European Heart Journal Advance Access originally published online on June 24, 2008
European Heart Journal 2008 29(14):1721-1728; doi:10.1093/eurheartj/ehn286
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In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography
1 Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
2 Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
3 Division of Cardiology, Nippon Medical School, Tokyo, Japan
Received 18 January 2008; revised 30 May 2008; accepted 5 June 2008; online publish-ahead-of-print 24 June 2008.
* Corresponding author. Tel: +1 617 726 9226, Fax: +1 617 726 7419, Email: ijang{at}partners.org
See page 1704 for the editorial comment on this article (doi:10.1093/eurheartj/ehn201)
Aims: Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque.
Methods and results: OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 µm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 µm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001).
Conclusion: Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
Key Words: Atherosclerosis • Coronary disease • Coronary remodelling • Optical coherence tomography • Vulnerable plaque
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