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Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction

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Abstract

The aim of this study was to assess the association between the spatial location of plaque rupture and remodeling pattern of culprit lesions in acute anterior myocardial infarction (MI). Positive remodeling suggests a potential surrogate marker of plaque vulnerability, whereas plaque rupture causes thrombus formation followed by coronary occlusion and MI. Intravascular ultrasound (IVUS) can determine the precise spatial orientation of coronary plaque formation. We studied 52 consecutive patients with acute anterior MI caused by plaque rupture of the culprit lesion as assessed by preintervention IVUS. The plaques were divided into those with and without positive remodeling. We divided the plaques into three categories according to the spatial orientation of plaque rupture site: myocardial (inner curve), epicardial (outer curve), and lateral quadrants (2 intermediate quadrants). Among 52 plaque ruptures in 52 lesions, 27 ruptures were oriented toward the epicardial side (52%), 18 toward the myocardial side (35%), and 7 in the 2 lateral quadrants (13%). Among 35 plaques with positive remodeling, plaque rupture was observed in 21 (52%) on the epicardial side, 12 (34%) on the myocardial side, and 2 (6%) on the lateral side. However, among 17 plaques without positive remodeling, plaque rupture was observed in 6 (35%), 6 (35%), and 5 (30%), respectively (p = 0.047). Atherosclerotic plaques with positive remodeling showed more frequent plaque rupture on the epicardial side of the coronary vessel wall in anterior MI than those without positive remodeling.

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References

  1. Fuster V, Badimon L, Badimon JJ, Chesebro JH (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 326:242–250

    Article  PubMed  CAS  Google Scholar 

  2. Fuster V, Badimon L, Badimon JJ, Chesebro JH (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 326:310–318

    Article  PubMed  CAS  Google Scholar 

  3. Setianto BY, Hartopo AB, Gharini PP, Anggrahini DW, Irawan B (2010) Circulating soluble CD40 ligand mediates the interaction between neutrophils and platelets in acute coronary syndrome. Heart Vessels 25:282–287

    Article  PubMed  Google Scholar 

  4. Kusama I, Hibi K, Kosuge M, Nozawa N, Ozaki H, Yano H, Sumita S, Tsukahara K, Okuda J, Ebina T, Umemura S, Kimura K (2007) Impact of plaque rupture on infarct size in ST-segment elevation anterior acute myocardial infarction. J Am Coll Cardiol 50:1230–1237

    Article  PubMed  Google Scholar 

  5. Mukharji J, Rude RE, Poole WK, Gustafson N, Thomas LJ Jr, Strauss HW, Jaffe AS, Muller JE, Roberts R, Raabe DS Jr (1984) Risk factors for sudden death after acute myocardial infarction: two-year follow-up. Am J Cardiol 54:31–36

    Article  PubMed  CAS  Google Scholar 

  6. Varnava AM, Mills PG, Davies MJ (2002) Relationship between coronary artery remodeling and plaque vulnerability. Circulation 105:939–943

    Article  PubMed  Google Scholar 

  7. Yock PG, Linker DT (1990) Intravascular ultrasound. Looking below the surface of vascular disease. Circulation 81:1715–1718

    Article  PubMed  CAS  Google Scholar 

  8. Nissen SE, Gurley JC, Grines CL, Booth DC, McClure R, Berk M, Fischer C, de Maria AN (1991) Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 84:1087–1099

    Article  PubMed  CAS  Google Scholar 

  9. Tobis JM, Mallery J, Mahon D, Lehmann K, Zalesky P, Griffith J, Gessert J, Moriuchi M, McRae M, Dwyer ML (1991) Intravascular ultrasound imaging of human coronary arteries in vivo. Analysis of tissue characterizations with comparison to in vitro histological specimens. Circulation 83:913–926

    Article  PubMed  CAS  Google Scholar 

  10. Fitzgerald PJ, Yock C, Yock PG (1998) Orientation of intracoronary ultrasonography: looking beyond the artery. J Am Soc Echocardiogr 11:13–19

    Article  PubMed  CAS  Google Scholar 

  11. Nissen SE, Yock P (2001) Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation 103:604–616

    Article  PubMed  CAS  Google Scholar 

  12. von Birgelen C, Klinkhart W, Mintz GS, Papatheodorou A, Herrmann J, Baumgart D, Haude M, Wieneke H, Ge J, Erbel R (2001) Plaque distribution and vascular remodeling of ruptured and nonruptured coronary plaques in the same vessel: an intravascular ultrasound study in vivo. J Am Coll Cardiol 37:1864–1870

