Patterns of coronary plaque progression: phasic versus gradual. A combined optical coherence tomography and intravascular ultrasound study.
Patterns of coronary plaque progression: phasic versus gradual. A combined optical coherence tomography and intravascular ultrasound study.
复制标题
冠状动脉斑块进展的模式：阶段性与渐进性。
DOI：
10.1097/mca.0000000000000420
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Jang Ik-Kyung
中科院分区：
文献类型：
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作者：
Xie Zulong;Hou Jingbo;Yu Huai;Jia Haibo;Du Hongwei;Lee Hang;Yu Bo;Tian Jinwei;Jang Ik-Kyung
有些斑块以线性方式缓慢生长，而另一些则经历快速的阶段性进展。然而，斑块特征和斑块进展模式之间的详细体内关系尚未报道。目前的研究旨在探讨斑块的进展模式与系列血管内超声（IVUS）检查，并与基线斑块的光学相干断层扫描和IVUS与斑块进展patterns.MethodsA共248冠状动脉病变的特点进行评估，从157例患者进行了确定和成像的光学相干断层扫描和IVUS在基线。在6个月和12个月时重复IVUS检查。斑块进展定义为IVUS显示的动脉粥样硬化体积百分比增加≥ 5%。进展模式分为三组：无进展，快速阶段性进展，逐步progress.ResultsAmong 248个病灶，190（77%）显示无进展。在58个进展病灶中，20个（34%）呈逐渐进展，而38个（66%）呈快速阶段性进展。多变量分析表明，薄帽纤维粥样硬化[比值比（OR）= 5.24，95%置信区间（CI）2.04-13.4; P= 0.001]，微血管（OR= 2.20，95% CI 1.10-4.79; P= 0.045），（OR= 2.64，95% CI 1.19-5.81; P= 0.016）与快速阶段性进展独立相关。四分之一的冠状动脉斑块在现代医学治疗下没有随时间进展。在进展的病变中，三分之一显示渐进模式，三分之二显示快速阶段模式。存在薄帽纤维粥样硬化、微血管和正性重构是冠状动脉粥样硬化斑块快速阶段性模式进展的独立预测因子。
ObjectiveSome plaques grow slowly in a linear manner, whereas others undergo a rapid phasic progression. However, the detailed in-vivo relationship between plaque characteristics and plaque progression pattern has not been reported. The current study aimed to investigate the plaque progression patterns with serial intravascular ultrasound (IVUS) examinations, and to correlate baseline plaque characteristics assessed by optical coherence tomography and IVUS with plaque progression patterns.MethodsA total of 248 coronary lesions from 157 patients were identified and imaged by both optical coherence tomography and IVUS at baseline. IVUS examination was repeated at 6 and 12 months. Plaque progression was defined as greater than or equal to 5% increase in percent atheroma volume by IVUS. The progression patterns were divided into three groups: no progression, rapid phasic progression, and gradual progression.ResultsAmong 248 lesions, 190 (77%) showed no progression. Among 58 lesions with progression, 20 (34%) showed gradual progression, whereas 38 (66%) showed rapid phasic progression. Multivariate analysis indicated that thin-cap fibroatheroma [odds ratio (OR)= 5.24, 95% confidence interval (CI) 2.04–13.4; P= 0.001], microvessel (OR= 2.20, 95% CI 1.10–4.79; P= 0.045), and positive remodeling (OR= 2.64, 95% CI 1.19–5.81; P= 0.016) were associated independently with rapid phasic progression.ConclusionThree-quarters of coronary plaques did not progress over time with contemporary medical treatment. Among the lesions with progression, one-third showed a gradual pattern and two-thirds showed a rapid phasic pattern. The presence of thin-cap fibroatheroma, microvessel, and positive remodeling were the independent predictors for rapid phasic pattern progression of coronary atherosclerotic plaques.