INVIVO VALIDATION OF COMPENSATORY ENLARGEMENT OF ATHEROSCLEROTIC CORONARY-ARTERIES
INVIVO VALIDATION OF COMPENSATORY ENLARGEMENT OF ATHEROSCLEROTIC CORONARY-ARTERIES
复制标题
DOI：
10.1016/0002-9149(93)91007-5
复制
发表时间：
1993-03-15
影响因子：
2.8
通讯作者：
DAVIDSON, CJ
中科院分区：
文献类型：
--
作者：
HERMILLER, JB;TENAGLIA, AN;DAVIDSON, CJ
尸检和心外膜超声研究表明，冠状动脉粥样硬化发生代偿性扩张。这种血管尺寸的增加可能是维持心肌血流的重要机制。它在冠状动脉疾病进展和消退的血管造影研究中也是至关重要的。本研究的目的是确定，使用冠状动脉内超声是否冠状动脉在体内进行适应性扩张。研究了44例连续患者（30例男性，14例女性;平均年龄56 ± 10岁）。分析了80个血管内超声图像（32个左主干、23个左前降支和25个右冠状动脉）。内弹性膜面积，总血管尺寸的测量值随着斑块面积的扩大而增加（r = 0.57，p = 0.0001，SEE = 5.5 mm 2）。当单独检查左主干、左前降支和右冠状动脉时，内弹性膜与斑块面积之间仍存在同样大或更大的正相关性（左前降支：r = 0.75，p = 0.0001;右冠状动脉：r = 0.63，p = 0.0007;左主干：r = 0.56，p = 0.0009），这意味着每根血管和所有血管总体上经历了适应性扩大。当仅检查面积狭窄< 30%的血管时，内弹性膜与斑块面积相关性良好（r = 0.79，p = 0.0001），斑块面积每增加1 mm 2，内弹性膜增加2.7 mm 2。这表明动脉扩大可能过度补偿早期动脉粥样硬化病变。结果，狭窄< 30%时，狭窄面积百分比与管腔面积之间没有关系，但随着狭窄程度的增加，管腔面积显著下降。这些人体体内结果验证了以下假设：个体冠状动脉在动脉粥样硬化的早期阶段经历维持或增加管腔面积的适应性扩大。
Necropsy examinations and epicardial ultrasound studies have suggested that atherosclerotic coronary arteries undergo compensatory enlargement. This increase in vessel size may be an important mechanism for maintaining myocardial blood flow. It also is of fundamental importance in the angiographic study of coronary disease progression and regression. The purpose of this study was to determine, using intracoronary ultrasound whether coronary arteries undergo adaptive expansion in vivo. Forty-four consecutive patients were studied (30 men, 14 women; mean age 56 +/- 10 years). Eighty intravascular ultrasound images were analyzed (32 left main, 23 left anterior descending and 25 right coronary arteries). internal elastic lamina area, a measure of overall vessel size increased as plaque area expanded (r = 0.57, p = 0.0001, SEE = 5.5 mm2). When the left main, left anterior descending and right coronary arteries were examined individually, there Continued to be as great or greater positive correlation between internal elastic lamina and plaque area (left anterior descending: r = 0.75, p = 0.0001; right coronary arteries: r = 0.63, p = 0.0007; left main: r = 0.56, p = 0.0009), implying that each of the vessels and all in aggregate underwent adaptive enlargement. When only those vessels with < 30% area stenosis were examined, internal elastic lamina correlated well with plaque area (r = 0.79, and p = 0.0001), and For each 1 mm2 increase in plaque area, internal elastic lamina increased 2.7 mm2. This suggests that arterial enlargement may overcompensate for early atherosclerotic lesions. As a result, there was no relation between percent area stenosis and lumen area for < 30% stenosis, but with greater stenoses, lumen area significantly declined. These human in vivo results validate the hypothesis that individual coronary arteries undergo adaptive enlargement that maintains or augments lumen area during the early stages of atherosclerosis.