∆ of max4mm LCBI>median (n=76) 33.0 ± 16.1 211 ± 119 581 ± 208 172 ± 162 -410 ± 193 61.75 ± 10.33 92.0 % 58.3 % 56.6 % 75.3 %
p-value 0.01 <0.001 <0.001 0.22 <0.001 0.38 0.30 0.19 0.75 0.23
• 大多数易损斑块检测设备都针对于薄纤维帽粥样
斑块(TCFAs， thin-cap fibroatheroma)，因为
TCFAs是最常见的易损斑块。
• 然而针对TCFA检测vulner有的TCFAs都有
破裂倾向*。
* Kolodgie FD, Burke AP, Farb A, Gold HK, Yuan J, Narula J, et al. The thin-cap fibroatheroma: type of vulnerable plaque: the major precursor lesion to acute coronary syndromes. Curr Opin Cardiol 2001;16:285-92.
TCFAs
• TCFAs are characterized by the presence
of the following: 较大的坏死核心, 薄纤维帽
, 炎性浸润, 丰富的斑块内字样血管, 正性重
构, 出血和钙化(or both).
NIRS
• 临床上将易损斑块的检测等同于脂质丰富 斑块。 • 其他的临床应用的检测手段，现用的和开 发中的各种设施，比如冠状动脉镜、OCT 、IVUS和磁共振均以脂质丰富（含或不含 坏死核心）的斑块为目标。 • 也有以其他可能指标作为检测标准（薄纤 维帽、炎性细胞等）。
• Background: Peri-procedural myocardial infarction
(peri-MI) is the result of distal embolization of lipid-core
plaque debris and/or thrombus during percutaneous coronary intervention (PCI) and may be associated with change of lipid-core burden index (LCBI) from pre to post-PCI.
• Methods: The COLOR Registry was a prospective, multicenter, observational study of pts undergoing near-infrared spectroscopy (NIRS) during PCI. • Raw spectroscopic information was transformed into a probability of lipid-rich plaque (LRP); pixels with a probability of LRP >0.6 were divided by all viable pixels to generate the LCBI. The 4mm-long segment with the maximum LCBI (maxLCBI4mm) was determined; and pts were divided according to the change of LCBI from pre to post-PCI.
clinical factors, statin use was an independent predictor
of a smaller reduction of maxLCBI4mm following PCI (p=0.043).
• Conclusion: Statin use prior to PCI is an
independent predictor of a smaller
reduction of LCBI after PCI. This may
explain the positive impact of statins on
the prevention of peri-procedural MI.
∆ of max4mm LCBI Lesion length (mm) Pre Lesion LCBI Pre Max4mm LCBI Post Max4mm LCBI ∆ Max4mm LCBI Age Male Diabetes ACS presentation Statin use at admission 27.6 ± 15.8 101 ± 95 267 ± 203 223 ± 202 -44 ± 104 63.6 ± 9.8 86.0 % 41.6 % 53.3 % 84.4 %
• 近红外光谱(NIRS)是一种光谱方法,使用近 红外区域的电磁波谱(从800 nm - 2500 nm)。 对检测目标进行扫描，
• 近红外能量的发现归功于威廉· 赫歇尔在19 世纪,但第一工业应用始于1950年代。在第 一个应用程序中,作为一个附加单元近红外 线只使用其他光学仪器使用等其他波长的 紫外线(UV),可见(Vis)或中红外光谱仪(MIR)。 在1980年代,单机制,独立的检测系统,但更 侧重于化学分析检测技术的应用。通过引 入light-fiber光学在1980年代中期和 monochromator-detector发展- 1990年代早 期,NIRS成为科学研究的一个更强大的工具。
PCI: Near-Infrared Spectroscopy Results
from the COLOR Registry
Author Block: Cristiano Souza, Tomotaka Dohi, Akiko Maehara, Annapoorna Kini, David Rizik, Emmanouil Brilakis, Kendrick Shunk, Brijeshwar Maini, Priti Shah, Kosaku Goto, Mitsuaki Matsumura, Ke Xu, Gregg Stone, Gary Mintz, James Muller, Giora Weisz, Cardiovascular Research Foundation, New York, NY, USA
Figure 1. NIR spectra of cholesterol, cholesterol esters, and collagen. Each substance has a particular NIR spectroscopic signature (peaks and troughs) based on its chemical composition. (Reproduced fromCaplan et al13 with permission from the American College of Cardiology Foundation.)
Figure 3. Drawing of an ideal catheter-based NIR spectroscopy device scanning an artery
Factors Associated with a Reduction of
Lipid Core Plaque in Patients Undergoing
近红外线光谱血脂检测 Near-infrared spectroscopy （NIRS）
FROM BENCH TO IMAGING: Rationale and use of near-infrared spectroscopy for detection of lipid-rich and vulnerable plaques
• Results: Overall, pre and post-PCI NIRS analyzable
images were available in 151 pts. Although there were
no clinical characteristics related to the reduction of maxLCBI4mm, a greater reduction in maxLCBI4mm was related to a larger pre-PCI LCBI. After multivariable analysis adjusted for the baseline maxLCBI4mm and
Sergio Waxman, MD,ab Fumiyuki Ishibashi, MD,ab and
Jay D. Caplan, SB, MBAc
IDENTIFICATION OF LIPID AS A POSSIBLE TARGET FOR DETECTION OF VULNERABLE PLAQUE