    Article  Google Scholar 

  13. Schoenhagen P, Ziada KM, Kapadia SR, Crowe TD, Nissen SE, Tuzcu EM (2000) Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 101:598–603

    Article  PubMed  CAS  Google Scholar 

  14. Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D, Nakamura Y, Yamashita H, Yamagishi H, Takeuchi K, Naruko T, Haze K, Becker AE, Yoshikawa J, Ueda M (2004) Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation 110:3424–3429

    Article  PubMed  Google Scholar 

  15. Dirksen MT, van der Wal AC, van den Berg FM, van der Loos CM, Becker AE (1998) Distribution of inflammatory cells in atherosclerotic plaques relates to the direction of flow. Circulation 98:2000–2003

    Article  PubMed  CAS  Google Scholar 

  16. Cheng GC, Loree HM, Kamm RD, Fishbein MC, Lee RT (1993) Distribution of circumferential stress in ruptured and stable atherosclerotic lesions. A structural analysis with histopathological correlation. Circulation 87:1179–1187

    Article  PubMed  CAS  Google Scholar 

  17. Fukumoto Y, Hiro T, Fujii T, Hashimoto G, Fujimura T, Yamada J, Okamura T, Matsuzaki M (2008) Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in vivo color mapping of shear stress distribution. J Am Coll Cardiol 51:645–650

    Article  PubMed  Google Scholar 

  18. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG (2001) American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:1478–1492

    Article  PubMed  CAS  Google Scholar 

  19. Sano T, Tanaka A, Namba M, Nishibori Y, Nishida Y, Kawarabayashi T, Fukuda D, Shimada K, Yoshikawa J (2003) C-reactive protein and lesion morphology in patients with acute myocardial infarction. Circulation 108:282–285

    Article  PubMed  CAS  Google Scholar 

  20. Hibi K, Ward MR, Honda Y, Suzuki T, Jeremias A, Okura H, Hassan AH, Maehara A, Yeung AC, Pasterkamp G, Fitzgerald PJ, Yock PG (2005) Impact of different definitions on the interpretation of coronary remodeling determined by intravascular ultrasound. Catheter Cardiovasc Interv 65:233–239

    Article  PubMed  Google Scholar 

  21. Losordo DW, Rosenfield K, Kaufman J, Pieczek A, Isner JM (1994) Focal compensatory enlargement of human arteries in response to progressive atherosclerosis. In vivo documentation using intravascular ultrasound. Circulation 89:2570–2577

    Article  PubMed  CAS  Google Scholar 

  22. Smits PC, Pasterkamp G, de Jaegere PP, de Feyter PJ, Borst C (1999) Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study. Cardiovasc Res 41:458–464

    Article  PubMed  CAS  Google Scholar 

  23. Pasterkamp G, Schoneveld AH, van der Wal AC, Haudenschild CC, Clarijs RJ, Becker AE, Hillen B, Borst C (1998) Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox. J Am Coll Cardiol 32:655–662

    Article  PubMed  CAS  Google Scholar 

  24. Kitabata H, Tanaka A, Kubo T, Takarada S, Kashiwagi M, Tsujioka H, Ikejima H, Kuroi A, Kataiwa H, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T (2010) Relation of microchannel structure identified by optical coherence tomography to plaque vulnerability in patients with coronary artery disease. Am J Cardiol 105:1673–1678

    Article  PubMed  Google Scholar 

  25. Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Matsumoto H, Arita Y, Ookochi K, Kuroi A, Kataiwa H, Tanimoto T, Ikejima H, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T (2009) Relationship between coronary arterial remodeling, fibrous cap thickness and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome. Circ J 73:1291–1295

    Article  PubMed  CAS  Google Scholar 

  26. Imoto K, Hiro T, Fujii T, Murashige A, Fukumoto Y, Hashimoto G, Okamura T, Yamada J, Mori K, Matsuzaki M (2005) Longitudinal structural determinants of atherosclerotic plaque vulnerability: a computational analysis of stress distribution using vessel models and three-dimensional intravascular ultrasound imaging. J Am Coll Cardiol 46:1507–1515

