Focal and multi-focal plaque distributions in patients with macrophage acute and stable presentations of coronary artery disease
Focal and multi-focal plaque distributions in patients with macrophage acute and stable presentations of coronary artery disease
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DOI：
10.1016/j.jacc.2004.05.066
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发表时间：
2004-09-01
影响因子：
24
通讯作者：
Tearney, GJ
中科院分区：
文献类型：
--
作者：
MacNeill, BD;Jang, IK;Tearney, GJ
目的：本研究旨在利用冠状动脉粥样硬化斑块巨噬细胞的光学相干断层扫描（OCT）图像来研究巨噬细胞分布与临床综合征的关系。背景局灶性巨噬细胞浸润和全身性冠状动脉炎症在预测急性冠状动脉事件中的相对意义目前在心脏病学中是一个相当有争议的来源。缺乏高分辨率的横断面成像方式限制了巨噬细胞在体内的评估。方法对稳定型心绞痛、不稳定型心绞痛和st段抬高型心肌梗死患者的罪魁斑块和非罪魁斑块进行冠状动脉内OCT成像。从这些图像中量化巨噬细胞密度，并根据所调查患者的临床表现进行分析。结果在纤维斑块和富含脂质的斑块中，不稳定患者的巨噬细胞密度均显著增加（p = 0.025和p = 0.002）。在每个患者中，罪魁祸首病变与非罪魁祸首病变的巨噬细胞密度具有显著相关性（r = 0.66, y = 0.88x + 0.43, p = 0.01）。斑块破裂部位的巨噬细胞密度高于未破裂部位（6.95 +/- 1.60%,5.29 +/- 1.17%,p = 0.002）。表面巨噬细胞浸润比表面下浸润更能预测罪魁祸首病变的不稳定临床表现（p = 0.035），但对远处病变则不然（p = 0.80）。结论：我们的研究结果表明，多灶性和局灶性巨噬细胞密度的增加与症状严重程度高度相关。通过提供一种在急性事件发生前检测斑块巨噬细胞含量增加的方法，该技术可能有助于确定预后和指导预防性治疗。(C) 2004年由美国心脏病学会基金会发布。
OBJECTIVES This study was designed to utilize optical coherence tomography (OCT) images of coronary atherosclerotic plaque macrophages to investigate the relationship between macrophage distributions and clinical syndrome.BACKGROUND The relative significance of focal macrophage infiltration and generalized coronary inflammation for predicting acute coronary events is a currently a source of considerable controversy in cardiology. Lack of a high-resolution cross-sectional imaging modality has limited macrophage evaluation in vivo.METHODS Intracoronary OCT imaging was performed at culprit and non-culprit plaques in patients presenting with stable angina pectorls, unstable angina pectoris, and ST-segment elevation myocardial infarction. Macrophage densities were quantified from these images and analyzed with respect to the clinical presentations of the patients under investigation.RESULTS A significantly greater macrophage density was found in unstable patients, both for fibrous and lipid-rich plaques (p = 0.025 and p = 0.002, respectively). Within each patient, the macrophage densities at culprit and non-culprit lesions correlated significantly (r = 0.66, y = 0.88x + 0.43, p = 0.01). Sites of plaque rupture demonstrated a greater macrophage density than non-ruptured sites (6.95 +/- 1.60%, 5.29 +/- 1.17%; p = 0.002). Surface macrophage infiltration was a stronger predictor of unstable clinical presentation than subsurface infiltration for culprit lesions (p = 0.035) but not for remote lesions (p = 0.80).CONCLUSIONS Our results demonstrate that increases in both multi-focal and focal macrophage densities are highly correlated with symptom severity. By providing a means of detecting increases in plaque macrophage content before an acute event, this technique may aid in determining prognosis and guiding preventive therapy. (C) 2004 by the American College of Cardiology Foundation.