D. Opincariu, N. Raț, A. Mester, R. Hodaș, D. Cernica, D. Păsăroiu, M. Rațiu, M. Chițu, I. Kovács, I. Benedek, T. Benedek
{"title":"根据其在冠状树中的位置,动脉粥样硬化病变的位点特异性表型-基于ccta的易损斑块研究","authors":"D. Opincariu, N. Raț, A. Mester, R. Hodaș, D. Cernica, D. Păsăroiu, M. Rațiu, M. Chițu, I. Kovács, I. Benedek, T. Benedek","doi":"10.2478/jce-2021-0010","DOIUrl":null,"url":null,"abstract":"Abstract Background: The evaluation of site-specific phenotype according to the topographic location of atherosclerotic lesions within the coronary tree has not been studied so far. The present study is based on the premise that the location of coronary plaques can influence their composition and degree of vulnerability. Aim: To evaluate different phenotypes of vulnerable coronary plaques across the three major coronary arteries in terms of composition, morphology, and degree of vulnerability, in patients with chest pain and low-to-intermediate probability of coronary artery disease, using coronary computed tomography angiography (CCTA) and a complex plaque analysis. Material and methods: This was a cross-sectional study on 75 subjects undergoing CCTA for chest pain, who presented at least one vulnerable coronary plaque (VP), defined as the presence of ≥1 CT vulnerability marker (low attenuation plaque, napkin-ring sign, spotty calcifications, positive remodeling). The study included per plaque analysis of 90 vulnerable coronary lesions identified in various locations within the coronary tree as follows: n = 30 VPs in the left anterior descending artery (LAD), n = 30 VPs in the circumflex artery (CXA), and n = 30 VPs in the right coronary artery (RCA). Results: The RCA exhibited significantly longer VPs (p = 0.001), with the largest volume (p = 0.0007) compared to those arising from the LAD and CXA. Vulnerable plaques located in the LAD exhibited a significantly more calcified phenotype (calcified volume: LAD – 44.07 ± 63.90 mm3 vs. CXA – 12.40 ± 19.65 mm3 vs. RCA – 33.69 ± 34.38 mm3, p = 0.002). Plaques from the RCA presented a more non-calcified phenotype, with the largest non-calcified (p = 0.002), lipid rich (p = 0.0005), and fibrotic volumes (p = 0.003). Low-attenuation plaques were most frequent in the RCA (p = 0.0009), while the highest vulnerability degree was present in lesions located in the LAD, which presented the highest number of vulnerability markers per plaque (p = 0.01). Conclusions: Vulnerable plaques arising from the right coronary artery are longer, more vo-luminous and with larger lipid and non-calcified content, whereas those located in the left anterior descending artery present a higher volume of calcium, but also a higher degree of vulnerability. The least vulnerable lesions were present in the circumflex artery.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"29 1","pages":"39 - 46"},"PeriodicalIF":0.6000,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Site-specific Phenotype of Atherosclerotic Lesions According to Their Location Within the Coronary Tree – a CCTA-based Study of Vulnerable Plaques\",\"authors\":\"D. Opincariu, N. Raț, A. Mester, R. Hodaș, D. Cernica, D. Păsăroiu, M. Rațiu, M. Chițu, I. Kovács, I. Benedek, T. Benedek\",\"doi\":\"10.2478/jce-2021-0010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Abstract Background: The evaluation of site-specific phenotype according to the topographic location of atherosclerotic lesions within the coronary tree has not been studied so far. The present study is based on the premise that the location of coronary plaques can influence their composition and degree of vulnerability. Aim: To evaluate different phenotypes of vulnerable coronary plaques across the three major coronary arteries in terms of composition, morphology, and degree of vulnerability, in patients with chest pain and low-to-intermediate probability of coronary artery disease, using coronary computed tomography angiography (CCTA) and a complex plaque analysis. Material and methods: This was a cross-sectional study on 75 subjects undergoing CCTA for chest pain, who presented at least one vulnerable coronary plaque (VP), defined as the presence of ≥1 CT vulnerability marker (low attenuation plaque, napkin-ring sign, spotty calcifications, positive remodeling). The study included per plaque analysis of 90 vulnerable coronary lesions identified in various locations within the coronary tree as follows: n = 30 VPs in the left anterior descending artery (LAD), n = 30 VPs in the circumflex artery (CXA), and n = 30 VPs in the right coronary artery (RCA). Results: The RCA exhibited significantly longer VPs (p = 0.001), with the largest volume (p = 0.0007) compared to those arising from the LAD and CXA. Vulnerable plaques located in the LAD exhibited a significantly more calcified phenotype (calcified volume: LAD – 44.07 ± 63.90 mm3 vs. CXA – 12.40 ± 19.65 mm3 vs. RCA – 33.69 ± 34.38 mm3, p = 0.002). Plaques from the RCA presented a more non-calcified phenotype, with the largest non-calcified (p = 0.002), lipid rich (p = 0.0005), and fibrotic volumes (p = 0.003). Low-attenuation plaques were most frequent in the RCA (p = 0.0009), while the highest vulnerability degree was present in lesions located in the LAD, which presented the highest number of vulnerability markers per plaque (p = 0.01). Conclusions: Vulnerable plaques arising from the right coronary artery are longer, more vo-luminous and with larger lipid and non-calcified content, whereas those located in the left anterior descending artery present a higher volume of calcium, but also a higher degree of vulnerability. 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引用次数: 0
摘要
背景:根据冠状动脉树内动脉粥样硬化病变的地形位置来评估位点特异性表型迄今尚未有研究。本研究的前提是冠状动脉斑块的位置会影响其组成和易损性。目的:利用冠状动脉计算机断层血管造影(CCTA)和复杂斑块分析,评估胸痛和低至中等冠状动脉疾病概率患者的三条主要冠状动脉易损斑块的组成、形态和易损程度的不同表型。材料和方法:本研究是一项横断面研究,对75名因胸痛接受CCTA的患者进行研究,这些患者至少有一个易损冠状动脉斑块(VP),定义为存在≥1个CT易损标志物(低衰减斑块、餐巾环征、点状钙化、阳性重构)。本研究包括对冠状动脉树内不同位置的90个易损冠状动脉病变的斑块分析,如下:左前降支(LAD) n = 30个VPs,旋支(CXA) n = 30个VPs,右冠状动脉(RCA) n = 30个VPs。结果:与LAD和CXA相比,RCA表现出更长的VPs (p = 0.001),体积最大(p = 0.0007)。位于LAD的易损斑块表现出明显的钙化表型(钙化体积:LAD - 44.07±63.90 mm3 vs. CXA - 12.40±19.65 mm3 vs. RCA - 33.69±34.38 mm3, p = 0.002)。来自RCA的斑块表现出更多的非钙化表型,最大的非钙化(p = 0.002),脂质丰富(p = 0.0005),纤维化体积(p = 0.003)。低衰减斑块在RCA最常见(p = 0.0009),而位于LAD的病变易损程度最高,每个斑块易损标志物数量最多(p = 0.01)。结论:产生于右冠状动脉的易损斑块更长、更亮、脂质和非钙化含量更高,而位于左前降支的易损斑块钙含量更高,但易损程度也更高。最不脆弱的病变出现在旋动脉。
Site-specific Phenotype of Atherosclerotic Lesions According to Their Location Within the Coronary Tree – a CCTA-based Study of Vulnerable Plaques
Abstract Background: The evaluation of site-specific phenotype according to the topographic location of atherosclerotic lesions within the coronary tree has not been studied so far. The present study is based on the premise that the location of coronary plaques can influence their composition and degree of vulnerability. Aim: To evaluate different phenotypes of vulnerable coronary plaques across the three major coronary arteries in terms of composition, morphology, and degree of vulnerability, in patients with chest pain and low-to-intermediate probability of coronary artery disease, using coronary computed tomography angiography (CCTA) and a complex plaque analysis. Material and methods: This was a cross-sectional study on 75 subjects undergoing CCTA for chest pain, who presented at least one vulnerable coronary plaque (VP), defined as the presence of ≥1 CT vulnerability marker (low attenuation plaque, napkin-ring sign, spotty calcifications, positive remodeling). The study included per plaque analysis of 90 vulnerable coronary lesions identified in various locations within the coronary tree as follows: n = 30 VPs in the left anterior descending artery (LAD), n = 30 VPs in the circumflex artery (CXA), and n = 30 VPs in the right coronary artery (RCA). Results: The RCA exhibited significantly longer VPs (p = 0.001), with the largest volume (p = 0.0007) compared to those arising from the LAD and CXA. Vulnerable plaques located in the LAD exhibited a significantly more calcified phenotype (calcified volume: LAD – 44.07 ± 63.90 mm3 vs. CXA – 12.40 ± 19.65 mm3 vs. RCA – 33.69 ± 34.38 mm3, p = 0.002). Plaques from the RCA presented a more non-calcified phenotype, with the largest non-calcified (p = 0.002), lipid rich (p = 0.0005), and fibrotic volumes (p = 0.003). Low-attenuation plaques were most frequent in the RCA (p = 0.0009), while the highest vulnerability degree was present in lesions located in the LAD, which presented the highest number of vulnerability markers per plaque (p = 0.01). Conclusions: Vulnerable plaques arising from the right coronary artery are longer, more vo-luminous and with larger lipid and non-calcified content, whereas those located in the left anterior descending artery present a higher volume of calcium, but also a higher degree of vulnerability. The least vulnerable lesions were present in the circumflex artery.