Assessment of vulnerable plaques causing acute coronary syndrome using integrated backscatter intravascular ultrasound
Assessment of vulnerable plaques causing acute coronary syndrome using integrated backscatter intravascular ultrasound
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DOI：
10.1016/j.jacc.2005.09.061
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发表时间：
2006-02-21
影响因子：
24
通讯作者：
Fujiwara, H
中科院分区：
文献类型：
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作者：
Sano, K;Kawasaki, M;Fujiwara, H
目的应用背向散射积分血管内超声(IB-IVUS)对急性冠脉综合征(ACS)前易损斑块的组织特征进行研究。背景：IB-IVUS可用于冠状动脉斑块的组织定征。方法140例心绞痛患者，选择160例无明显狭窄的冠状动脉病变进行评价。结果术后随访(30~7个月)，首次IVUS检查后12个斑块形成急性冠脉综合征。在12个斑块中，有10个斑块在基线时记录了IVUS参数。这10个斑块为易损性斑块(Vp)，其余斑块为稳定斑块(SP；11=143)。VP组与SP组的血管面积、管腔面积、斑块面积差异无统计学意义。然而，VP组的斑块负荷(60+/-9%vs.529%；1)、偏心率(0.70+/-0.10vs.0.55+/-0.17；p=0.013)、重构指数(1.30+/-0.08vs.1.16+/-0.16；p=0.006)和脂质面积百分比(72+/-10%vs.50+/-16%；p<；0.0001)均高于SP组。VP组纤维面积百分比(23+/-6%)小于SP组(47+/-14%；P<0.0001)。评价纤维面积百分比(分别为90%、96%和69%)和脂肪面积百分比(分别为80%、90%和42%)对VP分类的敏感性、特异性和阳性预测值。提示IB-IVUS分类的VP和SP对预测急性冠脉综合征有一定参考价值。
OBJECTIVES This study aims to define tissue characteristics of vulnerable plaques before acute coronary syndrome (ACS) by use of integrated backscatter intravascular ultrasound (IB-IVUS).BACKGROUND Tissue characterization of coronary plaques is possible with the use of IB-IVUS.METHODS The subjects were 140 patients with angina pectoris, and we selected 160 coronary lesions Without significant stenosis for evaluation. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter.RESULTS At the follow-up (30 7 months), 12 plaques caused ACS after the initial IVUS examination. Ten of the 12 plaques had IVUS parameters recorded at baseline. These 10 plaques were classified as vulnerable plaques (VP), and the other plaques were classified as stable plaques (SP; 11 = 143). There was no significant difference of vessel area, lumen area, and plaque area between VP and SP. However, plaque burden (60 +/- 9% vs. 52 9%; 1) = 0.01.4), eccentricity (0.70 +/- 0.10 vs. 0.55 +/- 0.17; p = 0.013), remodeling index (1.30 +/- 0.08 vs. 1.16 +/- 0.16; p = 0.006) and percentage lipid area (72 +/- 10% vs. 50 +/- 16%; p < 0.0001) were greater in VP than in SP. Percentage fibrous area (23 +/- 6% vs. 47 +/- 14%; p < 0.0001) was smaller in VP than in SP. The sensitivities, specificities, and positive predictive values of percentage fibrous area (90%, 96%, and 69%, respectively) and percentage lipid area (80%, 90%, and 42%, respectively for classifying VP were evaluated.CONCLUSIONS Tissue characteristics of VP before ACS were different from those of SP. This suggests that VP and SP as classified by IB-IVUS are useful in predicting ACS.