Assessment of Culprit Lesion Morphology in Acute Myocardial Infarction Ability of Optical Coherence Tomography Compared With Intravascular Ultrasound and Coronary Angioscopy

ObjectivesThe aim of the present study was to evaluate the ability of optical coherence tomography (OCT) for assessment of the culprit lesion morphology in acute myocardial infarction (AMI) in comparison with intravascular ultrasound (IVUS) and coronary angioscopy (CAS).BackgroundOptical coherence tomography is a new intravascular imaging method with a high resolution of approximately 10 μm. This may allow us to assess the vulnerable plaques in detail in vivo.MethodsWe enrolled 30 patients with AMI, and analyzed the culprit lesion by OCT, CAS, and IVUS.ResultsThe average duration from the onset of symptom to OCT imaging was 3.8 ± 1.0 h. The incidence of plaque rupture observed by OCT was 73%, and it was significantly higher than that by CAS (47%, p = 0.035) and IVUS (40%, p = 0.009). Furthermore, OCT (23%) was superior to CAS (3%, p = 0.022) and IVUS (0%, p = 0.005) in the detection of fibrous cap erosion. The intracoronary thrombus was observed in all cases by OCT and CAS, but it was identified in 33% by IVUS (vs. OCT, p < 0.001). Only OCT could estimate the fibrous cap thickness, and it was 49 ± 21 μm. The incidence of thin cap fibroatheroma (TCFA) was 83% in this population by OCT.ConclusionsOptical coherence tomography is a feasible imaging modality in patients with AMI and allows us to identify not only plaque rupture, but also fibrous cap erosion, intracoronary thrombus, and TCFA in vivo more frequently compared with conventional imaging techniques

Impact of Heterogeneity of Human Peripheral Blood Monocyte Subsets on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction

ObjectivesWe examined whether distinct monocyte subsets contribute in specific ways to myocardial salvage in patients with acute myocardial infarction (AMI).BackgroundRecent studies have shown that monocytes in human peripheral blood are heterogeneous.MethodsWe studied 36 patients with primary AMI. Peripheral blood sampling was performed 1, 2, 3, 4, 5, 8, and 12 days after AMI onset. Two monocyte subsets (CD14+CD16−and CD14+CD16+) were measured by flow cytometry. The extent of myocardial salvage 7 days after AMI was evaluated by cardiovascular magnetic resonance imaging as the difference between myocardium at risk (T2-weighted hyperintense lesion) and myocardial necrosis (delayed gadolinium enhancement). Cardiovascular magnetic resonance imaging was also performed 6 months after AMI.ResultsCirculating CD14+CD16−and CD14+CD16+monocytes increased in AMI patients, peaking on days 3 and 5 after onset, respectively. Importantly, the peak levels of CD14+CD16−monocytes, but not those of CD14+CD16+monocytes, were significantly negatively associated with the extent of myocardial salvage. We also found that the peak levels of CD14+CD16−monocytes, but not those of CD14+CD16+monocytes, were negatively correlated with recovery of left ventricular ejection fraction 6 months after infarction.ConclusionsThe peak levels of CD14+CD16−monocytes affect both the extent of myocardial salvage and the recovery of left ventricular function after AMI, indicating that the manipulation of monocyte heterogeneity could be a novel therapeutic target for salvaging ischemic damage

Implication of Plaque Color Classification for Assessing Plaque Vulnerability A Coronary Angioscopy and Optical Coherence Tomography Investigation

ObjectivesThe purpose of this study was to assess the relationship between plaque color evaluated by coronary angioscopy and fibrous cap thickness estimated by optical coherence tomography (OCT) in vivo.BackgroundYellow color intensity of coronary plaque evaluated by coronary angioscopy might be associated with plaque vulnerability.MethodsSeventy-seven coronary artery plaques in patients with acute coronary syndrome were observed by angioscopy and OCT. Plaque color was graded as white, light yellow, yellow, or intensive yellow.ResultsThere were significant differences among the groups classified by plaque color with respect to the fibrous cap thickness estimated by OCT: 389 ± 74 μm in white plaques, 228 ± 51 μm in light yellow plaques, 115 ± 28 μm in yellow plaques, and 59 ± 14 μm in intensive yellow plaques (p &lt; 0.0001). In Spearman rank-order correlation analysis, there was a significant negative correlation between yellow color intensity and fibrous cap thickness (p &lt; 0.0001). Furthermore, 80% of intensive yellow plaques were thin cap fibroatheroma with a cap thickness of ≤65 μm.ConclusionsThe plaque color in coronary angioscopy was determined by the fibrous cap thickness, which was assessed by OCT. Although coronary angioscopy remains a specialized research tool, it might allow us to evaluate plaque vulnerability