Natural History of Vulnerable Coronary Plaques

易损冠状动脉斑块的自然史

• 批准号: 7028906
• 负责人: Guillermo J Tearney
• 金额: $ 65.28万
• 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/7028906
• 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）： 急性心肌梗死（AMI）占工业化国家发病率和死亡率的大部分。尸检研究表明，某些动脉粥样硬化斑块类型（称为“易损斑块”）在心肌梗死后患者中更常见。这些斑块在血管造影上并不狭窄，并且由覆盖着大的富含脂质的核心的充满巨噬细胞的薄纤维帽组成。虽然目前认为易损斑块患者发生斑块破裂和急性冠状动脉血栓的风险较高，但这一假设尚未经过前瞻性检验，且易损斑块的临床意义目前尚不清楚。由于缺乏识别活体人类患者易损斑块的方法，尚未进行确定这些病变的患病率、发生率和自然史的临床研究。此外，由于这些斑块仅在死后进行研究，因此人们对这些斑块知之甚少。破裂前斑块的形态。我们之前已经证明，冠状动脉内光学相干断层扫描（OCT）能够准确识别易损斑块的所有微观特征。然而，由于现有成像技术的图像采集速度慢，目前的研究仅限于对患者离散的冠状动脉位置进行成像。我们提供的初步数据证明了 OCT 的新范例，可通过大幅提高成像速度来实现长冠状动脉段的连续成像。拟议工作的目标是将这项新技术应用于多时间点临床研究，以调查易损斑块的发生率、患病率和自然史，并确定 AMI 的形态学预测因子。该计划的影响将会很大，因为它将提供 1) 一种能够在急性冠脉事件发生之前识别高风险斑块的诊断工具，以及 2) 确定最佳治疗策略所需的知识。这些病变。