Feasibility of Noninvasive Assessment of Thin-Cap Fibroatheroma by Multidetector Computed Tomography

Kashiwagi, Manabu; Tanaka, Atsushi; Kitabata, Hironori; Tsujioka, Hiroto; Kataiwa, Hideaki; Komukai, Kenichi; Tanimoto, Takashi; Takemoto, Kazushi; Takarada, Shigeho; Kubo, Takashi; Hirata, Kumiko; Nakamura, Nobuo; Mizukoshi, Masato; Imanishi, Toshio; Akasaka, Takashi

doi:10.1016/j.jcmg.2009.09.012

Cited by 227 publications

(139 citation statements)

References 29 publications

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“…16,11) In vivo studies demonstrate that hs-CRP was associated with positive remodelling, fibrous cap thickness, and the presence of TCFA. 17,18) Furthermore, a higher prevalence of lesions with rupture ultrasonographic changes, with positive remodelling or lipid lakes was found in individuals with high CRP levels, as compared to patients with normal levels of this marker. 19) IPH is also an important contributor to lesion destabilization through mechanisms including extravasation of inflammatory factors such as macrophages and Hb-derived iron.…”

Section: Iph Accelerates Coronary Atherosclerosis and Evokes Cd163-pomentioning

confidence: 95%

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

et al. 2015

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SummaryCoronary intraplaque hemorrhage up-regulates hemoglobin scavenger receptor CD163 expression on macrophages, and has an association with vulnerable plaque development. During percutaneous coronary intervention, mechanical plaque disruption exposes potentially embolic atheromatous contents from culprit plaque.In 37 patients with stable angina pectoris (SAP, n = 20) or acute coronary syndrome (ACS, n = 17), atherothrombotic debris was collected using a filter-based distal embolic protection device. We immunohistochemically determined CD14-positive macrophages and CD163-positive macrophages in filtered debris. We also examined the relation of CD14-and CD163-positive macrophages with culprit plaque volume and components evaluated with ultrasonic tissue characterization (VH-IVUS).The only significant difference in clinical characteristics between the two groups was in hs-CRP. In ACS, the percentage of CD14-and CD163-positive macrophages to the whole cells (%CD14 and %CD163, respectively) was significantly higher than that in SAP (20.1 ± 8.2 versus 8.8 ± 6.8%, P < 0.001 and 32.6 ± 18.9 versus 9.0 ± 3.8%, P < 0.001, respectively). In IVUS indices of culprit plaque, the remodeling index was significantly higher in ACS than in SAP. However, necrotic core component (%NC) in ACS was significantly higher than that in SAP. Furthermore, fibrotic component (%Fibrous) in ACS was significantly lower than that in SAP (56.1 ± 4.7 versus 60.1 ± 3.3%, P = 0.03). %CD14 and %CD163 had a significant positive correlation with %NC (%CD14: r = 0.40, P = 0.01 and %CD163: r = 0.45, P = 0.01), but only %CD163 was negatively correlated with %Fibrous (%CD163: r = −0.48, P = 0.01).These findings suggest that the presence of CD14-and CD163-positive macrophages may reflect plaque inflammation, NC expansion, and plaque vulnerability in patients with coronary heart disease. (Int Heart J 2015; 56: 150-156) Key words: Coronary artery disease, Intraplaque hemorrhage, Catheters B oth macrophage infiltration and hemorrhage into coronary plaque are associated with the development of atherosclerotic lesions and plaque instability. 1) Atherosclerosis largely involves macrophage-mediated inflammation driven by oxidized lipids.2) CD14 on the macrophage surface is bound to lipopolysaccharides, thereby activating macrophages to produce cytokines such as TNF-α, IL-1, and IL-6, which, in turn, serve as endogenous mediators of inflammation.3) In a previous pathological report, CD14-positive macrophages were more prevalent in atherosclerotic lesions compared with normal intimal regions of coronary arteries.3) Thus, CD 14-positive macrophages within the plaque indicates plaque with inflammatory macrophage inflammation.In advanced atherosclerosis, intraplaque hemorrhage (IPH) is an important contributor to lesion development and destabilization by several mechanisms, including the release of hemoglobin (Hb) into plaque. 4) Hb derived from IPH binds tightly to haptoglobin (Hp) to form an Hp-Hb complex. The Hp-Hb complex is exclusively cleared by macrophages ...

