Relationship of a thinned medial layer to the attenuated contractile response in atherosclerotic coronary arteries
Relationship of a thinned medial layer to the attenuated contractile response in atherosclerotic coronary arteries
复制标题
DOI：
10.1152/ajpheart.00537.2019
复制
发表时间：
2020-01-01
影响因子：
4.8
通讯作者：
Kugiyama, Kiyotaka
中科院分区：
文献类型：
--
作者：
Nakamura, Takamitsu;Horikoshi, Takeo;Kugiyama, Kiyotaka
晚期动脉粥样硬化的冠状动脉不一定比早期动脉粥样硬化的冠状动脉有更大的收缩反应。本研究旨在利用光学相干断层扫描（OCT）技术研究冠状动脉中层厚度与乙酰胆碱（ACh）收缩反应的关系。对32例有心肌梗死病史的患者进行了OCT检查，并对ACh引起的冠状动脉左前降支血管收缩反应进行了评价。通过OCT图像的平面分析测量内膜和中层面积。冠状动脉对ACh的收缩反应与中膜面积呈直线正相关（r = 0.61，P < 0.001）。相反，冠状动脉对ACh的收缩反应与内膜面积之间的关系由倒U形曲线描述，该曲线拟合二次回归模型（R-2 = 0.35，P = 0.002，y轴，收缩; x轴，内膜面积）。随着内膜层增厚，收缩反应增加，直至拐点;此后，收缩反应下降。中膜面积和内膜面积之间的关系也通过拟合二次回归模型的倒U形曲线来描述（R-2 = 0.41，P < 0.01，y轴，中膜面积; x轴，内膜面积）。随着内膜区域增厚，中膜区域增加，直至拐点;此后，中膜区域变薄。总之，在动脉粥样硬化程度较高的冠状动脉中，中层变薄与收缩反应减弱有关。NEW & NOTEWORTHY这是第一项使用OCT显示既往心肌梗死患者冠状动脉中中层平滑肌层厚度与收缩反应之间关系的临床研究。冠状动脉粥样硬化程度较轻、中度者中层变薄。冠状动脉收缩反应与冠状动脉中层厚度呈正相关。因此，晚期动脉粥样硬化的冠状动脉不一定比早期动脉粥样硬化的冠状动脉具有更大的收缩反应，这可能与中层变薄有关。
Coronary arteries with advanced atherosclerosis do not necessarily have greater contractile responses than those with early atherosclerosis. This study aimed to clarify the relationship between thickness of the medial layer and the contractile response to acetylcholine (ACh) in coronary artery using optical coherence tomography (OCT). The OCT and the vasomotor response to ACh in the left anterior descending coronary artery were assessed in 32 patients with previous myocardial infarction. The intimal and medial layer areas were measured by planimetric analysis of the OCT images. The coronary contractile response to ACh had a positive linear relationship with medial area (r = 0.61, P < 0.001). In contrast, the relationship between the coronary contractile response to ACh and intimal area was described by an inverted U-shaped curve that was fitted to a quadratic regression model (R-2 = 0.35, P = 0.002, y-axis, contraction; x-axis, intimal area). The contractile response increased as the intimal layer thickened up to the inflection point; thereafter, the contractile response declined. The relationship between medial area and intimal area was also described by an inverted U-shaped curve that was fitted to a quadratic regression model (R-2 = 0.41, P < 0.01, y-axis, medial area; x-axis, intimal area). The medial area increased as the intimal area thickened up to the inflection point; thereafter, the medial area thinned. In conclusion, the thinned medial layer was associated with the attenuated contractile response in a coronary artery with greater atherosclerosis.NEW & NOTEWORTHY This is the first clinical study to show the relationship between the contractile response and the thickness of medial smooth muscle layer in coronary artery of patients with previous myocardial infarction using OCT. The contractile response to acetylcholine was attenuated, and medial layer area was thinned in coronary artery with greater atherosclerosis compared with those in coronary artery with mild or moderate atherosclerosis. The coronary contractile response was positively correlated with thickness of the medial layer in coronary arteries with either mild or greater atherosclerosis. Thus, coronary arteries with advanced atherosclerosis do not necessarily have greater contractile responses than those with early atherosclerosis, which could be related to the thinned medial layer.