Abstract
Background and aimsMacrophage accumulation in arteriosclerotic plaque of coronary arteries is involved in plaque destabilization. Atherosclerosis has been known to be progressive in patients with type 2 diabetes mellitus (DM). This study compared the features of 3-dimensional (3D) spatial distribution of macrophage accumulation within coronary artery wall between acute coronary syndrome (ACS) patients with DM (n = 20) and those without (non-DM, n = 20) by using intravascular ultrasound (IVUS) and optical coherence tomography (OCT).MethodsThe OCT-derived macrophage accumulation was measured within the proximal left anterior-descending artery. This measurement was performed for the whole vessel segment of interest, higher shear stress region (flow divider side) and lower shear stress region (the opposite side).ResultsNormalized macrophage accumulation per unit length of the whole segment of interest was significantly larger in ACS patients with DM than without. In non-DM patients, macrophage density per IVUS-derived plaque volume was significantly higher in high shear stress region compared to low shear stress region, however, there was no significant difference between the two regions in DM patients. The macrophage density in the low shear stress region was significantly higher in the DM group than in the non-DM group. A multivariate analysis showed that the presence of DM was a major determinant for macrophage distribution.ConclusionsMacrophage accumulation was more abundant and homogeneous within coronary arterial wall in DM patients with ACS compared to non-DM patients, suggesting that plaque destabilization may occur more widely throughout coronary wall in DM patients.
Highlights
Background and aimsMacrophage accumulation in arteriosclerotic plaque of coronary arteries is involved in plaque destabilization
Study patients This study was a single-center, retrospective, non-randomized study conducted from 2011 to 2017, which selected patients who met the following criteria: (1) Patients diagnosed as the first acute coronary syndrome (ACS) to undergo coronary angiography (CAG) and percutaneous coronary intervention (PCI) at Nihon University Itabashi Hospital, (2) patients who underwent intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and (3) patients who had a distinct OCT-derived coronary macrophage accumulation in the range of 20 mm from the entrance of the left anterior descending branch (LAD)
The major finding of the present study with using threedimensional OCT and IVUS was that macrophage accumulation was more frequent in diabetes mellitus (DM) patients with ACS compared to non-DM patients, even indicating that its distribution pattern was significantly different in such patients
Summary
Background and aimsMacrophage accumulation in arteriosclerotic plaque of coronary arteries is involved in plaque destabilization. This study compared the features of 3-dimensional (3D) spatial distribution of macrophage accumulation within coronary artery wall between acute coronary syndrome (ACS) patients with DM (n = 20) and those without (non-DM, n = 20) by using intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Pathological examination of patients who died by ACS showed the involvement of inflammation accompanied by macrophages in both plaque rupture and erosion [6]. Plaques of ACS patients have been shown to have a higher density of macrophages than plaques of stable angina pectoris [7]. Those atherosclerotic processes have been more progressive in diabetes mellitus (DM) patients [9]
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