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Section: Iph Accelerates Coronary Atherosclerosis and Evokes Cd163-pomentioning

confidence: 95%

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

et al. 2015

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“…The high resolution of OCT enables the clinician to identify the thin fibrous cap of TCFA in vivo (Fig. 4 and 5), and OCT-derived TCFA lesions are associated with various features of plaque vulnerability on conventional imaging techniques, such as the accumulation of attenuated plaque on gray-scale IVUS, necrotic core-rich plaque on virtual histology IVUS, yellow color plaque on angioscopy and low-density plaque on coronary computed tomography [12][13][14][15] . In addition, the OCT-measured fibrous cap thickness is correlated with the serum levels of high-sensitivity C-reactive protein and oxidized low-density lipoprotein 16,17) , and OCT-derived TCFA has been shown to be a predictor of subsequent plaque progression and acute coronary events 18,19) .…”

Section: Thin Cap Fibroatheromamentioning

confidence: 99%

Assessment of Coronary Atherosclerosis using Optical Coherence Tomography

Kubo

Tanaka

Ino

et al. 2014

JAT

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Optical coherence tomography (OCT) is a catheter-based imaging system that uses near-infrared light to produce cross-sectional images of the coronary arteries. With its extraordinarily high resolution (10-20 μm), OCT allows clinicians to observe various morphological features of coronary atherosclerosis in vivo. For example, intimal thickening presents as homogeneous, signal-rich regions on OCT, while fibroatheroma with a lipid-rich necrotic core is characterized by the presence of signal-poor regions with a diffuse border. Furthermore, plaque rupture is detected in 50-70% of culprit lesions of acute coronary syndrome (ACS), and plaque erosion develops over areas of intimal thickening and/or thick-cap fibroatheroma. Meanwhile, calcified nodules are common in older patients with hypertension and chronic renal disease. Platelet-rich thrombi are visualized as low backscattering structures and often detected in patients with unstable angina, whereas red blood cellrich thrombi exhibit a high backscattering structure with signal-free shadowing and are frequently noted in patients with acute myocardial infarction. Moreover, OCT-derived thin cap fibroatheroma has been shown to be a predictor of subsequent plaque progression and acute coronary events, while vasa vasorum and the macrophage density are associated with a thin fibrous cap and large necrotic core as well as increased serum levels of inflammatory biomarkers. One current challenge of OCT examinations is to detect morphologic characteristics capable of discriminating vulnerable from stable plaques. The ability to detect vulnerable plaques in vivo would allow physicians to identify patients at high risk for adverse coronary events, thus significantly helping to prevent ACS. J Atheroscler Thromb, 2014; 21:895-903.

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“…5) CCTA findings of positive remodeling, low CT values, non-calcified or spotty calcification, and napkin-ring sign are now regarded as the defining features of a ruptureprone vulnerable plaque. [2][3][4][5][6] Naghavi et al, however, reported that various types of vulnerable plaque can cause ACS and sudden cardiac death. 7) Pathologically, the frequency of coronary lesions with ACScausing thrombi is 55-60% for ruptures, 30-35% for erosions, and 3-7% for lesions accompanied by calcified nodules.…”

Section: I．introductionmentioning

confidence: 99%

Plaque Characteristics of Consecutive 31 Cases Which Cause Acute Myocardial Infarction on Coronary Computed Tomography Angiography

Fujimoto

Kondo²,

Takamura

et al. 2015

J Jpn Coron Assoc

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Feasibility of Noninvasive Assessment of Thin-Cap Fibroatheroma by Multidetector Computed Tomography

Abstract: MDCT can identify differences in plaque morphologies between TCFA and non-TCFA. From our results, MDCT may provide for the noninvasive assessment of vulnerable plaque.

Cited by 227 publications

References 29 publications

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

Assessment of Coronary Atherosclerosis using Optical Coherence Tomography

Plaque Characteristics of Consecutive 31 Cases Which Cause Acute Myocardial Infarction on Coronary Computed Tomography Angiography

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