使用 CT 血管造影术评估颈动脉血管重塑和斑块钙化模式之间的关联及其对缺血性症状的影响。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2024-04-30 Epub Date: 2024-04-16 DOI:10.21037/cdt-23-428
Shanhu Xu, Jianjun Zhang, Jiahu Yang, Jianhua Mao, Baojie Mao, Qing Chen, Fengli Fu
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引用次数: 0

摘要

背景:动脉重塑是血管壁对动脉粥样硬化斑块生长的一种代偿机制。然而,颈动脉病变血管重塑的临床意义仍不清楚。通过这项研究,我们旨在评估颈内动脉(ICA)狭窄程度≥50%的患者血管重塑与缺血症状之间的关联,同时考虑斑块钙化模式的差异:这项回顾性横断面研究纳入了2018年9月至2023年3月期间浙江医院收治的伴有动脉粥样硬化斑块的中重度颈内动脉近端狭窄的成年患者。采用非对比和对比增强计算机断层扫描血管造影术(CTA)评估了管腔直径、斑块钙化类型、钙化评分和钙化厚度等参数。重塑比值(RR)的计算方法是将斑块部位动脉管腔内缘与斑块外缘之间的近端 ICA 最大距离除以管腔直径。记录动脉粥样硬化危险因素和药物。采用 Mann-Whitney U 检验或卡方检验比较组间差异。相关性采用皮尔逊相关系数进行测量。使用多变量逻辑回归分析评估缺血症状的预测因素,结果以几率比(OR)和 95% 置信区间(CI)表示。分析了斑块钙化类型之间 RR 的差异以及血管重塑与临床症状之间的关联:本研究共纳入196名患者的242条ICA,其中有症状的84条,无症状的158条。无症状组的RR[中位数,1.31(四分位间范围,1.17-1.68)]明显高于无症状组[中位数,1.20(四分位间范围,1.05-1.45)],P=0.006。)不同斑块钙化类型的 RR 存在显著差异,其中 5 型和 6 型斑块的 RR 最高。约71.5%(173/242)的ICA出现了正重塑。观察发现,RR 与缺血症状之间以及阳性重塑与钙化厚度之间存在明显的相关性(结论:动脉重塑存在于所有的中动脉中:主动脉瓣中存在动脉重塑。动脉正重塑与斑块钙化厚度之间存在明显关联。RR有助于预测缺血症状。我们的研究结果表明,动脉重塑是一种新的测量方法,有助于确定颈动脉粥样硬化疾病缺血性事件的风险分层。
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Evaluating the association between vascular remodeling and plaque calcification patterns of the carotid artery and its effects on ischemic symptoms using CT angiography.

Background: Arterial remodeling is a compensatory mechanism of the vessel wall in response to atherosclerotic plaque growth. However, the clinical significance of vascular remodeling of carotid lesions remains unclear. Through this study, we aimed to evaluate the association between vascular remodeling and ischemic symptoms in patients with an internal carotid artery (ICA) stenosis degree ≥50%, considering the differences in plaque calcification patterns.

Methods: This retrospective cross-sectional study included adult patients with moderate-to-severe proximal ICA stenosis associated with atherosclerotic plaques admitted to the Zhejiang Hospital between September 2018 and March 2023. Parameters such as lumen diameter, plaque calcification types, calcium scores, and calcification thickness were assessed using non-contrast and contrast-enhanced computed tomography angiography (CTA). The remodeling ratio (RR) was calculated by dividing the maximum distance of the proximal ICA between the inner border of the arterial lumen at the plaque site and the outer borders of the plaque by the luminal diameter. Atherosclerosis risk factors and medications were recorded. The Mann-Whitney U test or chi-square test was used to compare the differences between groups. Correlations were measured using Pearson's correlation coefficient. Predictors of ischemic symptoms were assessed using multivariable logistic regression analysis, with results expressed as odds ratio (ORs) with 95% confidence intervals (CIs). A P value less than 0.05 (two-sided) was considered to indicate statistical significance The differences in RR among plaque calcification types and the association between vascular remodeling and clinical symptoms were analyzed.

Results: A total of 242 ICAs in 196 patients were included in this study, and 84 were symptomatic and 158 were asymptomatic. The RR in symptomatic ICA [median, 1.31 (interquartile range, 1.17-1.68)] was significantly greater than that in asymptomatic group [median, 1.20 (interquartile range, 1.05-1.45)], P=0.006). Significant differences in RR existed among plaque calcification types, among which type 5 and 6 plaques had the highest RR. About 71.5% (173/242) of all ICAs showed positive remodeling. Significant correlations were observed between RR and ischemic symptoms and between positive remodeling and calcification thickness (P<0.05 for all variables). On multivariable logistic regression analysis, calcification thickness remained significantly associated with positive remodeling of carotid arteries (OR 2.30; 95% CI: 1.06-5.01; P=0.036).

Conclusions: Arterial remodeling exists in the ICA. A significant association between arterial positive remodeling and plaque calcification thickness was established. RR helps predict ischemic symptoms. The results of our study suggest that arterial remodeling serves as a novel measure to help ascertain the risk stratification of ischemic events in carotid atherosclerotic disease.

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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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