急性冠状动脉综合征患者心外膜脂肪组织体积与冠状动脉斑块特征相关性研究

Correlation between epicardial adipose tissue volume and coronary plaque characteristics in patients with acute coronary syndrome

目的通过iMap-血管内超声(IVUS)分析急性冠状动脉综合征(ACS)患者冠状动脉粥样硬化斑块成分,探讨心外膜脂肪组织体积(EATV)与冠状动脉斑块特征的相关性。方法连续筛选2018年1月至2020年1月在佛山市第一人民医院接受择期冠状动脉造影(CAG)或经皮冠状动脉支架植入术,并完成iMap-IVUS分析的ACS患者89例。所有患者入院后均接受心脏CTA检查,测算EATV。根据EATV水平将患者分为高水平组(H组,≥86 cm^(3),n=47)和低水平组(L组,<86 cm^(3),n=42),分析比较两组患者CAG和iMap-IVUS影像学结果。结果H组患者高敏C反应蛋白(hs-CRP)、肌钙蛋白(Tn)I、肌酸激酶同工酶(CK-MB)、肌酐(Cr)、脂蛋白相关磷脂酶(Lp-PLA)2均高于L组(P<0.05);冠状动脉斑块含钙化成分明显少于L组(P=0.002),坏死核心明显多于L组(P=0.007),且薄纤维帽斑块(TCFA)发生率显著高于L组(P=0.002)。logistic回归分析发现,EATV(OR=2.465,95%CI=1.35~4.50,P=0.002)是TCFA的独立预测因子。结论iMap-IVUS分析证实,ACS患者EATV升高与易损斑块有良好相关性,可作为预测TCFA的潜在标志物。

Objective To analyze the composition of coronary atherosclerotic plaque in patients with acute coronary syndrome(ACS)by using iMap-intravascular ultrasound(iMap-IVUS),and to evaluate the correlation between the epicardial adipose tissue volume(EATV)and the composition of coronary plaque.Methods A total of consecutive 89 ACS patients,who received selective coronary angiography(CAG)or percutaneous coronary stent implantation and had iMap-IVUS analysis results at the Foshan Municipal First People’s Hospital of China between January 2018 and January 2020,were collected.After admission,cardiac CT angiography(CTA)examination was performed to calculate EATV in all patients.Based on EATV value,the patients were divided into high-value group(EATV≥86 cm^(3),n=47)and low-value group(EATV<86 cm^(3),n=42).The CAG findings and iMap-IVUS results were analyzed and compared between the two groups.Results In coronary atherosclerotic plaque the contents of high-sensitivity C-reactive protein(hs-CRP),troponin I(TnI),creatine kinase isoenzyme(CK-MB),creatinine(Cr)and lipoprotein-related phospholipase 2(Lp-PLA2)in high-value group were strikingly higher than those in low-value group(P<0.05).In high-value group the content of the calcified components was significantly lower than that in low-value group(P=0.002),the number of necrotic cores was obviously larger than that in low-value group(P=0.007),and the incidence of thin-cap fibroatheroma(TCFA)was prominently higher than that in low-value group(P=0.002).Logistic regression analysis revealed that EATV was an independent predictor of TCFA(OR=2.465,95%CI=1.35-4.50,P=0.002).Conclusion The results of this study indicate that in ACS patients an elevated EATV is well correlated with the vulnerable plaques,therefore,EATV can be used as a potential marker for predicting the occurrence of TCFA.