Features of Coronary Plaque in Patients With Metabolic Syndrome and Diabetes Mellitus Assessed by 3-Vessel Optical Coherence Tomography-猫眼课题宝

DOI：

10.1161/circimaging.113.000345

发表时间：

2013-09

期刊：

Circulation: Cardiovascular Imaging

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

T. Yonetsu;Koji Kato;S. Uemura;Byeong‐Keuk Kim;Y. Jang;Soo-Jin Kang;Seung‐Jung Park;S. Lee;Soo-Joong Kim;H. Jia;R. Vergallo;Farhad Abtahian;Jinwei Tian;Sining Hu;R. Yeh;R. Sakhuja;I. McNulty;Hang Lee;Shaosong Zhang;Bo Yu;T. Kakuta;I. Jang

背景-代谢综合征（MetS）和冠状动脉疾病之间相关性的病理生理学基础还不清楚。我们试图通过光学相干断层扫描来表征代谢综合征患者的冠状动脉斑块。方法和结果-我们从171名接受光学相干断层成像的3支冠状动脉中识别出451个冠状动脉斑块。受试者被分为3组：糖尿病组（DM，n=77）、代谢综合征组（MetS，n=35）和对照组（C组，n=59）。光学相干断层扫描分析包括富脂斑块、最大脂质弧、脂质核心长度、脂质指数（LI）、纤维帽厚度和薄帽纤维粥样硬化的存在。我们将LI定义为平均脂质弧乘以脂质核心长度。DM组和MetS组的脂核长度和LI显著大于C组（脂核长度：7.7±4.0和7.0±3.8 vs 5.5±2.4 mm; P<0.001和P=0.012; LI：1164±716和1086±693 vs 796±417 mm; P<0.001和P=0.008）。DM组最大脂弧明显大于C组，而MetS组和C组之间无显著差异（196±45°，187±42° vs 176±52°; P=0.002和P=0.182）。纤维帽厚度和薄帽纤维粥样硬化在3组之间无显著差异。在多变量分析中，DM和MetS与LI独立相关，而只有急性冠状动脉综合征是薄帽纤维粥样硬化的独立预测因子。结论：与对照组相比，代谢综合征患者的冠状动脉斑块中含有更多的脂质。然而，本研究中使用的MetS标准无法区分脆弱的特征，如薄帽纤维粥样硬化，这表明有必要补充信息，以确定心血管事件的高风险患者。

Background— The pathophysiological basis for the association between metabolic syndrome (MetS) and coronary artery disease is not well understood. We sought to characterize coronary plaques in patients with MetS by using optical coherence tomography. Methods and Results— We identified 451 coronary plaques from 171 subjects who underwent optical coherence tomographic imaging in 3 coronary arteries. Subjects were divided into 3 groups: diabetes mellitus (DM, n=77), MetS (n=35), and a control group (C group, n=59) without DM or MetS. Optical coherence tomographic analysis included the presence of lipid-rich plaque, maximum lipid arc, lipid-core length, lipid index (LI), fibrous cap thickness, and thin-cap fibroatheroma. We defined LI as mean lipid arc multiplied by lipid-core length. Lipid-core length and LI were significantly greater in DM and MetS than in C group (lipid-core length: 7.7±4.0 and 7.0±3.8 versus 5.5±2.4 mm; P<0.001 and P=0.012, and LI: 1164±716 and 1086±693 versus 796±417 mm; P<0.001 and P=0.008). Maximum lipid arc was significantly greater in DM than in C group, whereas no significant difference was observed between MetS and C group (196±45°, 187±42° versus 176±52°; P=0.002 and P=0.182). Fibrous cap thickness and thin-cap fibroatheroma showed no significant difference among the 3 groups. In multivariate analysis, DM and MetS were independently associated with LI, whereas only acute coronary syndrome was the independent predictor for thin-cap fibroatheroma. Conclusions— Compared with control subjects, coronary plaques in MetS contain larger lipid. However, the MetS criteria used in this study could not distinguish the vulnerable features such as thin-cap fibroatheroma, suggesting the necessity of complementary information to identify patients at high risk for cardiovascular events.

Features of Coronary Plaque in Patients With Metabolic Syndrome and Diabetes Mellitus Assessed by 3-Vessel Optical Coherence Tomography

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