Impact of renal function on coronary plaque composition

背景：最近的研究表明，慢性肾脏疾病患者动脉粥样硬化的风险很高。近年来，背向散射积分血管内超声(IB-IVUS)可以评价冠状动脉斑块成分，富脂斑块与易损斑块相关。本研究旨在探讨经皮冠状动脉介入治疗(Pci)靶点狭窄部位斑块成分与肾功能的关系。方法：对连续确诊为稳定型心绞痛的患者行择期经皮冠状动脉介入治疗前行IB-IVUS检查。根据估计的肾小球滤过率分为两组(EGFR+lt组60ml/min/1.73m2或EGFR≧组60ml/min/1.73m2)。结果：与EGFR≧60ml/min/1.73m2组比较，EGFR60ml/min/1.73m2组冠状动脉内脂肪体积百分比明显增加(36.7±10.6%vs.28.7±9.3%，P&lt；0.001)，纤维体积百分比明显降低(66.3±8.3%vs.66.3±8.3%，P&lt；0.001)。EGFR与冠脉斑块内脂质体积呈显著负相关，与斑块内纤维体积呈显著正相关(r=-0.44，p&lt；0.0001；r=0.46，p&lt；0.0001)。结论：肾功能损害与冠脉斑块中脂质体积所占比例增加、纤维体积所占百分比减少有关。我们的发现可能解释了肾功能不全患者心血管事件风险增加的原因。

Background : Recent studies have demonstrated that patients with chronic kidney disease are at high risk of atherosclerosis. Recently, coronary plaque components can be evaluated by integrated-backscatter intravascular ultrasound (IB-IVUS) and lipid-rich plaque is associated with vulnerable plaque. This aim of the study was to investigate relationship between renal function and tissue characterization of coronary plaque composition at the target stenotic site for percutaneous coronary intervention (PCI).Methods : We prospectively performed IB-IVUS before elective PCI to 89 consecutive patients with stable angina. According to estimated glomerular filtration rate (eGFR), they were divided into the two groups (eGFR<60 ml/min/1.73m2 or eGFR≧60 ml/min/1.73m2). The tissue characteristics of the coronary plaque at each target stenotic site were evaluated by three-dimensional IB-IVUS just before PCI procedure.Results : Patients with eGFR<60 ml/min/1.73m2 had higher percentage of lipid volume and lower percentage of fibrous volume compared to patients with eGFR≧60 ml/min/1.73m2 on the 3-D IB-IVUS images (36.7±10.6% vs.28.7±9.3%, P<0.001 and 59.1±8.7% vs. 66.3±8.3%, P<0.001, respectively). eGFR showed a significant negative correlation with lipid volume and had a significant positive correlation with fibrous volume in coronary plaques(r=-0.44, p<0.0001, and r=0.46, p<0.0001, respectively)Conclusions : Impaired renal function was related to higher percentage of lipid volume and lower percentage of fibrous volume in coronary plaque. Our findings may explain the increasing risk of cardiovascular events in patients with renal dysfunction.