MacNeill Briain D, Bouma Brett E, Yabushita Hiroshi, Jang Ik-Kyung, Tearney Guillermo J
Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA.
J Nucl Cardiol. 2005 Jul-Aug;12(4):460-5. doi: 10.1016/j.nuclcard.2005.05.013.
The vast majority of acute coronary events are attributed to rupture or erosion of high-risk or vulnerable plaques. Novel imaging techniques are being actively sought that can detect quiescent vulnerable features within coronary plaque and thereby identify populations at risk, monitor plaque progression, and target therapy appropriately. Optical coherence tomography is an intravascular imaging modality capable of detecting and characterizing coronary plaque in vivo. Recently, optical coherence tomography quantification of macrophage infiltration within atherosclerotic plaque ex vivo was demonstrated. Application of this technique to clinical practice yields a hybrid image incorporating plaque morphology with a measure of biologic activity. In a recently conducted clinical study assessing macrophage distributions in patients, evidence supporting both the vulnerable plaque model and the hypothesis of multifocal inflammatory risk, linked by the common thread of increased macrophage infiltration, has been found. These results suggest that elevated multifocal coronary macrophage content, present both in culprit lesions and at remote sites, serves as a background for heightened risk. Superimposed on this inflammatory background, local increases in macrophage content, particularly at the cap surface and at areas at high risk for rupture, further promote the instability of individual lesions.
绝大多数急性冠脉事件归因于高危或易损斑块的破裂或糜烂。人们正在积极寻找新的成像技术，这些技术能够检测冠状动脉斑块内静止的易损特征，从而识别高危人群、监测斑块进展并合理靶向治疗。光学相干断层扫描是一种能够在体内检测和表征冠状动脉斑块的血管内成像方式。最近，已证明可在体外对动脉粥样硬化斑块内的巨噬细胞浸润进行光学相干断层扫描定量分析。将该技术应用于临床实践可产生一种融合了斑块形态与生物活性指标的混合图像。在最近一项评估患者巨噬细胞分布的临床研究中，已发现支持易损斑块模型以及多灶性炎症风险假说的证据，这些证据通过巨噬细胞浸润增加这一共同线索相互关联。这些结果表明，在罪犯病变部位和远处部位均存在的多灶性冠状动脉巨噬细胞含量升高是风险增加的背景。叠加在这种炎症背景之上，巨噬细胞含量的局部增加，特别是在帽表面和破裂高危区域，进一步促进了单个病变的不稳定性。
