Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Clin Res Cardiol. 2018 Sep;107(9):763-771. doi: 10.1007/s00392-018-1243-1. Epub 2018 Apr 13.
The minimal fibrous cap thickness overlying the necrotic lipid core as well as the presence of macrophages are established characteristics of coronary plaque vulnerability. Recently, the presence of microcalcifications has emerged as a novel feature of vulnerable lesions. However, clinical and plaque morphological predictors of microcalcifications are unknown.
In patients with stable coronary artery disease, analysis of plaque morphology (n = 112) was performed using optical coherence tomography prior to coronary intervention to assess predictors of microcalcifications.
Microcalcifications were present in 21/112 (18.7%) lesions. Segments with microcalcifications showed a higher total number of calcifications per lesion (6.7 ± 3.0 vs. 3.2 ± 2.5, p < 0.001), a lower percent area stenosis (70.9 ± 11.1 vs. 76.2 ± 9.7%, p = 0.028), and a higher frequency of macrophage infiltration (66.7 vs. 37.4%, p = 0.014). In lesions with vs. without microcalcifications, macrophage infiltration was characterized by a wider macrophage angle (31.1° ± 34.4° vs. 13.7° ± 20.6°, p = 0.003), a higher macrophage index (105.6 ± 269.0 vs. 31.6 ± 66.5° mm, p = 0.020), and an increased frequency of calcium-macrophage co-localization (47.6 vs. 15.6%, p = 0.001). In multivariable logistic regression analysis, the total number of calcifications per lesion (OR 1.53, 95% CI 1.23-1.91, p < 0.001), average macrophage angle (OR 1.28 for 10°-variation, 95% CI 1.03-1.60, p = 0.024), and percent area stenosis (OR 0.59 for 10% increase, 95% CI 0.34-1.04, p = 0.070) were independent predictors for the presence of microcalcifications, whereas the latter did not reach statistical significance.
Microcalcifications are related to a less advanced stenosis severity and to extensive plaque inflammation, but not to clinical parameters. Our data may add to the understanding and role of microcalcifications in coronary artery lesions.
覆盖坏死脂质核心的最小纤维帽厚度以及巨噬细胞的存在是冠状动脉斑块易损性的既定特征。最近，微钙化的存在已成为易损病变的一个新特征。然而，微钙化的临床和斑块形态学预测因素尚不清楚。
在稳定型冠状动脉疾病患者中，在进行冠状动脉介入治疗之前，使用光学相干断层扫描对斑块形态进行分析（n=112），以评估微钙化的预测因素。
21/112（18.7%）病变中存在微钙化。存在微钙化的节段，每个病变的钙化总数更高（6.7±3.0 与 3.2±2.5，p<0.001），狭窄百分比更低（70.9±11.1 与 76.2±9.7%，p=0.028），巨噬细胞浸润频率更高（66.7%与 37.4%，p=0.014）。与无微钙化的病变相比，巨噬细胞浸润的特征是巨噬细胞角度更宽（31.1°±34.4°与 13.7°±20.6°，p=0.003），巨噬细胞指数更高（105.6±269.0 与 31.6±66.5°mm，p=0.020），以及钙-巨噬细胞共定位频率增加（47.6%与 15.6%，p=0.001）。在多变量逻辑回归分析中，每个病变的钙化总数（OR 1.53，95%CI 1.23-1.91，p<0.001）、平均巨噬细胞角度（OR 1.28 为 10°变化，95%CI 1.03-1.60，p=0.024）和狭窄百分比（OR 0.59 为 10%增加，95%CI 0.34-1.04，p=0.070）是微钙化存在的独立预测因素，而后者未达到统计学意义。
微钙化与狭窄严重程度较轻和广泛的斑块炎症有关，但与临床参数无关。我们的数据可能有助于理解和认识微钙化在冠状动脉病变中的作用。
