急性冠状动脉综合征患者非高密度脂蛋白胆固醇与斑块负荷和罪魁祸首病变组成的关系。血管内超声-虚拟组织学研究。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Indian heart journal Pub Date : 2024-09-01 DOI:10.1016/j.ihj.2024.10.004

Sreenivas Reddy , Raghavendra Rao K , Jeet Ram Kashyap , Vikas Kadiyala , Suraj Kumar , Debabrata Dash , Lipi Uppal , Jaspreet Kaur , Manpreet Kaur , Hithesh Reddy , Imran Ibni Gani Rather , Samir Malhotra

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引用次数: 0

摘要

目的：血脂在冠状动脉粥样硬化中起着关键作用。利用血管内成像技术，非高密度脂蛋白胆固醇（non-HDL-C）在动脉粥样硬化斑块中的作用仍不清楚。本研究旨在使用血管内超声（IVUS）评估非高密度脂蛋白胆固醇与急性冠状动脉综合征（ACS）冠状动脉斑块特征的关系：共有 601 名患者，分为两组：非高密度脂蛋白胆固醇正常值≤130 毫克/分升（410 人）和非高密度脂蛋白胆固醇高值>130 毫克/分升（191 人）。冠状动脉介入治疗前进行 IVUS：平均年龄（53.18±12.29）岁。各组之间在高血压、糖尿病和吸烟方面无明显差异。非高密度脂蛋白胆固醇正常组和高非高密度脂蛋白胆固醇组的斑块负荷明显更高（79.59±9.98% vs. 81.61±5.39%；P=0.001）。在最小管腔部位，非高密度脂蛋白胆固醇正常组的纤维脂肪比例更高（P=0.027），而非高密度脂蛋白胆固醇高组的坏死核心更高（P=0.033）。分段分析显示，非高密度脂蛋白胆固醇正常组和高非高密度脂蛋白胆固醇组坏死核心的百分比（p=0.006）和体积（p=0.011）均明显高于非高密度脂蛋白胆固醇高组。总胆固醇（r=0.099，p=0.015）、低密度脂蛋白胆固醇（r=0.081，p=0.046）、甘油三酯（r=0.083，p=0.041）和非高密度脂蛋白胆固醇（r=0.099，p=0.015）与斑块负荷呈正相关。总胆固醇（r=0.115，p=0.005）、低密度脂蛋白胆固醇（r=0.107，p=0.009）和非高密度脂蛋白胆固醇（r=0.105，p=0.010）与坏死核心体积呈正相关。线性回归分析显示，年龄和非高密度脂蛋白胆固醇是较高斑块负荷的预测因素。多元线性回归分析显示，年龄、体重指数和非高密度脂蛋白胆固醇是预测较大坏死核心体积的因素：结论：非高密度脂蛋白胆固醇水平与衡量动脉粥样硬化程度的斑块负荷呈正相关。结论：非高密度脂蛋白胆固醇水平与斑块负荷正相关，斑块负荷是衡量动脉粥样硬化程度的指标，非高密度脂蛋白胆固醇水平与坏死核心体积密切相关，是预测坏死核心体积的指标；坏死核心体积是斑块脆弱性的标志。这项IVUS研究证明了非高密度脂蛋白胆固醇在ACS斑块成因中的潜在作用。

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Association of non-HDL cholesterol with plaque burden and composition of culprit lesion in acute coronary syndrome. An intravascular ultrasound-virtual histology study

Objective

Lipids play key role in coronary atherosclerosis. The role of non-high-density lipoprotein cholesterol (non-HDL-C) in atherosclerotic plaques using intravascular imaging remains unclear. This study aimed to assess its relationship with coronary plaque features using intravascular ultrasound (IVUS) in acute coronary syndrome (ACS).

Methods

A total of 601 patients divided into two groups: normal non-HDL-C≤130 mg/dl (n = 410) and high non-HDL cholesterol >130 mg/dl (n = 191). IVUS performed before coronary intervention.

Results

Mean age 53.18 ± 12.29 years. No significant differences in hypertension, diabetes, and smoking between groups. Plaque burden was significantly higher among normal versus high non-HDL-C groups (79.59 ± 9.98 % vs. 81.61 ± 5.39 %; p = 0.001). At minimal luminal site, fibrofatty percentage was higher in normal non-HDL-C group (p = 0.027), while necrotic core greater in high non-HDL-C group (p = 0.033). Segmental analysis, necrotic core was significantly higher in percentage (p = 0.006) and volumes (p = 0.011) in normal versus high non-HDL-C groups. Total cholesterol (r = 0.099, p = 0.015), LDL-C (r = 0.081, p = 0.046), triglycerides (r = 0.083, p = 0.041),and non-HDL-C (r = 0.099, p = 0.015) positively correlated with plaque burden. Total cholesterol (r = 0.115, p = 0.005), LDL-C (r = 0.107, p = 0.009), and non-HDL-C (r = 0.105, p = 0.010) positively correlated with necrotic core volume. Linear regression analysis showed age and non-HDL-C as predictors of higher plaque burden. Multiple linear regression analysis; age, body mass index, and non-HDL-C were predictors of larger necrotic core volume.

Conclusion

Non-HDL-C levels were positively associated with plaque burden, measure of extent of atherosclerosis. It is closely associated with and is a predictor of necrotic core volume; a marker of plaque vulnerability. This IVUS study demonstrates potential role of non-HDL-C in causation of plaque in ACS.

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来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.