Prati Francesco, Zimarino Marco
Emodinamica e Cardiologia Interventistica, Ospedale San Giovanni, Roma.
G Ital Cardiol (Rome). 2010 May;11(5):367-76.
Atherosclerosis is a slowly progressive degenerative disease occasionally characterized by a sudden shift in its natural history with a rupture of the atherosclerotic plaque and consequent acute thrombosis and clinical events. In recent years, biological and morphological factors responsible for the instability of coronary plaques have been identified. According to the most frequent pathophysiological sequence the fibrous cap that separates the lipid core of the atherosclerotic plaque from the circulation, ruptures thus exposing the highly thrombogenic biochemical elements and resulting in acute thrombosis and possible vessel occlusion. In this scenario, plaque morphology plays a crucial role along with systemic responses, such as activation of inflammation and coagulation cascade, in the definition of the patients at risk of acute myocardial infarction. Recent advances in intracoronary imaging techniques capable of defining the morphological characteristics of vulnerable plaques with high resolution, have given us the reasonable expectation that, in the immediate future, critical information on the pathophysiology of atherosclerosis and the direct causes of myocardial infarction can be obtained. It is conceivable that in the next few years these new high-resolution imaging techniques will be able to identify the crucial characteristics that define a vulnerable plaque that is likely to rupture. A scoring system designed to assess the specific risk of instability for any given atherosclerotic plaque could be generated with the purpose of identifying prospectively acute coronary events. In this perspective, optical coherence tomography is certainly the most promising imaging technique. Thus, the association of specific morphological information with systemic markers of vulnerability may allow in the near future to predict the true risk of acute myocardial infarction for each individual patient.
动脉粥样硬化是一种缓慢进展的退行性疾病，偶尔会因其自然病程的突然转变而具有特征，即动脉粥样硬化斑块破裂，继而发生急性血栓形成和临床事件。近年来，已确定了导致冠状动脉斑块不稳定的生物学和形态学因素。根据最常见的病理生理过程，将动脉粥样硬化斑块的脂质核心与血液循环分隔开的纤维帽破裂，从而暴露具有高度血栓形成性的生化成分，导致急性血栓形成并可能造成血管阻塞。在这种情况下，斑块形态与全身反应（如炎症激活和凝血级联反应）在确定急性心肌梗死风险患者方面起着关键作用。能够高分辨率定义易损斑块形态特征的冠状动脉内成像技术的最新进展，使我们有理由期待在不久的将来能够获得有关动脉粥样硬化病理生理学和心肌梗死直接原因的关键信息。可以想象，在未来几年，这些新的高分辨率成像技术将能够识别出定义可能破裂的易损斑块的关键特征。可以生成一个评分系统，用于评估任何给定动脉粥样硬化斑块的特定不稳定风险，目的是前瞻性地识别急性冠状动脉事件。从这个角度来看，光学相干断层扫描无疑是最有前景的成像技术。因此，特定形态学信息与易损性全身标志物的结合可能在不久的将来使我们能够预测每个患者急性心肌梗死的真实风险。
