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Association between inflammatory biomarkers and thin-cap fibroatheroma detected by optical coherence tomography in patients with coronary heart disease.

Koyama K, Yoneyama K, Mitarai T, Ishibashi Y, Takahashi E, Kongoji K, Harada T, Akashi YJ - Arch Med Sci (2015)

Bottom Line: Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively).Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT.Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

ABSTRACT

Introduction: The relationship between plaque morphology detected by optical coherence tomography (OCT) and inflammatory biomarkers is not well known.

Material and methods: This study included 47 patients with ischemic heart disease (22 patients with acute coronary syndrome and 25 patients with effort angina pectoris) who underwent percutaneous coronary intervention (PCI). Before PCI, peripheral blood levels of the inflammatory biomarkers high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured. The OCT can detect thin-cap fibroatheroma (TCFA), a lesion with high potential for adverse cardiac events. We investigated the relationships between TCFAs in culprit lesions detected by OCT and the peripheral blood levels of these biomarkers.

Results: We observed 12 lesions detected as TCFAs. The natural logs of hs-CRP and IL-6 levels in the TCFA group were higher than those in the non-TCFA group (hs-CRP 0.87 (-0.96 to 0.87) vs. -0.47 (-0.92 to 0.30) mg/l, p = 0.027; and IL-6 1.63 (0.63-3.23) vs. 0.53 (-0.21 to 1.05) pg/dl, p = 0.005, respectively). In multivariate logistic regression analysis, log IL-6 was an independent predictor for TCFA detected by OCT (log IL-6, 0.970 pg/dl, p = 0.023). Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively).

Conclusions: Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT. Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.

No MeSH data available.


Related in: MedlinePlus

Non-thin cap fibroatheroma (non-TCFA). Culprit lesion in left descending artery (LAD) in a patient with effort angina pectoris. A – Coronary angiography in culprit lesion of a patient with effort angina pectoris. Severe stenosis was observed in proximal LAD (arrow). B, C – Optical coherence tomography shows fibrous plaque (homogeneous and high reflective area). The thinnest part of the plaque measured 270 μm (arrow). Peripheral blood level of CRP and IL-6 was 0.44 mg/l and 2.38 pg/dl
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Figure 0002: Non-thin cap fibroatheroma (non-TCFA). Culprit lesion in left descending artery (LAD) in a patient with effort angina pectoris. A – Coronary angiography in culprit lesion of a patient with effort angina pectoris. Severe stenosis was observed in proximal LAD (arrow). B, C – Optical coherence tomography shows fibrous plaque (homogeneous and high reflective area). The thinnest part of the plaque measured 270 μm (arrow). Peripheral blood level of CRP and IL-6 was 0.44 mg/l and 2.38 pg/dl

Mentions: The OCT examinations were performed before PCI. All patients were administered 100 U/kg heparin before the procedure. A 6 Fr or 7 Fr guiding catheter was introduced into the coronary artery, and nitroglycerin (0.1–0.2 mg) was administered through the guiding catheter. The OCT images were obtained with a time-domain (M3 OCT system; LightLab Imaging/St Jude Medical, Westford, MA, USA) or a frequency-domain OCT C7XR system and Dragon Fly catheter (LightLab Imaging/St Jude Medical). In the M3 OCT system, a 0.016-inch OCT imaging catheter (LightLab Imaging) was inserted into the distal end of the culprit lesion through the central lumen in an occlusion balloon catheter (Helios; Avantec Vascular Corp, Sunnyvale, CA, USA). While the images were acquired during a pullback of the catheter, the occlusion balloon, which was positioned at the proximal site of the culprit lesion, was inflated to 0.5–0.7 atm, and Ringer's lactate solution was infused at 0.6–0.8 ml/s. When the target lesion was located close to the ostium of the coronary artery, a continuous-flushing nonocclusive technique was used for a detailed evaluation. Low-molecular-weight dextran L (Otsuka Pharmaceutical Factory, Tokushima, Japan) was directly infused through the guiding catheter at 3.0–4.0 ml/s to remove blood from the coronary artery. The OCT pullback speed was 1.0 mm/s. Furthermore, in the C7XR system, a 2.7 Fr OCT imaging catheter was carefully inserted into the distal end of the culprit lesion. The automated pullback system was performed at 20 mm/s while blood was displaced by flushing with contrast medium or dextran using the guiding catheter. The culprit lesions in patients with ACS with a Thrombolysis in Myocardial Infarction (TIMI) flow grade of 0–2 were evaluated after thrombectomy using the thrombus aspiration catheter (Thrombuster III; Kaneka Medical Products, Osaka, Japan). In this study, we evaluated the presence of plaque rupture, coronary thrombus, and TCFA in the culprit lesion. A plaque rupture was defined as a plaque containing a cavity that communicated with the lumen with an overlying residual fibrous cap fragment [6]. Intracoronary thrombus was identified by the mass images protruding into the vessel lumen from the vessel wall [11]. The TCFA was defined as a lipid-rich plaque (signal-poor and attenuated area with 2 or more quadrants) of the vessel lumen with the thinnest part of the fibrous cap measuring ≤ 65 µm [12]. In nonruptured plaques, the thinnest fibrous cap thickness was defined as the distance from the arterial lumen to the inner border of the lipid pool. In ruptured plaques, the thinnest fibrous cap thickness was defined as the minimum residual fibrous cap identified as a flap between the arterial lumen and the cavity caused by the plaque [13, 14]. An average of 3 measurements of the minimum fibrous cap thickness in the culprit plaque were taken (Figures 1 and 2). These plaque morphologies were observed by 2 independent observers who were blinded to the clinical presentation. The OCT images were digitalized and analyzed using proprietary software from LightLab Imaging.


