急性冠状动脉综合征患者冠状动脉血栓的偏振特征。
Polarimetric Signatures of Coronary Thrombus in Patients With Acute Coronary Syndrome.
机构信息
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center.
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School.
出版信息
Circ J. 2021 Sep 24;85(10):1806-1813. doi: 10.1253/circj.CJ-20-0862. Epub 2021 Apr 7.
BACKGROUND
Intravascular polarization-sensitive optical frequency domain imaging (PS-OFDI) offers a novel approach to measure tissue birefringence, which is elevated in collagen and smooth muscle cells, that in turn plays a critical role in healing coronary thrombus (HCT). This study aimed to quantitatively assess polarization properties of coronary fresh and organizing thrombus with PS-OFDI in patients with acute coronary syndrome (ACS).
METHODS AND RESULTS
The POLARIS-I prospective registry enrolled 32 patients with ACS. Pre-procedural PS-OFDI pullbacks using conventional imaging catheters revealed 26 thrombus-regions in 21 patients. Thrombus was manually delineated in conventional OFDI cross-sections separated by 0.5 mm and categorized into fresh thrombus caused by plaque rupture, stent thrombosis, or erosion in 18 thrombus-regions (182 frames) or into HCT for 8 thrombus-regions (141 frames). Birefringence of coronary thrombus was compared between the 2 categories. Birefringence in HCTs was significantly higher than in fresh thrombus (∆n=0.47 (0.37-0.72) vs. ∆n=0.25 (0.17-0.29), P=0.007). In a subgroup analysis, when only using thrombus-regions from culprit lesions, ischemic time was a significant predictor for birefringence (ß (∆n)=0.001 per hour, 95% CI [0.0002-0.002], P=0.023).
CONCLUSIONS
Intravascular PS-OFDI offers the opportunity to quantitatively assess the polarimetric properties of fresh and organizing coronary thrombus, providing new insights into vascular healing and plaque stability.
背景
血管内偏振敏感光频域成像（PS-OFDI）提供了一种新的方法来测量组织双折射，组织双折射在胶原和平滑肌细胞中升高，而胶原和平滑肌细胞在冠状动脉血栓（HCT）的愈合中起着关键作用。本研究旨在通过 PS-OFDI 定量评估急性冠状动脉综合征（ACS）患者冠状动脉新鲜和正在机化血栓的偏振特性。
方法和结果
前瞻性 POLARIS-I 注册研究纳入了 32 例 ACS 患者。使用传统成像导管进行术前 PS-OFDI 拉回，在 21 例患者中发现了 26 个血栓区域。在常规 OFDI 横截面中手动描绘血栓，这些横截面每隔 0.5mm 分离，并将血栓分类为斑块破裂、支架内血栓形成或侵蚀引起的新鲜血栓（18 个血栓区域，182 个帧）或 HCT（8 个血栓区域，141 个帧）。比较了这两种血栓类型的双折射。HCT 的双折射明显高于新鲜血栓（∆n=0.47（0.37-0.72）vs. ∆n=0.25（0.17-0.29），P=0.007）。在亚组分析中，当仅使用罪犯病变的血栓区域时，缺血时间是双折射的显著预测因子（∆n=0.001/小时，95%CI[0.0002-0.002]，P=0.023）。
结论
血管内 PS-OFDI 提供了定量评估新鲜和正在机化冠状动脉血栓偏振特性的机会，为血管愈合和斑块稳定性提供了新的见解。
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