Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany.
Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Int J Cardiovasc Imaging. 2021 Jan;37(1):25-35. doi: 10.1007/s10554-020-01956-9. Epub 2020 Aug 6.
Neointimal infiltration with foamy macrophages is recognized as an early and important sign of de-novo atherosclerosis after stent implantation (neoatherosclerosis). Recent histopathological studies have proven that automated quantification of signal attenuation using intravascular optical coherence tomography (OCT) imaging allows for sensitive identification of macrophages in native atherosclerotic disease. Whether this is true for neointimal foam cells in the setting of neoatherosclerosis remains unknown. Autopsy samples of stented coronary arteries (n = 13 cases) were evaluated by histology and OCT. After co-registration with histology, the attenuation rate of emitted laser light was measured in regions with and without neointimal foamy macrophages relative to its peak intensity at the blood-tissue interface. Attenuation index was subsequently determined as slope of a regression curve fitted to individual data points. Receiver operating curve (ROC) analysis was used to establish an optimal cut-off for detecting foamy macrophages in homogenous and non-homogenous neointima, respectively. Finally, the tissue attenuation index was applied to confirm or exclude the presence of neointimal foamy macrophages in symptomatic patients presenting with in-stent restenosis and undergoing intravascular OCT imaging (n = 29 cases). Tissue attenuation index derived from post-mortem samples differed significantly between histologically confirmed regions with and without neointimal foamy macrophages (- 1.23 ± 1.42 vs. - 0.52 ± 1.79, p < 0.05). ROC analysis was able to distinguish neointima with foamy macrophage infiltration from neointima without (93% sensitivity, 73% specificity, cut-off - 0.79, AUC 0.87 for homogenous neointima and 40% sensitivity, 95% specificity, cut-off - 1.93, AUC 0.69 for non-homogenous neointima). In symptomatic patients presenting with in-stent restenosis after stent implantation and undergoing intravascular imaging with OCT, neointimal foamy macrophages were detected in 34.2% of homogenous and 43.6% of non-homogenous neointimal ROI's evaluated. OCT-derived and histopathologically validated tissue attenuation index enables identification of neointimal foamy macrophages in stented coronary arteries. Such image-based post-processing software algorithm may help discern and triage subjects at increased risk for device-related events.
新生内膜泡沫细胞浸润被认为是支架植入后（新生动脉粥样硬化）新生动脉粥样硬化的早期和重要标志。最近的组织病理学研究已经证明，使用血管内光学相干断层扫描（OCT）成像对信号衰减进行自动量化，可以敏感地识别天然动脉粥样硬化病变中的巨噬细胞。在新生动脉粥样硬化的情况下，这种情况是否适用于新生内膜泡沫细胞仍然未知。通过组织学和 OCT 评估了支架置入的冠状动脉的尸检样本（n=13 例）。在与组织学进行配准后，测量了有和无新生内膜泡沫细胞的区域相对于血液-组织界面处激光光的发射强度的衰减率。随后，衰减指数被确定为拟合个别数据点的回归线的斜率。接收器操作曲线（ROC）分析用于确定分别用于检测同质和非同质新生内膜中泡沫巨噬细胞的最佳截断值。最后，应用组织衰减指数来确认或排除有症状的支架内再狭窄患者接受血管内 OCT 成像时（n=29 例）存在新生内膜泡沫细胞。从尸检样本中得出的组织衰减指数在组织学上证实有和无新生内膜泡沫细胞的区域之间有显著差异（-1.23±1.42 vs. -0.52±1.79，p<0.05）。ROC 分析能够区分有泡沫巨噬细胞浸润的新生内膜和无泡沫巨噬细胞浸润的新生内膜（同质新生内膜的敏感性为 93%，特异性为 73%，截断值为-0.79，AUC 为 0.87；非同质新生内膜的敏感性为 40%，特异性为 95%，截断值为-1.93，AUC 为 0.69）。在支架置入后出现支架内再狭窄并接受 OCT 血管内成像的有症状患者中，在评估的同质新生内膜 ROI 中，有 34.2%和非同质新生内膜 ROI 中 43.6%检测到新生内膜泡沫细胞。OCT 衍生和组织病理学验证的组织衰减指数可用于识别支架置入的冠状动脉中的新生内膜泡沫细胞。这种基于图像的后处理软件算法可能有助于识别和分类设备相关事件风险增加的患者。
