| Objective:To observe the change of coronary plaque and analyze the relationship between coronary plaques and lipid by noninvasive method, computed tomography coronary angiography.Method:Dual-Source CT was performed in 53 patients (57.1±11.9 years old,6 female), and rechecked in 237.8±91.5 days. TC, TG, HDL-C and LDL-C were tested simultaneously. HU ranges for fatty or fibrous plaque, lumen and calcification were-10-69,70-158,159-436 and 437+, calcified plaques were excluded. Using these cut-offs, the burden, area and CT values of coronary plaque were calculated. Patients were divided into 2 groups as the lesion aggravated or not. The profiles of lipid and angina pectoris classification were compared between the two groups.Results:Of all 53 patients, TC and LDL-C were increased and lesion aggravated slightly(p>0.05). The TC and LDL-C of stable group were lower than aggravated group significantly(3.90±0.62 vs 4.51±1.05, p=0.0105; 2.09±0.43 vs 2.46±0.80, p=0.0385). Multiple regression analysis and stepwise regression showed positive correlation between the burden of plaque and LDL-C(r=0.37, p=0.0071), positive correlation between the area of fatty plaque and LDL-C, TG(r=0.54, p=0.0383, p=0.0082). The lesion will not aggrevated if the LDL-C less than 2.12mmol/L or the TC less than 4.0mmol/L. Of the patients without revascularization, angina pectoris classification increased significantly in aggravated group(1.15±0.37 vs 1.40±0.60, p=0.0210).Conclusion:This retrospective study showed that, as a noninvasive method, CTCA could used to monitor progression of coronary plaque. Lipid-lowering therapy can stop the coronary plaque aggravated. The role of TG in coronary plaque needs to be more valued. Objective:The aim of this study was to stratify the coronary lesions into the discrete and diffuse lesions in order to better understand coronary plaque pathophysiology in ACS(acute coronary syndrome).Materials and Methods:Of the 1900 patients examined,95 patients satisfied the entry criteria. All CT scans were performed on a Dual-Source CT scanner or a 64-row slice CTCA scanner. The patients were divided into 2 groups, the discrete and defuse lesion group. The discreet lesion was defined as only 1 severity lesions founded in a main artery. The defuse lesion was defined as those severity lesions are more than 1. The plaque score was calculated:segment-stenosis score, segment-involvement score, 3-vessel plaque score, left main coronary score, calcification score and remodeling index.Results:There were 61(64%) patients in the discrete plaque group and 34(36%) patients in the diffuse plaque group. The patients in the diffuse plaque group were older, more hypertensions, PAD, DM, old myocardial infarctions and heart failure. In general, there was no statistical difference between the 2 groups in UAP, NSTEMI and STEMI. However, all the 5 patients with STEMI are in the discrete plaque group. There were more diffuse lesion in the NSTEMI. The stenosis score, the segment score,3 vessel disease, left main disease and calcification score were less in the discrete lesion than in the diffuse lesion group. Most of the discrete plaques were positively remodeled and most of the diffuse plaques were negatively remodeled. The major adverse cardiac events occurred in diffuse plaque group were much more than those occurred in discrete group at follow-up.Conclusions:The diffuse plaque group comprises high risk pts. The extensive atherosclerosis with calcification and multiple stenosis are predominant feature. These pts have higher motility. The discrete group, however, comprises mainly positively remodeled soft plaque. They are vulnerable but respond well to medical or revascularization therapy. Distinguishing the discrete and diffuse plaque in ACS patients is useful to assess the state of illness and the prognosis of patient.
|
PDF Full Text Request