| Aim and BackgroundsThe emergence of intravascular ultrasound makes up for the limitations of coronary artery angiography in evaluating classification and structure of atherosclerotic plaques, coronary remodeling, stent expansion and stent apposition. Echo-attenuated phenomenon is a newly recognized ultrasound findings, it is closely correlated with fibroatheroma containing big necrotic core and pathological intimal thickening containing big lipid pool. Thin-cap fibroatheroma with big necrotic core tend to rupture and causing acute coronary syndrome. iMAP-IVUS can recognize unstable plaque better by analyzing plaque components. Coronary no-reflow phenomenon suggests myocardial perfusion disturbance, which usually predict post infarction extending, ventricle remodeling, heart failure and complications like severe arrhythmia. And its mechanism is still not clear. Bile acid is the main outlet of cholesterol, of which the general physiological function is to help digest and absorb lipids. Many studies indicate that bile acid participated in the initiation and progression of many cardiovascular diseases. Researches in recent years found that bile acid regulated gene transcription by modulate the activation of farnesoid X receptor and TGR5. NSTEMI is one of the most severe complications of coronary heart diseases and its harm is not ever small than STEMI. It had been underestimated in a quite long time. This is the first time that we use serum total bile acid concentration as biomarker to study the relation with NSTEMI patients' culprit plaque signature and level of myocardial perfusion. Methods1) The study of the relationship between serum bile acid concentration and plaques' signature in NSTEMI patients. 277 adults diagnosed with non ST-segment elevation myocardial infarction from January 1, 2012 to November 30, 2014 in Department of Cardiology of Renji Hospital were enrolled. Fasting blood samples were collected to determine serum bile acid concentration. Coronary artery angiography and intravascular ultrasound were performed in every enrolled patient. The relationship of bile acid concentration and echo-attenuated plaque and necrotic plaque was analyzed.2) The study of the relationship between serum bile acid concentration and myocardial perfusion. Patients enrolled were the same with the first part study. Fasting blood samples were collected to determine serum bile acid concentration. TIMI flow grade after intracoronary intervention was recorded. The relationship of bile acid concentration and no-reflow phenomenon was analyzed. Results277 patients were divided in tertile according to the serum bile acid concentration. The age, gender, history of diabetes, history of smoking, history of coronary artery disease, history of stroke, history of PCI and CABG history of renal dysfunction and previous statins intake were no difference among 3 groups(P>0.05). The history of hypertension is different among 3 groups(P=0.022). The TC, HDL, LDL, non-HDL, Apo A, Apo B, albumin, TBil and DBil were no difference among 3 groups(P>0.05). Culprit vessel plaque volume(mm3): 387.4±134.2 in the lowest tertile, 498.0±185.3 in the highest tertile, with significant statistics difference(P<0.05). The vessel CSA, plaque CSA, plaque burden remodeling index between lowest tertile and highest tertile is significantly different(P<0.05). Culprit vessel necrotic core volume(mm3): 38.7±21.6 in the lowest tertile, 68.1±25.5 in the highest tertile, with significant statistics difference(P =0.04). The percentage of echo-attenuated plaque: 9.10% in the lowest tertile, 21.20% in the middle tertile, 32.30% in the highest tertile, with significant statistics difference(P<0.001). The optimal cut-off point of the serum bile acid concentration predicting echo-attenuated plaque is 3.30 umol/L, with a sensitivity of 68.85% and specificity of 64.81%.2) The baseline characteristics were the same with the first part. The incidence rate of no-reflow: 6.80% in the lowest tertile, 16.70% in the middle tertile and 26.8% in the highest tertile, with a significant statistics diffenrence(P<0.001). The optimal cut-off point of the serum bile acid concentration predicting echo-attenuated plaque is 3.30 umol/L, with a sensitivity of 61.74% and specificity of 63.83%. Conclusion1) The culprit vessel plaque burden, plaque volume, modeling index and necrotic core volume analyzed by iMAP-IVUS are positive correlated with serum bile acid concentration in NSTEMI patients. The optimal cut-off point of the serum bile acid concentration predicting echo-attenuated plaque is 3.30 umol/L, with a sensitivity of 68.85% and specificity of 64.81%.2) The incidence rate of no-reflow is positive correlated with serum bile acid concentration. The optimal cut-off point of the serum bile acid concentration predicting echo-attenuated plaque is 3.30 umol/L, with a sensitivity of 61.74% and specificity of 63.83%. |
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