Small entities with large impact: microcalcifications and atherosclerotic plaque vulnerability.
Small entities with large impact: microcalcifications and atherosclerotic plaque vulnerability.
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DOI：
10.1097/mol.0000000000000105
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发表时间：
2014-10
影响因子：
4.4
通讯作者：
Aikawa E
中科院分区：
文献类型：
--
作者：
Hutcheson JD;Maldonado N;Aikawa E
动脉粥样硬化斑块破裂和随后的急性事件，如心肌梗死和中风，导致大多数心血管相关死亡。钙化已经成为心血管发病率和死亡率的重要预测因子，挑战了以前认为钙化稳定动脉粥样硬化斑块的观点。在这篇综述中，我们通过最近的发现来解决这种差异，即并非所有的钙化在确定斑块稳定性方面都是等同的。与钙化相关的风险与钙化密度呈负相关。与可能稳定斑块的大钙化相反，生物力学建模表明斑块纤维帽内的小微钙化可导致足够的应力积累，从而导致斑块破裂。微钙化似乎来源于富含钙结合蛋白的基质囊泡，这些钙结合蛋白是由斑块内的细胞释放的。由于缺乏体内可视化所需的成像分辨率，微钙化的临床检测受到阻碍;然而，最近的研究表明，有希望的新技术来预测微钙化的存在。微钙化在动脉粥样硬化斑块的不稳定中起主要作用。识别导致不稳定性的关键特征，沿着新的成像模式以检测其在体内的存在，可以允许早期识别和预防急性心血管事件。
Atherosclerotic plaque rupture and subsequent acute events, such as myocardial infarction and stroke, contribute to the majority of cardiovascular-related deaths. Calcification has emerged as a significant predictor of cardiovascular morbidity and mortality, challenging previously held notions that calcifications stabilize atherosclerotic plaques. In this review, we address this discrepancy through recent findings that not all calcifications are equivalent in determining plaque stability. The risk associated with calcification is inversely associated with calcification density. As opposed to large calcifications that potentially stabilize the plaque, biomechanical modeling indicates that small microcalcifications within the plaque fibrous cap can lead to sufficient stress accumulation to cause plaque rupture. Microcalcifications appear to derive from matrix vesicles enriched in calcium-binding proteins that are released by cells within the plaque. Clinical detection of microcalcifications has been hampered by the lack of imaging resolution required for in-vivo visualization; however, recent studies have demonstrated promising new techniques to predict the presence of microcalcifications. Microcalcifications play a major role in destabilizing atherosclerotic plaques. The identification of critical characteristics that lead to instability along with new imaging modalities to detect their presence in vivo may allow early identification and prevention of acute cardiovascular events.