cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2017.12.10061cardio-65Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОМACUTE CORONARY SYNDROMEПризнаки нестабильности атеросклеротической бляшки в сонных артериях у больных с острым коронарным синдромом по данным ультразвукового дуплексного сканированияCarotid Plaque Instability in Patients With Acute Coronary Syndrome as Assessed by Ultrasound Duplex ScanningПогореловаО. А.PogorelovaOlga A.pogorelova.olya@gmaiI.comТрипотеньМ. И.TripotenM. I.noemail@neicon.ruГучаеваД. А.GuchaevaD. A.noemail@neicon.ruШахновичР. М.ShahnovichR. M.noemail@neicon.ruРудаМ. Я.RudaM. Ya.noemail@neicon.ruБалахоноваТ. В.BalakhonovaT. V.noemail@neicon.ru«Институт клинической кардиологии им. А.Л. Мясникова» ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РФРоссияNational Medical Research Center for CardiologyRussian Federation2017171120185712515Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/65

Цель исследования. Изучение особенностей ультразвуковой структуры атеросклеротических бляшек (АСБ) в каротидном бассейне с помощью дуплексного сканирования у больных с острым коронарным синдромом (ОКС). Материалы и методы. Обследованы 143 пациента с ОКС в возрасте то 32 до 83 лет и 28 пациентов со стабильной формой ишемической болезни сердца (ИБС) в возрасте от 46 до 83 лет. Ультразвуковое исследование (УЗИ) сонных артерий проводили через 3-5 сут после госпитализации на ультразвуковой системе iU 22 с использованием линейного датчика (L9-3) для определения наличия, степени выраженности, структуры и состояния поверхности АСБ в сонных артериях. Оценивали эхогенность АСБ в серой шкале с помощью модифицированной методики медианы серой шкалы (GSM). Результаты. Проанализировано 378 АСБ пациентов с ОКС и 59 АСБ больных со стабильной ИБС. При анализе структуры бляшки в В-режиме УЗИ рассматривали такие признаки нестабильности АСБ, как гетерогенная структура, наличие гипоэхогенного компонента и неровной поверхности, малых гипоэхогенных зон, а также дополнительных ультразвуковых критериев структуры АСБ в серой шкале, таких как наличие мурального роста, слоистой структуры бляшки, локального кальциноза. У пациентов с ОКС по сравнению с больными со стабильной ИБС достоверно чаще встречались АСБ с наличием гипоэхогенного компонента - 43,4 и 28,8% (р=0,0459), гетерогенной структуры - 77,8 и 64,4% (р=0,0327), неровной поверхности (включая изъязвления поверхности более 2,0 мм) - 22,5 и 6,8% (р=0,0048) соответственно. Выявлено достоверное отличие пациентов с ОКС от больных ИБС по наличию нового ультразвукового критерия - слоистости бляшки в сонных артериях - 55,7 и 35,8% соответственно (р=0,0011). У больных с ОКС по сравнению с больными ИБС выявлено большее число АСБ с муральным ростом 16,3 и 7,5% соответственно (р=0,06). Не выявлено различий средней эхогенности АСБ по параметру медианы серой шкалы у больных с ОКС и ИБС (53,1 и 57,2; p=0,24). Наличие точечного кальциноза в АСБ достоверно не различалось в группе ОКС и стабильной ИБС (23,2 и 24,4%; p=0,23). Выводы. По данным ультразвукового дуплексного сканирования сонных артерий при анализе морфологической структуры бляшки в В-режиме АСБ с признаками нестабильности встречаются у пациентов с ОКС достоверно чаще, чем у больных со стабильной ИБС.

Aim: to study carotid plaques structure in patients with acute coronary syndrome by ultrasound duplex scanning. Materials and methods. We included in this study143 patients with acute coronary syndrome (ACS) aged 32-83 years and 28 patients with documented coronary heart disease (CHD) aged 46-83 years. Duplex scanning of carotid arteries was carried out with Philips iU22 ultrasound system and L9-3 linear array transducer. Atherosclerotic plaques in CCA, CCA bifurcation, and ICA from right and left side were investigated. Off-line analysis of B-mode images and plaque gray scale median (GSM) was performed with computer semiautomated workstation MultiVox. Results. 378 plaques of ACS and 59 plaques of CHD patients were studied. We assessed traditional (heterogenous structure, hypoechogenic component, irregular plaque surface) as well as additional (positive remodeling, “layered” structure of plaque, local calcification) criteria of plaque instability. In ACS compared with CHD group there were more plaques with hypoechogenic component (43.4 and 28.8%, p=0.0459), heterogenous structure (77.8 and 64.4%, p=0.0327), irregular surface including irregularities more than 2.0 mm (22.5 and 6.8%, p=0.0048, respectively). There was significant difference in “layered” structure (55.7 and 35.8%, p=0.0011) and insignificant difference in positive remodeling (16.3 and 7.5%, p=0.06, respectively). There were no differences of GSM value (53.1 and 57.2, p=0.24) and local calcification (23.2 and 24.5%, p=0.23, respectively). Conclusion. In our study ultrasound duplex scanning revealed that signs of plaque instability in carotid arteries in patients with ACS were more frequent than in patients with stable CHD. The newly introduced parameter “layered” structure of atherosclerotic plaque was found to be most significant.

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The authors declare that there are no conflicts of interest present.