Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter-IVUS
Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter-IVUS
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DOI：
10.1016/j.jcmg.2011.11.012
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发表时间：
2012-02-01
影响因子：
14
通讯作者：
Narula, Jagat
中科院分区：
文献类型：
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作者：
Hattori, Kousuke;Ozaki, Yukio;Narula, Jagat
目的通过光学相干断层扫描(OCT)、灰度级和背向散射积分(IB)血管内超声(IVUS)成像，评价他汀类药物对冠状动脉斑块成分和形态的影响。背景：尽管已有研究表明他汀类药物显著提高了心脏死亡率，但其对冠状动脉粥样硬化性病变的脂质含量和纤维帽厚度的确切影响尚不清楚。虽然IVUS缺乏空间分辨率来准确评估纤维帽厚度，但OCT缺乏IVUS的穿透力。方法对42例稳定性心绞痛患者行冠状动脉介入治疗，采用OCT、灰阶和IB-IVUS三种方法对非靶点病变进行前瞻性连续OCT、灰阶和IB-IVUS检查。在这些患者中，26人在基线研究后接受了4 mg的匹伐他汀治疗；16名拒绝接受他汀类药物治疗的受试者仅接受了饮食修改。结果在接受他汀类药物治疗的患者中，随着时间的推移，斑块体积指数明显降低(48.5+/-10.4%，42.0+/-11.1%；p=0.033)，而单纯饮食患者的斑块体积指数无明显变化(48.7+/-10.4%，50.4+/-11.8%；p=NS)。IB-IVUS显示随着时间的推移，百分比脂肪体积指数显著降低(34.9%+/-12.2%，28.2+/-7.5%；p=0.020)；饮食治疗组没有观察到变化(31.0%+/-10.7%，33.8+/-12.4%；p=NS)。OCT显示纤维帽厚度显著增加(14 0+/-4 2微米，189+/-46微米；p=0.001)，而单纯饮食组没有观察到这种变化(14 0+/-35微米，14 2+/-36微米；p=NS)。他汀组和饮食组之间随着时间的推移，脂体积指数(-6.8+/-8.0%vs.2.8+/-9.9%，p=0.031)和纤维帽厚度(52+/-32µm对2+/-22µm，p<；0.001)的变化有非常显著的差异。(J Am Coll心脏ol IMG 2012；5：169-77)(C)2012，美国心脏病学会基金会
OBJECTIVES The purpose of this study was to evaluate the effect of statin treatment on coronary plaque composition and morphology by optical coherence tomography (OCT), grayscale and integrated backscatter (IB) intravascular ultrasound (IVUS) imaging.BACKGROUND Although previous studies have demonstrated that statins substantially improve cardiac mortality, their precise effect on the lipid content and fibrous cap thickness of atherosclerotic coronary lesions is less clear. While IVUS lacks the spatial resolution to accurately assess fibrous cap thickness, OCT lacks the penetration of IVUS. We used a combination of OCT, grayscale and IB-IVUS to comprehensively assess the impact of pitavastatin on plaque characteristics.METHODS Prospective serial OCT, grayscale and IB-IVUS of nontarget lesions was performed in 42 stable angina patients undergoing elective coronary intervention. Of these, 26 received 4 mg pitavastatin after the baseline study; 16 subjects who refused statin treatment were followed with dietary modification alone. Follow-up imaging was performed after a median interval of 9 months.RESULTS Grayscale IVUS revealed that in the statin-treated patients, percent plaque volume index was significantly reduced over time (48.5 +/- 10.4%, 42.0 +/- 11.1%; p = 0.033), whereas no change was observed in the diet-only patients (48.7 +/- 10.4%, 50.4 +/- 11.8%; p = NS). IB-IVUS identified significant reductions in the percentage lipid volume index over time (34.9 +/- 12.2%, 28.2 +/- 7.5%; p = 0.020); no change was observed in the diet-treated group (31.0 +/- 10.7%, 33.8 +/- 12.4%; p = NS). While OCT demonstrated a significant increase in fibrous cap thickness (140 +/- 42 mu m, 189 +/- 46 mu m; p = 0.001), such changes were not observed in the diet-only group (140 +/- 35 mu m, 142 +/- 36 mu m; p = NS). Differences in the changes in the percentage lipid volume index (-6.8 +/- 8.0% vs. 2.8 +/- 9.9%, p = 0.031) and fibrous cap thickness (52 +/- 32 mu m vs. 2 +/- 22 mu m, p < 0.001) over time between the pitavastatin and diet groups were highly significant.CONCLUSIONS Statin treatment induces favorable plaque morphologic changes with an increase in fibrous cap thickness, and decreases in both percentage plaque and lipid volume indexes. (J Am Coll Cardiol Img 2012;5:169-77) (C) 2012 by the American College of Cardiology Foundation