Clinical utility of quantitative bright spots analysis in patients with acute coronary syndrome: an optical coherence tomography study

Abstract

To investigate the clinical significance of bright spots in coronary plaque detected by optical coherence tomography (OCT) in patients with coronary artery disease. We identified 112 patients [acute coronary syndromes (ACS): n = 50, stable angina pectoris (SAP): n = 62] who underwent OCT imaging of the culprit lesion. A novel OCT algorithm was applied to detect bright spots representing the juxtaposition of a variety of plaque components including macrophages. The density of bright spots within the most superficial 250 μm of the vessel wall was measured at the site of culprit lesion. Bright spot density in the culprit lesion was significantly higher in patients presenting with ACS compared to those presenting with SAP (0.51 ± 0.43% vs. 0.37 ± 0.26%, P = 0.04), particularly in the subgroup with ruptured culprit plaque (0.59 ± 0.52%). Thin-cap fibroatheroma (TCFA) was associated with a trend towards a higher density of bright spots compared to non-TCFA plaques (0.57 ± 0.50% vs. 0.41 ± 0.31%, P = 0.08). Similar results were also obtained within 1000 μm depth. Positive linear correlation was demonstrated between bright spot density and hsCRP level (r = 0.45, P = 0.002). Using a novel algorithm, we demonstrated a significantly higher density of bright spots in the culprit lesions of patients presenting with ACS, particularly in case of plaque rupture, compared to those presenting with SAP. The density of bright spots also correlates with inflammatory status. These results suggest that the quantitative assessment of bright spot density may be useful in evaluating plaque vulnerability.

Association of cholesterol uptake capacity, a novel indicator for HDL functionality, and coronary plaque properties: An optical coherence tomography-based observational study

“…Therefore, at present, we cannot conclude on the relationship between CUC and fibrous cap thickness without additional longitudinal observations. Previous studies have reported the utility of OCT to detect macrophages the in coronary plaque and quantitatively evaluate the extent of macrophage accumulation [29,31]. In this study, we revealed there was an inverse relationship between CUC and the macrophage score assessed according to previously described methods [27].…”

Invasive coronary imaging of inflammation to further characterize high-risk lesions: what options do we have?

“…(Figure 5A) While OCT has not been proven to distinguish between active and inactive macrophages (94), bright spots do have a strong correlation with inflammation measured by hsCRP (95). Bright spot density is significantly higher in lipid plaques compared to fibrous plaques and plaques with TCFA show a trend toward higher bright spot density (95). Moreover, bright spot density is also significantly higher in plaques with rupture than those without (95).…”

“…Macrophages scatter light efficiently, which creates signal-rich regions called bright spots with a cast shadow behind (93). (Figure 5A) While OCT has not been proven to distinguish between active and inactive macrophages (94), bright spots do have a strong correlation with inflammation measured by hsCRP (95). Bright spot density is significantly higher in lipid plaques compared to fibrous plaques and plaques with TCFA show a trend toward higher bright spot density (95).…”

Optical Coherence Tomography Opportunities in Detection of Coronary Plaque Morphology

“…Активированные макрофаги вырабатывают повышенное количество матричных металлопротеиназ и катепсинов, которые умень-шают выработку коллагена и индуцируют апоптоз гладкомышечных клеток, что может провоциро-вать разрыв бляшки [14]. Плотность инфильтрации макрофагов в фиброатероме с тонкой покрыш-кой была выше, чем в бляшках без фиброатеромы (0,57±0,50% против 0,41±0,31%, p=0,08), и выше у пациентов с ОКС, чем со стабильной стенокарди-ей (0,51±0,43% против 0,37±0,26%, p=0,04) [15]. Более поверхностное расположение макрофагов (<50 мкм от поверхности сосуда) в сравнении с от-носительно глубоким расположением (>50 мкм от поверхности сосуда) в ОКС-зависимых артериях было предиктором их повреждения (p=0,035) [16].…”