Association between inflammatory biomarkers and thin-cap fibroatheroma detected by optical coherence tomography in patients with coronary heart disease.

Koyama K, Yoneyama K, Mitarai T, Ishibashi Y, Takahashi E, Kongoji K, Harada T, Akashi YJ - Arch Med Sci (2015)

Non-thin cap fibroatheroma (non-TCFA). Culprit lesion in left descending artery (LAD) in a patient with effort angina pectoris. A – Coronary angiography in culprit lesion of a patient with effort angina pectoris. Severe stenosis was observed in proximal LAD (arrow). B, C – Optical coherence tomography shows fibrous plaque (homogeneous and high reflective area). The thinnest part of the plaque measured 270 μm (arrow). Peripheral blood level of CRP and IL-6 was 0.44 mg/l and 2.38 pg/dl
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495146&req=5

Figure 0002: Non-thin cap fibroatheroma (non-TCFA). Culprit lesion in left descending artery (LAD) in a patient with effort angina pectoris. A – Coronary angiography in culprit lesion of a patient with effort angina pectoris. Severe stenosis was observed in proximal LAD (arrow). B, C – Optical coherence tomography shows fibrous plaque (homogeneous and high reflective area). The thinnest part of the plaque measured 270 μm (arrow). Peripheral blood level of CRP and IL-6 was 0.44 mg/l and 2.38 pg/dl
Mentions: The OCT examinations were performed before PCI. All patients were administered 100 U/kg heparin before the procedure. A 6 Fr or 7 Fr guiding catheter was introduced into the coronary artery, and nitroglycerin (0.1–0.2 mg) was administered through the guiding catheter. The OCT images were obtained with a time-domain (M3 OCT system; LightLab Imaging/St Jude Medical, Westford, MA, USA) or a frequency-domain OCT C7XR system and Dragon Fly catheter (LightLab Imaging/St Jude Medical). In the M3 OCT system, a 0.016-inch OCT imaging catheter (LightLab Imaging) was inserted into the distal end of the culprit lesion through the central lumen in an occlusion balloon catheter (Helios; Avantec Vascular Corp, Sunnyvale, CA, USA). While the images were acquired during a pullback of the catheter, the occlusion balloon, which was positioned at the proximal site of the culprit lesion, was inflated to 0.5–0.7 atm, and Ringer's lactate solution was infused at 0.6–0.8 ml/s. When the target lesion was located close to the ostium of the coronary artery, a continuous-flushing nonocclusive technique was used for a detailed evaluation. Low-molecular-weight dextran L (Otsuka Pharmaceutical Factory, Tokushima, Japan) was directly infused through the guiding catheter at 3.0–4.0 ml/s to remove blood from the coronary artery. The OCT pullback speed was 1.0 mm/s. Furthermore, in the C7XR system, a 2.7 Fr OCT imaging catheter was carefully inserted into the distal end of the culprit lesion. The automated pullback system was performed at 20 mm/s while blood was displaced by flushing with contrast medium or dextran using the guiding catheter. The culprit lesions in patients with ACS with a Thrombolysis in Myocardial Infarction (TIMI) flow grade of 0–2 were evaluated after thrombectomy using the thrombus aspiration catheter (Thrombuster III; Kaneka Medical Products, Osaka, Japan). In this study, we evaluated the presence of plaque rupture, coronary thrombus, and TCFA in the culprit lesion. A plaque rupture was defined as a plaque containing a cavity that communicated with the lumen with an overlying residual fibrous cap fragment [6]. Intracoronary thrombus was identified by the mass images protruding into the vessel lumen from the vessel wall [11]. The TCFA was defined as a lipid-rich plaque (signal-poor and attenuated area with 2 or more quadrants) of the vessel lumen with the thinnest part of the fibrous cap measuring ≤ 65 µm [12]. In nonruptured plaques, the thinnest fibrous cap thickness was defined as the distance from the arterial lumen to the inner border of the lipid pool. In ruptured plaques, the thinnest fibrous cap thickness was defined as the minimum residual fibrous cap identified as a flap between the arterial lumen and the cavity caused by the plaque [13, 14]. An average of 3 measurements of the minimum fibrous cap thickness in the culprit plaque were taken (Figures 1 and 2). These plaque morphologies were observed by 2 independent observers who were blinded to the clinical presentation. The OCT images were digitalized and analyzed using proprietary software from LightLab Imaging.

Bottom Line: Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively).Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT.Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

ABSTRACT

Introduction: The relationship between plaque morphology detected by optical coherence tomography (OCT) and inflammatory biomarkers is not well known.

Material and methods: This study included 47 patients with ischemic heart disease (22 patients with acute coronary syndrome and 25 patients with effort angina pectoris) who underwent percutaneous coronary intervention (PCI). Before PCI, peripheral blood levels of the inflammatory biomarkers high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured. The OCT can detect thin-cap fibroatheroma (TCFA), a lesion with high potential for adverse cardiac events. We investigated the relationships between TCFAs in culprit lesions detected by OCT and the peripheral blood levels of these biomarkers.

Results: We observed 12 lesions detected as TCFAs. The natural logs of hs-CRP and IL-6 levels in the TCFA group were higher than those in the non-TCFA group (hs-CRP 0.87 (-0.96 to 0.87) vs. -0.47 (-0.92 to 0.30) mg/l, p = 0.027; and IL-6 1.63 (0.63-3.23) vs. 0.53 (-0.21 to 1.05) pg/dl, p = 0.005, respectively). In multivariate logistic regression analysis, log IL-6 was an independent predictor for TCFA detected by OCT (log IL-6, 0.970 pg/dl, p = 0.023). Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively).

Conclusions: Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT. Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.

No MeSH data available.


Related in: MedlinePlus