Galon Micheli Zanotti, Wang Zhao, Bezerra Hiram G, Lemos Pedro Alves, Schnell Audrey, Wilson David L, Rollins Andrew M, Costa Marco A, Attizzani Guilherme F
Heart Institute - InCor, São Paulo University Medical School, São Paulo, Brazil.
Catheter Cardiovasc Interv. 2015 Mar;85(4):E108-15. doi: 10.1002/ccd.25660. Epub 2014 Oct 4.
While the current methodology for determining fibrous cap (FC) thickness of lipid plaques is based on manual measurements of arbitrary points, which could lead to high variability and decreased accuracy, it ignores the three-dimensional (3-D) morphology of coronary artery disease.
To compare, utilizing optical coherence tomography (OCT) assessments, volumetric quantification of FC, and macrophage detection using both visual assessment and automated image processing algorithms in non-culprit lesions of STEMI and stable angina pectoris (SAP) patients.
Lipid plaques were selected from 67 consecutive patients (1 artery/patient). FC was manually delineated by a computer-aided method and automatically classified into three thickness categories: FC < 65 μm (i.e., thin-cap fibroatheroma [TCFA]), 65-150 μm, and >150 μm. Minimum thickness, absolute categorical surface area, and fractional luminal area of FC were analyzed. Automated detection and quantification of macrophage was performed within the segmented FC.
A total of 5,503 cross-sections were analyzed. STEMI patients when compared with SAP patients had more absolute categorical surface area for TCFA (0.43 ± 0.45 mm(2) vs. 0.15 ± 0.25 mm(2) ; P = 0.011), thinner minimum FC thickness (31.63 ± 17.09 µm vs. 47.27 ± 26.56 µm, P = 0.012), greater fractional luminal area for TCFA (1.65 ± 1.56% vs. 0.74 ± 1.2%, P = 0.046), and greater macrophage index (0.0217 ± 0.0081% vs. 0.0153 ± 0.0045%, respectively, P < 0.01).
The novel OCT-based 3-D quantification of the FC and macrophage demonstrated thinner FC thickness and larger areas of TCFA coupled with more inflammation in non-culprit sites of STEMI compared with SAP.
目前用于确定脂质斑块纤维帽（FC）厚度的方法是基于对任意点的手动测量，这可能导致高变异性和准确性降低，并且忽略了冠状动脉疾病的三维（3-D）形态。
利用光学相干断层扫描（OCT）评估，比较ST段抬高型心肌梗死（STEMI）和稳定型心绞痛（SAP）患者非罪犯病变中FC的体积定量以及使用视觉评估和自动图像处理算法进行巨噬细胞检测。
从67例连续患者（每位患者1条动脉）中选取脂质斑块。通过计算机辅助方法手动勾勒FC，并自动分为三个厚度类别：FC＜65μm（即薄帽纤维粥样瘤[TCFA]）、65 - 150μm和＞150μm。分析FC的最小厚度、绝对分类表面积和管腔面积分数。在分割的FC内进行巨噬细胞的自动检测和定量。
共分析了5503个横截面。与SAP患者相比，STEMI患者的TCFA绝对分类表面积更大（0.43±0.45mm²对0.15±0.25mm²；P = 0.011），FC最小厚度更薄（31.63±17.09μm对47.27±26.56μm，P = 0.012），TCFA的管腔面积分数更大（1.65±1.56%对0.74±1.2%，P = 0.046），巨噬细胞指数更高（分别为0.0217±0.0081%对0.0153±0.0045%，P＜0.01）。
与SAP相比，基于OCT的FC和巨噬细胞的新型三维定量显示，STEMI非罪犯部位的FC厚度更薄，TCFA面积更大，且炎症更严重。
