Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography
Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography
复制标题
DOI：
10.1016/j.jacc.2006.01.041
复制
发表时间：
2006-04-18
影响因子：
24
通讯作者：
Brady, TJ
中科院分区：
文献类型：
--
作者：
Hoffmann, U;Moselewski, F;Brady, TJ
本研究的目的是评估罪犯和稳定性冠状动脉病变的形态和组成的多排计算机断层扫描（MDCT）。背景罪犯病变的非侵入性识别有可能提高急性胸痛患者的非侵入性危险分层。方法37例急性冠状动脉综合征（ACS）或稳定性心绞痛患者进行冠状动脉16排MDCT和有创选择性血管造影。在所有显著的冠状动脉病变中，两名观察员测量狭窄程度、狭窄处的斑块面积和重塑指数，并评估斑块组成。ACS患者的罪犯病变与ACS或稳定型心绞痛患者的稳定病变之间的差异determined.Results我们分析了14例ACS患者和9例稳定型心绞痛患者中40个图像质量优良的病变。ACS患者中的Cultiva病变（n = 14）的斑块面积和重塑指数显著大于ACS患者中的稳定病变（n = 13）和稳定型心绞痛患者（n = 13）（分别为17.5 +/- 5.9 mm（2）vs. 9.1 +/- 4.8 mm（2）vs. 13.5 +/- 10.7 mm（2），p = 0.02; 1.4 +/- 0.3 vs. 1.0 +/- 0.4 vs. 1.2 +/- 0.3，p = 0.04）。非钙化斑块的患病率分别为100%、62%和77%，钙化斑块的患病率分别为71%、92%和85%，ACS患者的罪犯病变和ACS或稳定型心绞痛患者的稳定病变。结论我们引入了ACS患者冠状动脉粥样硬化病变的无创检测和表征的概念，MDCT。我们确定了ACS罪犯病变与ACS或稳定型心绞痛稳定病变之间病变形态和斑块组成的差异，与既往血管内超声研究一致。
OBJECTIVES The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT).BACKGROUND Noninvasivc identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain.METHODS Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined.RESULTS We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 +/- 5.9 mm(2) vs. 9.1 +/- 4.8 mm(2) vs. 13.5 +/- 10.7 mm(2), p = 0.02; and 1.4 +/- 0.3 vs. 1.0 +/- 0.4 vs. 1.2 +/- 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina.CONCLUSIONS We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.