.35 to 0.64 mm] vs. 0.70mm [IQR: 0.54 to 0.92 mm] [p < 0.001]; arc: 74.5 degrees [IQR: 59.0 degrees to 101.0 degrees] vs. 90 degrees [IQR: 70.0 degrees to 112.0 degrees] [p < 0.001]), although 82.8% of superficial echolucent zones indicated an NC-containing FA. IVUS spotty calcification, especially when superficial in location (72.6%), was often associated with an FA with calcium deposits and had smaller arcs of calcium in the setting of FA compared with fibrocalcific plaques (37.5 degrees [IQR: 23.0 degrees to 53.0 degrees] vs. 59.0 degrees [IQR: 46.0 degrees to 69.0 degrees]; p < 0.001). Comparisons between IVUS and near-infrared spectroscopy revealed that echo-attenuated plaques contained the highest probability of near-infrared spectroscopy-derived lipid core plaque, followed by echolucent plaques and spotty calcifications.Conclusions This study demonstrated that echo-attenuated plaque, especially superficial echo attenuation, was the most reliable IVUS signature for identifying a high-risk plaque (i.e., an FA containing a large NC). (J Am Coll Cardiol 2014; 63: 2220-33) (C) 2014 by the American College of Cardiology Foundation