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ȣ - 510231 300 |
| Plaque tissue characteristics analysis of spasm segments with Virtual Histology in Korean Prinzmetal angina patients |
| 서울대학교 의과대학 내과학교실¹ , 분당서울대학교병원 심장센터² , 서울대학교병원 심혈관센터³ |
| 정우영¹ ², 이숙진¹ ², 양한모¹ ² , 권동아¹ ² ,박경우¹ ², 조영석¹ ² , 연태진¹ ² , 채인호¹ ² , 최동주¹ ² , 강현재¹ ³, 김효수 ¹ ³ , 오병희¹ ³ ,박영배¹ ³ |
Background : Prinzmetal angina is unique ischemic heart disease of which pathophysiology is still not fully known. Its characteristics is spontaneous coronary vasospasm showing ST elevation with diurnal variation occasionally resulting in myocardial infarction or sudden cardiac death. Most spasm segments have atheromatous plaque and some concern exist about its vulnerability. The purpose of this study is to investigate tissue characteristics of spasm segments in Korean Prinametal angina patients with Virtual Histology imaging.
Methods : All patients were diagnosed as Prinzmetal angina by Ergonovin provocation coronary angiography. Diagnostic criteria were as the followings; 1) reproduced chest pain, 2) ST elevation on ECG in at least two contiguous leads during provocation, 3) angiographically proven coronary vasospasm relieved by intracoronary nitroglycerin. After spasm was relieved, IVUS images were obtained in spasm segments and plaque tissue characteristics were analysed. (Volcano VH IVUS Imaging system for IVG3, verson 2.0) Tissue characteristics were classified into 4 category. 1) fibrous, 2) fibrofatty, 3) lipid core, 4) calcified, and volumetry for each component was performed.
Results : Total 9 patients were included. 6 patients were male and mean age was 59±9.75. All of them had normal ventricular systolic function. LDL cholesterol, HDL cholesterol level was 108±21mg/dl, 49±17mg/dl. Spasm occurred in 5 LAD, 4 RCA. Only two patients had insignificant (≥ 50% in % diameter stenosis) stenosis in spasm segments. Analysed vessel volume, lumen volume, % plaque volume was 204.5±145.0mm3, 156.4±113.0mm3, 25.0±6.4% respectively. Among 4 tissue characteristics, fibrous plaque was the most predominant (13.8±11.1 mm3, 60.5±23.3% of total plaque volume). Lipid core volume was 2.80±1.95mm3 to be only 15.6±9.1%. Calcification volume was similar with lipid core volume (2.0mm3, 14.6%). (Some patients is being enrolled)
Conclusion : In Prinzmetal angina, the plaques of spasm segments are mainly composed of fibrous tissue, and small amount of lipid core. It suggests the plaque is stable and had better prognosis with conventional medical treatments than acute coronary syndrome.
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