Japan Foundation for Cardiovascular Research, Funabashi and Tokyo, Japan.
JACC Cardiovasc Imaging. 2010 Apr;3(4):398-408. doi: 10.1016/j.jcmg.2009.09.030.
This study was carried out to detect vulnerable coronary plaques by color fluorescent angioscopy.
Collagen fibers (CFs) mainly provide mechanical support to coronary plaques. Oxidized low-density lipoprotein (Ox-LDL) induces macrophage proliferation, which in turn destroy CFs while accumulating lipids. As such, demonstration of the absence of CFs, deposition of lipids, and the Ox-LDL may suggest plaque instability.
Fluorescence of the major components of the atherosclerotic plaques was examined by fluorescent microscopy using a 345-nm band-pass filter and 420-nm band-absorption filter (A-imaging). Fluorescence of Ox-LDL was examined using a 470-nm band-pass filter and 515-nm band-absorption filter (B-imaging) and Evans blue dye as an indicator. Fluorescence in 57 excised human coronary plaques was examined by A-imaging color fluorescent angioscopy. Oxidized LDL in 31 excised coronary plaques and in 12 plaques of 7 patients was investigated by B-imaging color fluorescent angioscopy.
Collagen I, collagen IV, and calcium exhibited blue, light blue, and white autofluorescence, respectively. In the presence of beta-carotene which coexists with lipids in the vascular wall, collagen I and IV exhibited green, collagen III and V white, cholesterol yellow, cholesteryl esters orange fluorescence. Oxidized LDL exhibited reddish brown fluorescence in the presence of Evans blue dye. Therefore, coronary plaques exhibited blue, green, white-to-light blue, or yellow-to-orange fluorescence based on plaque composition. Histological examination revealed abundant CFs without lipids in blue plaques; CFs and lipids in green plaques; meager CFs and abundant lipids in white-to-light blue plaques; and the absence of CFs and deposition of lipids, calcium, and macrophage foam cells in the thin fibrous cap in yellow-to-orange plaques, indicating that the yellow-to-orange plaques were most vulnerable. Reddish brown fluorescence characteristic of Ox-LDL was observed in excised coronary plaques, as also in patients.
Color fluorescent angioscopy provides objective information related to coronary plaque composition and may help identify unstable plaques.
本研究旨在通过彩色荧光血管镜检测易损性冠状动脉斑块。
胶原纤维（CFs）主要为冠状动脉斑块提供机械支撑。氧化型低密度脂蛋白（Ox-LDL）诱导巨噬细胞增殖，进而破坏 CFs 并同时积累脂质。因此，CFs 缺失、脂质沉积和 Ox-LDL 的存在可能提示斑块不稳定。
采用 345nm 带通滤光片和 420nm 带阻滤光片（A 成像）的荧光显微镜检查动脉粥样硬化斑块的主要成分的荧光；采用 470nm 带通滤光片和 515nm 带阻滤光片（B 成像）和 Evans 蓝染料作为指示剂检查 Ox-LDL 的荧光。通过 A 成像彩色荧光血管镜检查 57 个人体冠状动脉斑块的荧光。通过 B 成像彩色荧光血管镜检查 31 个切除的冠状动脉斑块和 7 名患者的 12 个斑块中的 Ox-LDL。
胶原 I、胶原 IV 和钙分别显示蓝色、浅蓝色和白色自发荧光。在β-胡萝卜素存在的情况下，β-胡萝卜素与血管壁中的脂质共存，胶原 I 和 IV 显示绿色，胶原 III 和 V 显示白色，胆固醇显示黄色，胆固醇酯显示橙色荧光。在 Evans 蓝染料存在下，Ox-LDL 显示红棕色荧光。因此，根据斑块组成，冠状动脉斑块显示蓝色、绿色、白色至浅蓝色或黄色至橙色荧光。组织学检查显示，蓝色斑块中富含 CFs 且不含脂质；绿色斑块中含有 CFs 和脂质；白色至浅蓝色斑块中 CFs 较少而脂质丰富；黄色至橙色斑块中 CFs 缺失且沉积有脂质、钙和巨噬细胞泡沫细胞，表明黄色至橙色斑块最不稳定。在切除的冠状动脉斑块和患者中也观察到 Ox-LDL 特有的红棕色荧光。
彩色荧光血管镜提供与冠状动脉斑块组成相关的客观信息，可能有助于识别不稳定斑块。
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