C-reactive protein and lesion morphology.

Abstract

HomeCirculationVol. 109, No. 9C-Reactive Protein and Lesion Morphology Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBC-Reactive Protein and Lesion Morphology Dimitris Tousoulis, MD, PhD, Christos Pitsavos, MD and Christodoulos Stefanadis, MD Dimitris TousoulisDimitris Tousoulis Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece, Search for more papers by this author , Christos PitsavosChristos Pitsavos Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece, Search for more papers by this author and Christodoulos StefanadisChristodoulos Stefanadis Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece, Search for more papers by this author Originally published9 Mar 2004https://doi.org/10.1161/01.CIR.0000118317.57890.49Circulation. 2004;109:e153To the Editor:Sano et al1 in a recent work using intravascular ultrasound examined the relationship between lesion morphology and C-reactive protein (CRP) in patients with acute myocardial infarction. They found that elevated CRP is related to the presence of ruptured plaque, and this may reflect the inflammatory activity of the ruptured plaque.The importance of stenosis morphology in predicting the high-risk stenoses that will progress to acute myocardial infarction has been recognized since 1988. Stenoses with an eccentric neck and multiple irregularities are often prone to rupture leading to an acute myocardial infarction.2 Furthermore, these morphological types of stenoses showed increased vasoconstrictor responses to different stimuli such as acetylcholine, serotonin, etc.3–4The finding of Sano et al1 that an inflammatory marker such as CRP is significantly increased in patients with myocardial infarction and ruptured plaques indirectly indicates activation of the systemic inflammatory process. This is consistent with recent data published from our group, indicating a thermal heterogeneity within human atherosclerotic coronary arteries. This heterogeneity is detected in vivo by application of a special thermography catheter, and correlates with the levels of CRP in the plasma.5 Therefore, plaques prone to acute coronary syndromes showed increased vasoconstriction and thermal heterogeneity, suggesting an active dynamic inflammatory process.However, Sano et al1 did not examine the inflammatory process locally within the ruptured plaque. Thus, pathological studies are needed to further elucidate the crucial relationship between the morphology of the ruptured plaque and the systemic and local inflammatory processes.1 Sano T, Tanaka A, Namba M, et al. C-reactive protein and lesion morphology in patients with acute myocardial infarction. Circulation. 2003; 108: 282–285.LinkGoogle Scholar2 Ambrose J, Tannenbaum MA, Alexopoulos D, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol. 1988; 12: 56–62.CrossrefMedlineGoogle Scholar3 Tousoulis D, Davies G, McFadden E, et al. Coronary vasomotor effects of serotonin in patients with angina: relation to coronary stenosis morphology. Circulation. 1993; 88: 1518–1526.CrossrefMedlineGoogle Scholar4 Tousoulis D, Crake T, Kaski JC, et al. Enhanced vasomotor responses of complex stenoses to acetylcholine in chronic stable angina pectoris. Am J Cardiol. 1995; 75: 725–728.CrossrefMedlineGoogle Scholar5 Stefanadis C, Diamantopoulos L, Vlachopoulos C, et al. Thermal heterogeneity within human atherosclerotic coronary arteries detected in vivo: a new method of detection by application of a special thermography catheter. Circulation. 1999; 99: 1965–1971.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseTanaka Atsushi, , MD, Sano Toshihiko, , MD, Namba Masashi, , MD, Nishibori Yoshiharu, , MD, Nishida Yukio, , MD, Kawarabayashi Takahiko, , MD, Fukuda Daiju, , MD, Shimada Kenei, , MD, and Yoshikawa Junichi, , MD09032004We are grateful to Dr Tousoulis and colleagues for their comments regarding our manuscript.1 Dr. Tousoulis has reported that there is a thermal heterogeneity within the coronary plaque, that this heterogeneity correlates with CRP levels, and that it is suggestive of the inflammatory process.2 We consider their findings to be in support of our own conclusions. As we also cited in our manuscript, Burke et al3 have previously reported that CRP may correlate with the number of thin-capped atheromas that can be considered vulnerable plaques using immunohistochemical staining for CRP in patients who have suffered sudden death with associated severe coronary artery disease. These pathological findings, too, support our findings. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Drakopoulou M, Toutouzas K and Tousoulis D (2018) Acute Coronary Syndromes Coronary Artery Disease, 10.1016/B978-0-12-811908-2.00012-X, (201-233), . March 9, 2004Vol 109, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000118317.57890.49PMID: 15007022 Originally publishedMarch 9, 2004 PDF download Advertisement