Feasibility of diagnosing unstable plaque in patients with acute coronary syndrome using iMap-IVUS

关于iMap-IVUS指导急性冠脉综合征患者不稳定斑块诊断价值的研究(英文)

Objective： To compare the plaque composition between stable and unstable plaques, characterize unstable plaque by using iMap-intravascular ultrasound （IVUS）, and quantify the diagnostic criteria for unstable plaque. Methods： Thirty-three acute coronary syndrome （ACS） patients who had undergone coronary angiography and IVUS from February 19, 2014 to December 19, 2014 at Peking University People＇s Hospital were enrolled in the study. Baseline data were collected. The patients were divided into two groups according to their gray-scale IVUS imaging, stable plaque and unstable plaque. A difference-in-difference evaluation was performed using the baseline data and off-line iMap imaging results between the two groups. A receiver operating characteristic （ROC） curve was constructed to obtain the optimal cut-off value to diagnose unstable plaque. Results： Percentages of fibrotic and necrotic tissues, absolute values of lipidic, necrotic, and calcified tissues, and plaque burden were independent predictors for unstable plaque. Absolute necrotic area was the best predictor and exhibited the highest diagnostic value for plaque vulnerability （area under the curve （AUC）=0.806, P=0.000, 95% CI （0.718, 0.894））. The cut-off score for predicting unstable plaque was 4.0 mm2. Conclusions： This study attempted to propose a cut-off value based on absolute necrotic area using iMap-IVUS to predict plaque vulnerability in patients with ACS. This score might provide a valuable reference for diagnosing unstable plaque.

目的:比较稳定斑块与不稳定斑块虚拟组织学血管内超声(i Map-IVUS)评价斑块组成成分的不同特点,量化不稳定斑块的诊断标准。创新点:首次提出运用i Map-IVUS评价不稳定斑块的量化标准,简化不稳定斑块的诊断。方法:连续入选接受冠状动脉造影及血管内超声检查的急性冠脉综合征患者,收集包括人口学资料、既往史、实验室生化检查、冠脉病变情况等在内的基线数据。分析所有患者的灰阶IVUS影像,根据影像学特点,将斑块分为稳定斑块和不稳定斑块。比较两组患者的基线资料,并离线对比分析两组i Map-IVUS影像结果,应用受试者工作特征曲线(ROC)获取诊断不稳定斑块的最佳阈值并进行验证。结论:研究运用i Map-IVUS提出急性冠脉综合患者不稳定斑块的诊断阈值,对不稳定斑块的诊断有一定价值。