Background:Endovascular treatment(EVT)is an alternative option for symptomatic intracranial atherosclerotic disease(ICAD).However,the effect of EVT treatment on ICAD plaques is still unclear.This study describes the I...Background:Endovascular treatment(EVT)is an alternative option for symptomatic intracranial atherosclerotic disease(ICAD).However,the effect of EVT treatment on ICAD plaques is still unclear.This study describes the ICAD plaque characteristics after EVT treatment and analyzes the effect of different EVT treatments on plaque characteristics.Method:From 2017 January to 2022 January,ICAD patients who underwent endovascular treatment and had follow-up high-resolution magnetic resonance image(HRMRI)were enrolled in the study.Multiple plaque characteristics,including plaque enhancement,plaque burden,were measured based on preoperative,and follow-up HRMRI.Plaque characteristics and postoperative plaque changes were analyzed between different treatment groups.Result:Finally,50 intracranial atherosclerotic plaques in 45 patients were included.Including 28 male patients and 17 female,media age 63.0 years old.Among 50 plaques,41 received percutaneous angioplasty(including 22 plain balloons and 19 drug-coated balloons(DCB))and the other 9 underwent stenting.Stenosis rate,plaque burden and eccentricity index at the lesion site were significantly decreased after EVT compared with preoperative periods(p<0.001).And only the DCB group showed a significant reduction in plaque enhancement at follow-up(p<0.001).No significant preoperative and postoperative changes in other plaque characteristics were found.Conclusion:EVT treatment could compromise the characteristics of intracranial periarterial atherosclerotic plaques,and DCB treatment may result in a reduction in plaque enhancement after treatment.展开更多
Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atheroscleroti...Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.展开更多
Background:Age-related vulnerable characteristics of pancoronary plaques in patients with ST-segment elevation myocardial infarction(STEMI)have not been systemically evaluated by optical coherence tomography(OCT).Ther...Background:Age-related vulnerable characteristics of pancoronary plaques in patients with ST-segment elevation myocardial infarction(STEMI)have not been systemically evaluated by optical coherence tomography(OCT).There-fore,we sought to explore the discrepancies in pancoronary characteristics between younger and older patients with STEMI through OCT.Methods:This retrospective single-center study included 588 patients who had STEMI and underwent three-vessel OCT through emergency percutaneous coronary intervention between October 2016 and September 2018.With a median age of 56 years as a cutoff,the patients were divided into a younger group(≤56 years,n=298)and an older group(>56 years,n=290).Results:Atotal of 795 non-culprit plaques were found in 298 of the younger patients,whereas 858 non-culprit plaques were identified in 290 of the older patients.Fewer high-risk OCT plaques(15.8%vs.23.1%;P=0.025),as well as other structures(cholesterol crystals,P=0.001;microchannels,P=0.032;calcifications,P<0.001;spotty calcifications,P<0.001;large calcifications,P<0.001;and thrombi,P=0.001)were identified in younger patients than older patients,at the patient level.In addition,pancoronary vulnerability in younger patients was independently predicted by culprit plaque rupture{CLIMA-defined high-risk plaques(odds ratio[OR]:3.179;95%CI:1.501 to 6.733;P=0.003),non-culprit rupture(OR:3.802;95%CI:1.604 to 9.014;P=0.002),non-culprit thin-cap fibroatheroma(OR:3.536;95%CI:2.051 to 6.094;P<0.001)},hyper-tension(OR:1.920;95%CI:1.099 to 3.355;P=0.022),and total cholesterol(OR:1.094;95%CI:1.002 to 1.195;P=0.045).In older patients with STEMI,the predictor was male sex(OR:3.031;95%CI:1.352 to 6.795;P=0.007).Conclusions:Among patients with STEMI,younger patients had limited vulnerable plaque characteristics,and pan-coronary vulnerability was associated with culprit plaque rupture,hypertension,and total cholesterol.In contrast,older patients had greater pancoronary vulnerability with the single predictor of male sex,thus suggesting that traditional risk factors have limited applicability in predicting pancoronary vulnerability in older patients.展开更多
Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular ...Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular events(MACE)between patients with and without diabetes mellitus.Methods A total of 425 patients who underwent CCTA in Shunde Hospital Affiliated to Southern Medical University from June 2016 to November 2016 were retrospectively analyzed.Patients were divided into DM group(n=120)and non-DM group(n=305)for follow-up.According to the occurrence of MACE during follow-up,patients were divided into DM group(n=81),DM+MACE group(n=39),non-DM group(n=39),non-DM group(n=244)and non-DM+MACE group(n=61).The differences in general characteristics,biochemical index and parameters in imaging were compared among the four groups.Cox proportional hazards regression analysis was used to analyze the influencing factors for MACE in the two populations.The receiver operating characteristic(ROC)curve was used to analyze the difference in the predictive value of different plaque characteristics and CT-derived parameters for MACE.Results The levels of coronary artery calcification score(CACS),and the proportion of low-attenuation plaque(LAP)were higher in the DM+MACE group than in the DM group(P<0.05).The levels of positive reconstruction(PR),the proportionof antihypertensive drugs,CAD-RADS,CACS,residual cholesterol and apolipoprotein B were higher in the non-DM+MACE group than in the non-DM group(P<0.05).Cox proportional hazards regression analysis showed that CACS≥100(HR 2.151,95%CI 1.128-4.102,P=0.020)and LAP(HR 2.337,95%CI1.032-5.290,P=0.042)were the influencing factors for MACE in patients withDM.PR(HR 124.305,95%CI42.883-360.326,P<0.001)was the influencing factor for MACE in patients without DM.ROC curve analysis showed that the AUC of CACS combined with LAP were 0.606,0.609 and 0.660 for predicting MACE in DM patients within 1,3 and 5 years respectively.The AUC of PR for predicting MACE were 0.862,0.927,and 0.806 in the non-DM population within 1,3,and 5 years respectively.The predictive value of CACS and LAP for MACE in the DM patients was stable during the 5 years,while the predictive value of PR for MACE in the non-DM population decreased significantly after 4 years.Conclusion The predictive values of different plaque characteristics and CT derived parameters for future MACE are different between population with and without diabetes.The combination of CACS andlow-attenuationnplaques can effectively evaluate the risk of MACE in diabetic patients,while PR has a higher predictive value for MACE in non-diabetic patients.展开更多
基金funded by the Beijing Hospital Clinical Research 121 Project(BJ-2018-086 and BJ-2018-202)Capital’s Funds for Health Improvement and Research(2020-4-4053)
文摘Background:Endovascular treatment(EVT)is an alternative option for symptomatic intracranial atherosclerotic disease(ICAD).However,the effect of EVT treatment on ICAD plaques is still unclear.This study describes the ICAD plaque characteristics after EVT treatment and analyzes the effect of different EVT treatments on plaque characteristics.Method:From 2017 January to 2022 January,ICAD patients who underwent endovascular treatment and had follow-up high-resolution magnetic resonance image(HRMRI)were enrolled in the study.Multiple plaque characteristics,including plaque enhancement,plaque burden,were measured based on preoperative,and follow-up HRMRI.Plaque characteristics and postoperative plaque changes were analyzed between different treatment groups.Result:Finally,50 intracranial atherosclerotic plaques in 45 patients were included.Including 28 male patients and 17 female,media age 63.0 years old.Among 50 plaques,41 received percutaneous angioplasty(including 22 plain balloons and 19 drug-coated balloons(DCB))and the other 9 underwent stenting.Stenosis rate,plaque burden and eccentricity index at the lesion site were significantly decreased after EVT compared with preoperative periods(p<0.001).And only the DCB group showed a significant reduction in plaque enhancement at follow-up(p<0.001).No significant preoperative and postoperative changes in other plaque characteristics were found.Conclusion:EVT treatment could compromise the characteristics of intracranial periarterial atherosclerotic plaques,and DCB treatment may result in a reduction in plaque enhancement after treatment.
文摘Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
基金supported partly by grants from the Natural Science Foundation of Heilongjiang Province(TD2020H001)the National Major Scientific Instruments and Equipment’s Development Project of the National Natural Science Foundation of China(81827806).
