Natural History of Vulnerable Coronary Plaques

易损冠状动脉斑块的自然史

• 批准号: 6762194
• 负责人: Guillermo J Tearney
• 金额: $ 67.93万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6762194
• 关键词: angiography; artery stenosis; atherosclerotic plaque; bioengineering /biomedical engineering; bioimaging /biomedical imaging; biomedical equipment development; clinical research; coronary vessels; diagnosis design /evaluation; diagnosis quality /standard; disease /disorder etiology; early diagnosis; heart disorder diagnosis; human subject; myocardial infarction; optical tomography; pathologic process; patient oriented research; rapid diagnosis; swine; ultrasound blood flow measurement

DESCRIPTION (provided by applicant): Acute myocardial infarction (AMI) accounts for the majority of morbidity and mortality in industrialized countries. Autopsy studies have demonstrated that certain atherosclerotic plaque types, termed "vulnerable plaques," are more commonly identified in post-MI patients. These plaques are not angiographically stenotic and consist of a macrophage-laden thin fibrous cap overlying a large lipid rich core. While it is currently thought that patients with vulnerable plaques are at a higher risk for plaque rupture and acute coronary thrombosis, this hypothesis has not been prospectively tested, and the clinical significance of a vulnerable plaque is currently unknown. Clinical studies to determine the prevalence, incidence, and natural history of these lesions have not been conducted due to the lack of a method for identifying vulnerable plaques in living human patients, Furthermore, since these plaques have only been studied postmortem, little is known about the morphology of plaques prior to rupture. We have previously demonstrated that intracoronary optical coherence tomography (OCT) is capable of accurately identifying all of the microscopic features of vulnerable plaques. Due to the slow image acquisition rate of existing imaging technology, however, current studies have been limited exclusively to imaging discrete coronary locations in patients. We present preliminary data demonstrating a new paradigm for OCT that enables continuous imaging of long coronary segments by vastly increasing imaging speed. The goal of the proposed work is to apply this new technology in a multiple time point clinical study to investigate the incidence, prevalence, and natural history of vulnerable plaques and determine the morphologic predictors of AMI. The impact of this program will be high, as it will provide 1) a diagnostic tool that is capable of identifying high-risk plaques prior to the occurrence of an acute coronary event, and 2) the knowledge required to determine the optimal therapeutic strategy for these lesions.

描述（由申请人提供）： 急性心肌梗塞（AMI）占工业化国家的大部分发病率和死亡率。尸检研究表明，在MI后患者中，某些被称为“脆弱斑块”的动脉粥样硬化斑块类型更常见。这些斑块在血管造影上不是狭窄的，并且由含有巨大脂质富含脂质的大芯的巨噬细胞纤维帽组成。尽管目前认为易受损斑块的患者面临着斑块破裂和急性冠状动脉血栓形成的较高风险，但该假设尚未被前瞻性检验，并且目前尚不清楚易受伤害斑块的临床意义。此外，由于缺乏鉴定活着的人类患者的脆弱斑块的方法，尚未进行确定这些病变的患病率，发病率和自然病史的临床研究，此外，由于这些斑块仅研究了术后，因此对破裂前斑块的形态知之甚少。我们以前已经证明，冠状动脉内光学相干断层扫描（OCT）能够准确识别易受攻击的斑块的所有显微镜特征。但是，由于现有成像技术的图像采集速度缓慢，因此当前的研究仅限于成像患者的离散冠状动脉位置。我们提供了初步数据，展示了OCT的新范式，该数据可以通过大大提高成像速度来对长冠状动脉段进行连续成像。拟议工作的目的是将这项新技术应用于多个时间点临床研究中，以研究脆弱斑块的发生率，流行率和自然史，并确定AMI的形态预测因子。该计划的影响将很高，因为它将提供1）能够在发生急性冠状动脉事件之前识别高风险斑块的诊断工具，以及2）确定这些病变最佳治疗策略所需的知识。