Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress - An intravascular ultrasound and histopathology natural history study
Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress - An intravascular ultrasound and histopathology natural history study
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DOI：
10.1161/circulationaha.107.695254
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发表时间：
2008-02-26
期刊：
影响因子：
37.8
通讯作者：
Stone, Peter H.
中科院分区：
文献类型：
--
作者：
Chatzizisis, Yiannis S.;Jonas, Michael;Stone, Peter H.
背景-低内皮剪切应力（ESS）促进动脉粥样硬化的发展;然而，其在动脉粥样硬化斑块进展和向炎症高危斑块演变中的作用尚未研究。我们的假设是，ESS的最低值是负责发展的高风险的冠状动脉粥样硬化斑块与过度膨胀remodel.Methods和结果-24猪，用链脲佐菌素诱导糖尿病和高脂饮食，被分配到早期（n = 12）和晚期（n = 12）动脉粥样硬化组。在早期组第4周和第8周以及晚期组第23周和第30周通过冠状动脉血管内超声评估内膜中层厚度。斑块在第8周后开始形成，导致第30周时斑块严重程度的显著异质性。在第23周，在晚期组中的无斑块感兴趣的亚段（n = 142）中计算ESS。30周时取冠状动脉（n = 31），进行组织病理学分析。低ESS是高风险斑块发展的独立预测因子，其特征在于强烈的脂质积聚、炎症、薄纤维帽、严重的内弹性膜降解和过度扩张性重塑。第30周高危斑块特征的严重程度与第23周低ESS的程度显著相关。结论-低ESS的程度决定了动脉粥样硬化病变的复杂性和异质性，并预测了高危斑块的发展。
Background- Low endothelial shear stress (ESS) promotes the development of atherosclerosis; however, its role in the progression of atherosclerotic plaques and evolution to inflamed high-risk plaques has not been studied. Our hypothesis was that the lowest values of ESS are responsible for the development of high-risk coronary atherosclerotic plaques associated with excessive expansive remodeling.Methods and Results- Twenty-four swine, treated with streptozotocin to induce diabetes and fed a high-fat diet, were allocated into early (n = 12) and late (n = 12) atherosclerosis groups. Intima-media thickness was assessed by intravascular ultrasound in the coronary arteries at weeks 4 and 8 in the early group and weeks 23 and 30 in the late group. Plaques started to develop after week 8, leading to marked heterogeneity in plaque severity at week 30. ESS was calculated in plaque-free subsegments of interest (n = 142) in the late group at week 23. Coronary arteries (n = 31) of this group were harvested at week 30, and the subsegments of interest were identified and analyzed histopathologically. Low ESS was an independent predictor of the development of high-risk plaques, characterized by intense lipid accumulation, inflammation, thin fibrous cap, severe internal elastic lamina degradation, and excessive expansive remodeling. The severity of high-risk plaque characteristics at week 30 was significantly correlated with the magnitude of low ESS at week 23.Conclusions- The magnitude of low ESS determines the complexity and heterogeneity of atherosclerotic lesions and predicts the development of high-risk plaque.