Association of coronary microvascular endothelial dysfunction with vulnerable plaque characteristics in early coronary atherosclerosis.
- 作者列表："Godo S","Corban MT","Toya T","Gulati R","Lerman LO","Lerman A
AIMS:The aim of this study was to test the hypothesis that coronary microvascular endothelial dysfunction (CMED) is associated with epicardial coronary atherosclerosis. METHODS AND RESULTS:We performed a cross-sectional analysis of a comprehensive invasive assessment of coronary physiology with a focus on endothelium-dependent coronary microvascular function and virtual-histology intravascular ultrasound (VH-IVUS) in a total of 148 consecutive patients with chest pain and angiographically normal coronary arteries or non-obstructive coronary artery disease (CAD). Endothelium-dependent coronary vascular reactivity was evaluated by graded doses of intracoronary acetylcholine (ACh). CMED was defined as a percent increase in coronary blood flow of ≤50% in response to ACh. Patients with CMED (n=87) showed more vulnerable plaque characteristics as compared to those without (n=61); they showed higher plaque burden in association with larger necrotic core volume and higher frequency of imaged arteries containing at least one VH-IVUS-derived thin-capped fibroatheroma (TCFA) (n=22 [25.3%] vs 5 [8.2%], p=0.008). Multivariate logistic regression analysis revealed that CMED was an independent predictor of VH-IVUS-derived TCFA (adjusted odds ratio 2.28 [95% confidence interval: 1.30-4.02], p=0.004). CONCLUSIONS:Independently of conventional coronary risk factors, CMED was associated with vulnerable plaque characteristics in patients with non-obstructive CAD.
目的: 本研究的目的是验证冠状动脉微血管内皮功能障碍 (CMED) 与心外膜冠状动脉粥样硬化相关的假设。 方法和结果: 我们对冠状动脉生理学的全面侵入性评估进行了横断面分析，重点是内皮依赖性冠状动脉微血管功能和虚拟组织学血管内超声 (vh-ivus) 在总共148名连续的胸痛患者和血管造影正常的冠状动脉或非阻塞性冠状动脉疾病 (CAD)。通过冠状动脉内乙酰胆碱 (ACh) 的分级剂量评估内皮依赖性冠状动脉血管反应性。CMED被定义为响应于ACh的冠状动脉血流增加 ≤ 50% 的百分比。与没有CMED的患者 (n = 61) 相比，CMED患者 (n = 87) 显示出更易损的斑块特征; 他们显示出更高的斑块负荷与更大的坏死核心体积和更高频率的成像动脉包含至少一个VH-IVUS衍生的薄盖纤维粥样瘤 (TCFA) (n = 22 [25.3%] vs 5 [8.2%]，p = 0.008)。多因素logistic回归分析显示，CMED是vh-ivus衍生TCFA的独立预测因子 (校正比值比2.28 [95% 可信区间: 1.30-4.02]，p = 0.004)。 结论: 在非梗阻性CAD患者中，CMED与易损斑块特征无关。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.