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ȣ - 520012 32 |
| Relation Between N-Terminal Pro-B-Type Natriuretic Peptide and Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis |
| 전남대학교병원 심장센터, 전남대학교 심혈관질환 치료재생 특성화사업단, 과학기술부 제대혈 및 중간엽줄기세포 기능연구사업단 |
| 홍영준, 안영근, 심두선, 윤남식, 윤현주, 김계훈, 박형욱, 김주한, 정명호, 조정관, 박종춘, 강정채 |
Background: The N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a sensitive indicator of hemodynamic stress and its increased level is associated with higher mortality in acute coronary syndrome (ACS) patients. Virtual histology-intravascular ultrasound (VH-IVUS) can provide quantitative information on plaque components. We used VH-IVUS to evaluate the relation between NT-pro-BNP levels and plaque components in patients with ACS.
Methods: We measured pre-procedural serum NT-pro-BNP levels in 156 ACS patients with preserved left ventricular systolic function and normal serum creatinine. VH-IVUS classified the color-coded tissue into four major components: fibrotic; fibro-fatty; dense calcium; and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥ 10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥ 40%. We divided the patients into two groups according to the NT-pro-BNP levels [Group I: ≥ 200 pg/ml (n=58) vs. Group II: < 200 pg/ml (n=98)].
Results:: The percent area of NC at the minimum lumen site (19.8±13.1% vs. 15.2±11.1%, p=0.027) and at the largest NC site (24.7±10.3% vs. 19.2±11.4%, p=0.015) were significantly greater in Group I than in Group II. Percent NC volume was significantly greater in Group I than in Group II (15.8±8.1% vs. 10.1±9.1%, p=0.008). The total number of TCFAs was 38 in group I and 56 in group II. The presence of at least one TCFA (58% vs. 38%, p=0.009) and multiple TCFAs (25% vs. 10%, p=0.005) within culprit lesions were observed more frequently in Group I than in Group II. The TCFAs were located more in proximal in Group I than in Group II [the length from coronary ostium to TCFA: 10.8±7.6 mm in Group I vs. 25.7±16.3 mm in Group II (p<0.001).] 85% of TCFAs was located within 20 mm from coronary ostium in Group I; conversely only 36% of TCFAs was located within 20 mm from coronary ostium in Group II (p<0.001).
Conclusions: VH-IVUS analysis demonstrates that ACS patients with high NT-pro-BNP levels had more vulnerable plaque component (more NC-containing lesions and higher frequency of culprit lesion TCFAs) and had more proximally located TCFAs.
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