    Article  PubMed  Google Scholar 

  27. Friedman MH, Bargeron CB, Deters OJ, Hutchins GM, Mark FF (1987) Correlation between wall shear and intimal thickness at a coronary artery branch. Atherosclerosis 68:27–33

    Article  PubMed  CAS  Google Scholar 

  28. Krams R, Wentzel JJ, Oomen JA, Vinke R, Schuurbiers JC, de Feyter PJ, Serruys PW, Slager CJ (1997) Evaluation of endothelial shear stress and 3D geometry as factors determining the development of atherosclerosis and remodeling in human coronary arteries in vivo. Combining 3D reconstruction from angiography and IVUS (ANGUS) with computational fluid dynamics. Arterioscler Thromb Vasc Biol 17:2061–2065

    Article  PubMed  CAS  Google Scholar 

  29. Jeremias A, Huegel H, Lee DP, Hassan A, Wolf A, Yeung AC, Yock PG, Fitzgerald PJ (2000) Spatial orientation of atherosclerotic plaque in non-branching coronary artery segments. Atherosclerosis 152:209–215

    Article  PubMed  CAS  Google Scholar 

  30. Wentzel JJ, Janssen E, Vos J, Schuurbiers JC, Krams R, Serruys PW, de Feyter PJ, Slager CJ (2003) Extension of increased atherosclerotic wall thickness into high shear stress regions is associated with loss of compensatory remodeling. Circulation 108:17–23

    Article  PubMed  Google Scholar 

  31. Cheng C, Tempel D, van Haperen R, van der Baan A, Grosveld F, Daemen MJ, Krams R, de Crom R (2006) Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation 113:2744–2753

    Article  PubMed  Google Scholar 

  32. Chatzizisis YS, Jonas M, Coskun AU, Beigel R, Stone BV, Maynard C, Gerrity RG, Daley W, Rogers C, Edelman ER, Feldman CL, Stone PH (2008) Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress: an intravascular ultrasound and histopathology natural history study. Circulation 117:993–1002

    Article  PubMed  Google Scholar 

  33. Ishio N, Kobayashi Y, Iwata Y, Kitahara H, Fukushima K, Asano T, Nakayama T, Kuroda N, Komuro I (2010) Ubiquitous atherosclerosis in coronary arteries without angiographically significant stenosis. Heart Vessels 25:35–40

    Article  PubMed  Google Scholar 

  34. Hiro T, Kimura T, Morimoto T, Miyauchi K, Nakagawa Y, Yamagishi M, Ozaki Y, Kimura K, Saito S, Yamaguchi T, Daida H, Matsuzaki M (2009) Effect of intensive statin therapy on regression of coronary atherosclerosis in patients with acute coronary syndrome: a multicenter randomized trial evaluated by volumetric intravascular ultrasound using pitavastatin versus atorvastatin (JAPAN-ACS [Japan assessment of pitavastatin and atorvastatin in acute coronary syndrome] study). J Am Coll Cardiol 54:293–302

    Article  PubMed  Google Scholar 

  35. Yamada R, Okura H, Kume T, Saito K, Miyamoto Y, Imai K, Tsuchiya T, Maehama T, Okahashi N, Obase K, Hayashida A, Neishi Y, Kawamoto T, Yoshida K (2010) Relationship between arterial and fibrous cap remodeling: a serial three-vessel intravascular ultrasound and optical coherence tomography study. Circ Cardiovasc Interv 3:484–490

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Ikuyoshi Kusama, Kiyoshi Hibi, Masami Kosuge, Shinnichi Sumita, Kengo Tsukahara, Jun Okuda, Toshiaki Ebina & Kazuo Kimura

  2. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Satoshi Umemura

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  1. Ikuyoshi Kusama
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  2. Kiyoshi Hibi
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  3. Masami Kosuge
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  4. Shinnichi Sumita
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  6. Jun Okuda
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  8. Satoshi Umemura
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  9. Kazuo Kimura
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Correspondence to Kiyoshi Hibi.

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Kusama, I., Hibi, K., Kosuge, M. et al. Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction. Heart Vessels 27, 541–547 (2012). https://doi.org/10.1007/s00380-011-0184-7

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  • DOI: https://doi.org/10.1007/s00380-011-0184-7

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