TCT-598 Plaque rupture in coronary atherosclerosis is associated with increased plaque structural stress
TCT-598 Plaque rupture in coronary atherosclerosis is associated with increased plaque structural stress
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TCT-598 冠状动脉粥样硬化斑块破裂与斑块结构应力增加相关
DOI：
10.1016/j.jacc.2016.09.737
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发表时间：
2016
影响因子：
24
通讯作者：
Costopoulos C
中科院分区：
文献类型：
--
作者：
Costopoulos C
BackgroundPlaque rupture is the commonest cause of myocardial infarction, occurring particularly in higher-risk lesions such as fibroatheromas. However, prospective virtual-histology intravascular ultrasound (VH-IVUS) studies indicate that< 10% higher-risk plaques cause clinical events over 3-years, indicating that other factors also determine plaque rupture. Plaque rupture occurs when plaque structural stress (PSS) exceeds its mechanical strength; however, the determinants of PSS and its association with plaque rupture are not known. The objective of this study was to identify the determinants of PSS, and the relationship between PSS and plaque rupture.MethodsWe analyzed plaque structure and composition in 4,053 VH-IVUS frames from 32 fibroatheromas with rupture from the VIVA study and 32 fibroatheromas without rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the peri-luminal region was estimated by calculating maximum principal plaque structural stress by finite element analysis.ResultsPSS increased with increasing lumen area (r= 0.46; p= 0.001), lumen eccentricity (r= 0.32; p= 0.001), and necrotic core≥ 10%(r= 0.12; p= 0.001), but reduced when dense calcium≥ 10%(r=-0.12; p= 0.001). Ruptured fibroatheromas showed higher PSS (133 [90-191] vs. 104kPa [75-142]; p= 0.002) and variation in PSS (55 [37-75] vs. 43kPa [34-59]; p= 0.002) than non-ruptured fibroatheromas. PSS was higher in segments proximal to the rupture site (143 [101-200] vs. 120kPa [78-180]; p= 0.001) vs. distal segments, associated with increased necrotic core (19.1 [11-29] vs. 14.3%[8-23]; p= 0.001) but reduced fibrous/fibrofatty tissue (63.6 [46-78] vs. 72.7%[54-86]; p= 0.001). PSS> 135kPa was a good predictor of rupture in higher-risk regions.
