Carotid plaque, arterial stiffness gradient, and remodeling in hypertension
Carotid plaque, arterial stiffness gradient, and remodeling in hypertension
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DOI：
10.1161/hypertensionaha.108.115972
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发表时间：
2008-10-01
期刊：
影响因子：
8.3
通讯作者：
Laurent, Stephane
中科院分区：
文献类型：
--
作者：
Beaussier, Helene;Masson, Ingrid;Laurent, Stephane
沿纵向的斑块力学分析(弯曲应变)可能会提供有用的信息，因为动脉粥样硬化斑块的重复弯曲应变会使壁材疲劳，导致斑块破裂。原发性高血压是否与一种特定的弯曲应变模式有关还没有确定。这项研究包括92名颈总动脉斑块患者：66名高血压患者，无论是否接受治疗，以及26名血压正常的患者。一种新的非侵入性回声跟踪系统(ArtLab；Esaote，荷兰)被用来测量一个4厘米长的颈动脉节段上128个部位的内中膜厚度、直径和扩张性。颈动脉斑块要么弹性低于邻近颈动脉(向内应变)，要么比邻近颈动脉弹性更大(向外应变)。向内应变更多地与向内斑块重塑有关，而向外应变更常与外部重塑相关。在多因素Logistic回归分析中，高血压病患者更可能出现向内的颈动脉斑块(优势比=6.9[1.4~34.9]；P<；0.0 2)，独立于2个有利于向内应变的因素：外部重构(优势比=4.6[1.7~13.4]；P<；0.005)和不使用肾素-血管紧张素系统阻滞剂(优势比=4.8[1.1~2 0.4]；P<；0.0 5)。综上所述，高血压病患者的动脉壁材料在斑块部位的弹性小于上游，在斑块影响区颈动脉内向张力。这可能会产生高度的应力集中和疲劳，使斑块面临更大的破裂风险。
The analysis of plaque mechanics along the longitudinal axis (bending strain) may provide useful information because repetitive bending strain of an atherosclerotic plaque can fatigue the wall material and result in plaque rupture. Whether essential hypertension is associated with a specific pattern of bending strain has not yet been determined. The study included 92 patients with an atherosclerotic plaque on the common carotid artery: 66 patients with essential hypertension, either treated or not, and 26 normotensive patients. A novel noninvasive echotracking system (ArtLab; Esaote, The Netherlands) was used to measure intima-media thickness, diameter, and distensibility at 128 sites on a 4-cm-long carotid segment. Carotid plaque was either less elastic than adjacent carotid artery (inward strain) or more elastic (outward strain). Inward strain was more frequently associated with an inward plaque remodeling, whereas an outward strain was more frequently associated with an outer remodeling. In multivariate logistic regression analysis, patients with essential hypertension were more likely to exhibit an inward strain of carotid plaque (odds ratio = 6.9 [1.4 to 34.9]; P < 0.02), independently of 2 factors favoring inward strain: an outer remodeling (odds ratio = 4.6 [1.7 to 13.4]; P < 0.005) and the absence of renin-angiotensin system blockers (odds ratio = 4.8 [1.1 to 20.4]; P < 0.05). In conclusion, arterial wall material of hypertensive patients was less elastic at the site of the plaque than upstream, and carotid was inwardly strained in the zone affected by plaque. This may generate a high level of stress concentrations and fatigue, exposing the plaque to a greater risk of rupture.