CVPath Institute, Inc., Gaithersburg, MD 20878, USA.
Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3125, Japan.
Int J Mol Sci. 2023 Aug 27;24(17):13298. doi: 10.3390/ijms241713298.
Acute coronary syndromes due to atherosclerotic coronary artery disease are a leading cause of morbidity and mortality worldwide. Intra-plaque hemorrhage (IPH), caused by disruption of intra-plaque leaky microvessels, is one of the major contributors of plaque progression, causing a sudden increase in plaque volume and eventually plaque destabilization. IPH and its healing processes are highly complex biological events that involve interactions between multiple types of cells in the plaque, including erythrocyte, macrophages, vascular endothelial cells and vascular smooth muscle cells. Recent investigations have unveiled detailed molecular mechanisms by which IPH leads the development of high-risk "vulnerable" plaque. Current advances in clinical diagnostic imaging modalities, such as magnetic resonance image and intra-coronary optical coherence tomography, increasingly allow us to identify IPH in vivo. To date, retrospective and prospective clinical trials have revealed the significance of IPH as detected by various imaging modalities as a reliable prognostic indicator of high-risk plaque. In this review article, we discuss recent advances in our understanding for the significance of IPH on the development of high-risk plaque from basic to clinical points of view.
动脉粥样硬化性冠状动脉疾病引起的急性冠状动脉综合征是全球发病率和死亡率的主要原因。斑块内出血（IPH）是由斑块内漏微血管破裂引起的，是斑块进展的主要原因之一，导致斑块体积突然增加，最终导致斑块不稳定。IPH 及其愈合过程是一个高度复杂的生物学事件，涉及斑块内多种类型细胞之间的相互作用，包括红细胞、巨噬细胞、血管内皮细胞和血管平滑肌细胞。最近的研究揭示了 IPH 导致高危“脆弱”斑块形成的详细分子机制。目前，临床诊断成像模式（如磁共振成像和冠状动脉光学相干断层扫描）的进展越来越能够让我们在体内识别 IPH。迄今为止，回顾性和前瞻性临床试验已经揭示了通过各种成像模式检测到的 IPH 作为高危斑块的可靠预后指标的意义。在这篇综述文章中，我们从基础和临床的角度讨论了我们对 IPH 在高危斑块发展中的意义的理解的最新进展。
