Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium ...Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes. Methods and results: In 51 consecutive patients(45 men), aged 38-76 years(mean age: 58± 10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data(IVUS Virtual HistologyTM). The study vessel was the left anterior descending artery in 23(45% ) patients; the circumflex artery in nine(18% ), and right coronary artery in 19(37% ). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5± 13 mm long(range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first(median: 8.75% ; IQR: 5.7-18) vs. the third(median: 6.1% ; IQR: 3.2-12)(P=0.036) and fourth(median: 4.5% ; IQR: 2.4-7.9)(P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [β =-0.28(95% CI:-0.15,-0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus. Conclusion: Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.展开更多
Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relations...Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relationship between plaque composition determined by intravascular ultrasound(IVUS) radio frequency(RF) data analysis and clinical presentation. Methods: In 55 patients, a nonculprit vessel with< 50%diameter stenosis was studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software. Results: Mean percentage of the different plaque components were 0.99%±0.9%, calcium; 68.04%±9.8%, fibrous; 19.31%±7.3%, fibrolipidic; and 9.43%±6.6%, lipid core. Mean lipid core percentage was significantly larger in patients with acute coronary syndrome(ACS) when compared with stable patients(12.26%±7.0%vs 7.40%±5.5%, P=.006). In addition, stable patients showed more fibrotic vessels(70.97%±9.3%vs 63.96%±9.1%, P=.007). There was no significant difference for either mean calcium(1.20%±1.1%vs 0.83%±0.7%, P=.124) or fibrolipidic(20.57%±6.9%vs 18.40%±7.6%, P=.281) percentages in ACS and stable patients, respectively. Vessel area obstruction did not differ between groups(46.49%±10.9%vs 42.83%±11.8%, P=.221). There was a significant, albeit weak, positive correlation between lipid core percentage and stenosis severity as determined by vessel area obstruction(r=0.34, P=.015). Conclusions: In this study, plaque characterization of nonculprit vessels using spectral analysis of IVUS RF data analysis was significantly related to clinical presentation. Percentage of lipid core, a feature related to acute coronary events and worse prognosis, was significantly larger in patients with ACS. Conversely, stable patients showed more fibrotic content.展开更多
文摘Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes. Methods and results: In 51 consecutive patients(45 men), aged 38-76 years(mean age: 58± 10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data(IVUS Virtual HistologyTM). The study vessel was the left anterior descending artery in 23(45% ) patients; the circumflex artery in nine(18% ), and right coronary artery in 19(37% ). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5± 13 mm long(range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first(median: 8.75% ; IQR: 5.7-18) vs. the third(median: 6.1% ; IQR: 3.2-12)(P=0.036) and fourth(median: 4.5% ; IQR: 2.4-7.9)(P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [β =-0.28(95% CI:-0.15,-0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus. Conclusion: Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.
文摘Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relationship between plaque composition determined by intravascular ultrasound(IVUS) radio frequency(RF) data analysis and clinical presentation. Methods: In 55 patients, a nonculprit vessel with< 50%diameter stenosis was studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software. Results: Mean percentage of the different plaque components were 0.99%±0.9%, calcium; 68.04%±9.8%, fibrous; 19.31%±7.3%, fibrolipidic; and 9.43%±6.6%, lipid core. Mean lipid core percentage was significantly larger in patients with acute coronary syndrome(ACS) when compared with stable patients(12.26%±7.0%vs 7.40%±5.5%, P=.006). In addition, stable patients showed more fibrotic vessels(70.97%±9.3%vs 63.96%±9.1%, P=.007). There was no significant difference for either mean calcium(1.20%±1.1%vs 0.83%±0.7%, P=.124) or fibrolipidic(20.57%±6.9%vs 18.40%±7.6%, P=.281) percentages in ACS and stable patients, respectively. Vessel area obstruction did not differ between groups(46.49%±10.9%vs 42.83%±11.8%, P=.221). There was a significant, albeit weak, positive correlation between lipid core percentage and stenosis severity as determined by vessel area obstruction(r=0.34, P=.015). Conclusions: In this study, plaque characterization of nonculprit vessels using spectral analysis of IVUS RF data analysis was significantly related to clinical presentation. Percentage of lipid core, a feature related to acute coronary events and worse prognosis, was significantly larger in patients with ACS. Conversely, stable patients showed more fibrotic content.
