Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques - A high-resolution magnetic resonance Imaging study
Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques - A high-resolution magnetic resonance Imaging study
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DOI：
10.1161/circulationaha.104.504167
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发表时间：
2005-05-31
期刊：
影响因子：
37.8
通讯作者：
Hatsukami, TS
中科院分区：
文献类型：
--
作者：
Takaya, N;Yuan, C;Hatsukami, TS
背景-以前的研究表明，斑块内出血进入坏死核心的红细胞膜是游离胆固醇的来源，并可能成为动脉粥样硬化进展的驱动力。我们已经证明MRI可以准确地识别颈动脉斑块内出血和精确地测量斑块体积。我们测试的假设，出血到颈动脉粥样硬化刺激斑块progression.Methods和结果-29名受试者（14例斑块内出血和15例对照组与大小斑块无斑块内出血在基线）进行了一系列颈动脉MRI检查与一个multicontrast加权协议（T1，T2，质子密度，3D飞行时间）超过一段时间的18个月。使用定制的图像分析工具测量壁、腔、富脂坏死核心、钙化和斑块内出血的体积。在整个研究过程中，出血组的壁体积（6.8%对-0.15%; P = 0.009）和富脂坏死核心体积（28.4%对-5.2%; P = 0.001）的百分比变化显著高于对照组。此外，与对照组相比，基线时斑块内出血的患者在18个月时更有可能出现新的斑块扩张（43%对0%; P = 0.006）。反复出血进入斑块可能通过增加脂质核心和斑块体积并产生新的不稳定因素而刺激动脉粥样硬化的进展。
Background - Previous studies suggest that erythrocyte membranes from intraplaque hemorrhage into the necrotic core are a source of free cholesterol and may become a driving force in the progression of atherosclerosis. We have shown that MRI can accurately identify carotid intraplaque hemorrhage and precisely measure plaque volume. We tested the hypothesis that hemorrhage into carotid atheroma stimulates plaque progression.Methods and Results - Twenty-nine subjects ( 14 cases with intraplaque hemorrhage and 15 controls with comparably sized plaques without intraplaque hemorrhage at baseline) underwent serial carotid MRI examination with a multicontrast weighted protocol (T1, T2, proton density, and 3D time of flight) over a period of 18 months. The volumes of wall, lumen, lipid-rich necrotic core, calcification, and intraplaque hemorrhage were measured with a custom-designed image analysis tool. The percent change in wall volume (6.8% versus -0.15%; P = 0.009) and lipid-rich necrotic core volume (28.4% versus -5.2%; P = 0.001) was significantly higher in the hemorrhage group than in controls over the course of the study. Furthermore, those with intraplaque hemorrhage at baseline were much more likely to have new plaque hemorrhages at 18 months compared with controls (43% versus 0%; P = 0.006).Conclusions - Hemorrhage into the carotid atherosclerotic plaque accelerated plaque progression in an 18-month period. Repeated bleeding into the plaque may produce a stimulus for the progression of atherosclerosis by increasing lipid core and plaque volume and creating new destabilizing factors.