Author + information
- Received October 23, 2003
- Accepted May 31, 2004
- Published online September 1, 2004.
- Briain D. MacNeill, MB, MSc⁎,†,
- Ik-Kyung Jang, MD, PhD⁎,
- Brett E. Bouma, PhD†,
- Nicusor Iftimia, PhD†,
- Masamichi Takano, MD, PhD⁎,†,
- Hiroshi Yabushita, MD, PhD⁎,†∥,
- Milen Shishkov, PhD†,
- Christopher R. Kauffman, BS†,
- Stuart L. Houser, MD†,‡,
- H. Thomas Aretz, MD‡,
- Denise DeJoseph, ACNP⁎,
- Elkan F. Halpern, PhD§ and
- Guillermo J. Tearney, MD, PhD†,‡,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Guillermo J. Tearney, Wellman Center for Photomedicine, Massachusetts General Hospital, BAR 703, Boston, Massachusetts 02114
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 pectoris, 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.
This study was funded in part by the Center for Integration of Medicine and Innovative Technology (development of the imaging platform), Guidant Corporation, the National Institutes of Health (grant 5-R01-HL70039), and through a generous gift from Dr. and Mrs. J. S. Chen to the optical diagnostics program of the MGH Wellman Center for Photomedicine.
- Received October 23, 2003.
- Accepted May 31, 2004.
- American College of Cardiology Foundation