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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Correlation Between Morphologic Characteristics and Local Temperature Differences in Culprit Lesions of Patients With Symptomatic Coronary Artery Disease

First Department of Cardiology, Hippokration Hospital, University of Athens, Greece.

Manuscript received November 20, 2006; revised manuscript received January 29, 2007, accepted March 6, 2007.

^_* Reprint requests and correspondence: Dr. Konstantinos Toutouzas, 26 Karaoli and Dimitriou str., Holargos, 15562 Athens, Greece. (Email: ktoutouz{at}otenet.gr).

Objectives: The purpose of this study was to investigate the possible correlation between morphologic and functional characteristics of culprit lesions (CL) in patients with acute coronary syndromes (ACS) and chronic stable angina (CSA).

Background: Intravascular ultrasound (IVUS) provides morphologic assessment and intracoronary thermography (ICT) evaluates the local inflammatory activation of CL.

Methods: Eighty-one consecutive patients, 48 with ACS and 33 with CSA, were enrolled. Ratio of lesion to reference external elastic membrane area, indicated by IVUS, was defined as positive remodeling index (pRi) (1) or negative remodeling index (nRi) (<1). We also investigated the existence of ruptured plaque (rp) in the CL. By ICT temperature difference (T) between the CL and the proximal vessel wall was measured.

Results: Patients with ACS had greater remodeling index than patients with CSA (1.15 ± 0.18 vs. 0.90 ± 0.12; p < 0.01), as well as increased T (0.08 ± 0.03°C vs. 0.04 ± 0.02°C; p < 0.01). Patients with pRi had higher T than patients with nRi (0.07 ± 0.03°C vs. 0.04 ± 0.02°C; p < 0.001). In patients with nRi there was no difference in T between ACS and CSA (p = 0.22). Patients with rp had increased T compared with patients without rp (0.09 ± 0.03°C vs. 0.05 ± 0.02°C; p < 0.01). Multivariate analysis showed that T was independently correlated with the presence of rp, pRi, and ACS.

Conclusions: The present study showed that culprit lesions with plaque rupture and positive arterial remodeling have increased thermal heterogeneity, although in certain patients a discrepancy between morphogic and functional characteristics was observed. A combination of morphologic and functional examination may offer additional diagnostic and prognostic information.

Abbreviations and Acronyms   ACS = acute coronary syndromes   CAD = coronary artery disease   CSA = chronic stable angina   EEMA = external elastic membrane area   ICT = intracoronary thermography   IVUS = intravascular ultrasound   LA = lumen area   nRi = negative remodeling index   PA = plaque area   pRi = positive remodeling index   Ri = remodeling index   rp = ruptured plaque   T = temperature difference

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