冠心病患者非靶病变快速进展与斑块破裂的生物力学机制研究

冠状动脉非靶病变斑块的快速进展与斑块破裂是导致冠心病患者介入治疗预后不佳的重要因素，而斑块所处的生物力学环境起到关键作用。然而，由于缺乏准确在体评估冠脉斑块动应力的方法，非靶病变快速进展与斑块破裂的生物力学机制仍有待深入研究。本研究旨在：1）借助数值模拟与体外实验，实现并验证冠脉浅表壁动应力的科学分析方法，研究患者个体化参数（血压、心率等）以及斑块形态学参数对浅表壁动应力的影响；2）开展前瞻性临床研究，对非靶病变血管进行基线与随访的造影及血管内光学相干断层成像，研究浅表壁动应力对斑块快速进展与破裂的作用机制，定量非靶病变风险评估的生物力学指标，为临床制定非靶病变的治疗策略提供理论参考。

The rapid progression and rupture of non-culprit coronary lesions is a major factor leading to poor prognosis of patients who undergo coronary interventions, while abnormal biomechanical environment is regarded as an important underlining mechanism. Nevertheless, the exact biomechanical mechanism is not completely understood, since in vivo methods for accurate assessment of the dynamic biomechanical behaviors of non-culprit lesions are still lacking. The purpose of this study is to: 1) Implement and validate a novel method of dynamic superficial wall stress by numerical simulation and in vitro experiments, and to study the influence of patient-specific hemodynamics (e.g. blood pressure and heart rate) and plaque morphology on superficial wall stress; 2) Carry out a prospective clinical study in which coronary angiography and intravascular optical coherence tomography of non-target lesions will be performed at baseline and follow-up. The role of dynamic superficial wall stress on the rapid progression and rupture of non-target lesions will be investigated. We also aim to establish quantitatively the biomechanical markers for risk stratification of non-culprit lesions and to provide the clinicians with theoretical basis for optimal management of non-culprit lesions.