The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:55

Article

Kubo, Takashi¹  Maehara, Akiko¹  Mintz, Gary S.¹  Doi, Hiroshi¹  Tsujita, Kenichi¹  Choi, So-Yeon¹  Katoh, Osamu²  Nasu, Kenya²  Koenig, Andreas³  Pieper, Michael⁴  Rogers, Jason H.⁵  Wijns, William⁶  Boese, Dirk⁷  Margolis, Pauliina⁸  Moses, Jeffrey W.¹  Stone, Gregg W.¹  Leon, Martin B.¹ 

[1] Cardiovasc Res Fdn, New York, NY 10022 USA

[2] Toyohashi Heart Ctr, Aichi, Japan

[3] Univ Munich, Munich, Germany

[4] Herzzentrum Bodensee, Kreuzlingen, Switzerland

[5] Univ Calif Davis, Med Ctr, Sacramento, CA 95817 USA

[6] Onze Lieve Vrouw Hosp, Aalst, Belgium

[7] Univ Duisburg Essen, Essen, Germany

[8] Volcano Corp, San Diego, CA USA

关键词: atherosclerosis;    coronary disease;    intravascular ultrasound;    virtual histology;   

DOI  :  10.1016/j.jacc.2009.07.078

来源: Elsevier

【 摘 要 】

Objectives We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology. Background Plaque stability is related to its histological composition. Methods We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden >= 40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque. Results At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs healed, 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm(2) [8.2 to 10.7 mm(2)] vs. 6.9 mm(2) [6.0 to 8.2 mm(2)], p = 0.021), vessel (18.7 mm(2) [17.3 to 28.6 mm(2)] vs. 15.5 mm(2) [13.3 to 16.6 mm(2)]; p = 0.010), and plaque (9.7 mm(2) [9.6 to 15.7 mm(2)] vs. 8.4 mm(2) [7 to 9.7 mm(2)], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm(2) [6.2 to 10.0 mm(2)] to 9.0 mm(2) [6.5 to 12.0 mm(2)], p < 0.001), VH-TCFAs (8.6 mm(2) [7.3 to 9.9 mm(2)] to 9.5 mm(2) [7.8 to 10.8 mm2], p = 0.024), and ThCFAs (8.6 mm(2) [6.8 to 10.2 mm(2)] to 8.8 mm(2) [7.1 to 11.4 mm(2)], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque. Conclusions Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque. (J Am Coll Cardiol 2010;55:1590-7) (C) 2010 by the American College of Cardiology Foundation

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