Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques.
Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques.
复制标题
DOI：
10.1016/j.jacc.2012.10.054
复制
发表时间：
2013-03-12
影响因子：
24
通讯作者：
Finn, Aloke V.
中科院分区：
文献类型：
--
作者：
Narula, Jagat;Nakano, Masataka;Virmani, Renu;Kolodgie, Frank D.;Petersen, Rita;Newcomb, Robert;Malik, Shaista;Fuster, Valentin;Finn, Aloke V.
本研究的目的是确定动脉粥样硬化斑块的组织形态学特征，并确定这些成分中的一些成分可用作有创和无创成像的标记物。动脉粥样硬化斑块的破裂是大多数急性冠状动脉事件的原因，并且罪犯病变表现出不同的组织病理学特征。人们一直默认斑块破裂（PR）与血管造影最小闭塞病变相关。我们从181名男性和32名女性猝死者的心脏中获得了295个冠状动脉粥样硬化斑块，包括稳定型（纤维粥样硬化[FA]; n = 105）、脆弱型（薄帽纤维粥样硬化[TCFA]; n = 88）和破裂型（斑块破裂[PR]; n = 102）。纤维帽厚度、管腔狭窄百分比、巨噬细胞面积、坏死核心面积和钙化斑块面积的分层重要性通过递归分割分析进行评价。由于不可能通过无创成像对纤维帽厚度进行临床评估，因此将其从第二组划分分析中排除。纤维帽的厚度是斑块类型的最佳标志;在破裂斑块中测得的帽厚度<55 μm，所有FA均与>84 μm的帽厚度相关。尽管大多数TCFA出现在54- 84 μm厚度组，但厚度<54 μm的患者更可能显示<74%的管腔狭窄（曲线下面积：FA，1.0; TCFA，0.89; PR，0.90）。在排除帽厚度后，斑块特征分析显示巨噬细胞浸润和坏死核心是斑块类型的2个最佳鉴别因子（曲线下面积：FA，0.82; TCFA，0.58; PR，0.72）。在70%的PR和40%的TCFA中，横截面积狭窄超过75%;只有5%的PR和10%的TCFA狭窄<50%。这项尸检研究定义了易损斑块的组织形态学特征，这可能有助于制定识别急性冠状动脉事件高风险患者中此类斑块的成像策略。
The goal of this study was to identify histomorphologic characteristics of atherosclerotic plaques and to determine the amenability of some of these components to be used as markers for invasive and noninvasive imaging. Rupture of the atherosclerotic plaques is responsible for the majority of acute coronary events, and the culprit lesions demonstrate distinct histopathologic features. It has been tacitly believed that plaque rupture (PR) is associated with angiographically minimally occlusive lesions. We obtained 295 coronary atherosclerotic plaques, including stable (fibroatheroma [FA]; n = 105), vulnerable (thin-cap fibroatheroma [TCFA]; n = 88), and disrupted plaques (plaque rupture [PR]; n = 102) from the hearts of 181 men and 32 women who had died suddenly. The hierarchical importance of fibrous cap thickness, percent luminal stenosis, macrophage area, necrotic core area, and calcified plaque area was evaluated by using recursive partitioning analysis. Because clinical assessment of fibrous cap thickness is not possible by noninvasive imaging, it was excluded from the second set of partitioning analysis. Thickness of the fibrous cap emerged as the best discriminator of plaque type; the cap thickness measured <55 μm in ruptured plaques, and all FA were associated with >84-μm cap thickness. Although the majority of TCFA were found in the 54- to 84-μm thickness group, those with <54-μm thickness were more likely to show <74% luminal stenosis (area under the curve: FA, 1.0; TCFA, 0.89; PR, 0.90). After exclusion of cap thickness, analysis of the plaque characteristics revealed macrophage infiltration and necrotic core to be the 2 best discriminators of plaque types (area under the curve: FA, 0.82; TCFA, 0.58; PR, 0.72). More than 75% cross-section area stenosis was seen in 70% of PR and 40% of TCFA; only 5% PR and 10% TCFA were <50% narrowed. This postmortem study defines histomorphologic characteristics of vulnerable plaques, which may help develop imaging strategies for identification of such plaques in patients at a high risk of sustaining acute coronary events.
登录
查看更多内容
影响因子：
5.7
作者：
Mann, J;Davies, MJ
通讯作者：
Davies, MJ
影响因子：
14
作者：
Hattori, Kousuke;Ozaki, Yukio;Narula, Jagat
通讯作者：
Narula, Jagat
影响因子：
37.8
作者：
Burke, AP;Tracy, RP;Virmani, R
通讯作者：
Virmani, R
DOI：
10.1016/s0735-1097(86)80455-7
发表时间：
1986-03-01
影响因子：
24
作者：
AMBROSE, JA;WINTERS, SL;FUSTER, V
通讯作者：
FUSTER, V
影响因子：
24
作者：
Motoyama, Sadako;Sarai, Masayoshi;Narula, Jagat
通讯作者：
Narula, Jagat