文摘Background:Age-related vulnerable characteristics of pancoronary plaques in patients with ST-segment elevation myocardial infarction(STEMI)have not been systemically evaluated by optical coherence tomography(OCT).There-fore,we sought to explore the discrepancies in pancoronary characteristics between younger and older patients with STEMI through OCT.Methods:This retrospective single-center study included 588 patients who had STEMI and underwent three-vessel OCT through emergency percutaneous coronary intervention between October 2016 and September 2018.With a median age of 56 years as a cutoff,the patients were divided into a younger group(≤56 years,n=298)and an older group(>56 years,n=290).Results:Atotal of 795 non-culprit plaques were found in 298 of the younger patients,whereas 858 non-culprit plaques were identified in 290 of the older patients.Fewer high-risk OCT plaques(15.8%vs.23.1%;P=0.025),as well as other structures(cholesterol crystals,P=0.001;microchannels,P=0.032;calcifications,P<0.001;spotty calcifications,P<0.001;large calcifications,P<0.001;and thrombi,P=0.001)were identified in younger patients than older patients,at the patient level.In addition,pancoronary vulnerability in younger patients was independently predicted by culprit plaque rupture{CLIMA-defined high-risk plaques(odds ratio[OR]:3.179;95%CI:1.501 to 6.733;P=0.003),non-culprit rupture(OR:3.802;95%CI:1.604 to 9.014;P=0.002),non-culprit thin-cap fibroatheroma(OR:3.536;95%CI:2.051 to 6.094;P<0.001)},hyper-tension(OR:1.920;95%CI:1.099 to 3.355;P=0.022),and total cholesterol(OR:1.094;95%CI:1.002 to 1.195;P=0.045).In older patients with STEMI,the predictor was male sex(OR:3.031;95%CI:1.352 to 6.795;P=0.007).Conclusions:Among patients with STEMI,younger patients had limited vulnerable plaque characteristics,and pan-coronary vulnerability was associated with culprit plaque rupture,hypertension,and total cholesterol.In contrast,older patients had greater pancoronary vulnerability with the single predictor of male sex,thus suggesting that traditional risk factors have limited applicability in predicting pancoronary vulnerability in older patients.
文摘Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular events(MACE)between patients with and without diabetes mellitus.Methods A total of 425 patients who underwent CCTA in Shunde Hospital Affiliated to Southern Medical University from June 2016 to November 2016 were retrospectively analyzed.Patients were divided into DM group(n=120)and non-DM group(n=305)for follow-up.According to the occurrence of MACE during follow-up,patients were divided into DM group(n=81),DM+MACE group(n=39),non-DM group(n=39),non-DM group(n=244)and non-DM+MACE group(n=61).The differences in general characteristics,biochemical index and parameters in imaging were compared among the four groups.Cox proportional hazards regression analysis was used to analyze the influencing factors for MACE in the two populations.The receiver operating characteristic(ROC)curve was used to analyze the difference in the predictive value of different plaque characteristics and CT-derived parameters for MACE.Results The levels of coronary artery calcification score(CACS),and the proportion of low-attenuation plaque(LAP)were higher in the DM+MACE group than in the DM group(P<0.05).The levels of positive reconstruction(PR),the proportionof antihypertensive drugs,CAD-RADS,CACS,residual cholesterol and apolipoprotein B were higher in the non-DM+MACE group than in the non-DM group(P<0.05).Cox proportional hazards regression analysis showed that CACS≥100(HR 2.151,95%CI 1.128-4.102,P=0.020)and LAP(HR 2.337,95%CI1.032-5.290,P=0.042)were the influencing factors for MACE in patients withDM.PR(HR 124.305,95%CI42.883-360.326,P<0.001)was the influencing factor for MACE in patients without DM.ROC curve analysis showed that the AUC of CACS combined with LAP were 0.606,0.609 and 0.660 for predicting MACE in DM patients within 1,3 and 5 years respectively.The AUC of PR for predicting MACE were 0.862,0.927,and 0.806 in the non-DM population within 1,3,and 5 years respectively.The predictive value of CACS and LAP for MACE in the DM patients was stable during the 5 years,while the predictive value of PR for MACE in the non-DM population decreased significantly after 4 years.Conclusion The predictive values of different plaque characteristics and CT derived parameters for future MACE are different between population with and without diabetes.The combination of CACS andlow-attenuationnplaques can effectively evaluate the risk of MACE in diabetic patients,while PR has a higher predictive value for MACE in non-diabetic patients.
