title: Histopathology of human coronary atherosclerosis by quantifying its chemical composition with Raman spectroscopy.
abstract: BACKGROUND
  Lesion composition, rather than size or volume, determines whether an atherosclerotic plaque will progress, regress, or rupture, but current techniques cannot provide precise quantitative information about lesion composition. We have developed a technique to assess the pathological state of human coronary artery samples by quantifying their chemical composition with near-infrared Raman spectroscopy.
  
  
  RESULTS
  Coronary artery samples (n=165) obtained from explanted recipient hearts were illuminated with 830-nm infrared light. Raman spectra were collected from the tissue and processed to quantify the relative weights of cholesterol, cholesterol esters, triglycerides and phospholipids, and calcium salts in the examined artery location. The artery locations were then classified by a pathologist and grouped as either nonatherosclerotic tissue, noncalcified plaque, or calcified plaque. Nonatherosclerotic tissue, which included normal artery and intimal fibroplasia, contained an average of approximately 4+/-3% cholesterol, whereas noncalcified plaques had approximately 26+/-10% and calcified plaques approximately 19+/-10% cholesterol in the noncalcified regions. The average relative weight of calcium salts was 1+/-2% in noncalcified plaques and 41+/-21% in calcified plaques. To make this quantitative chemical information clinically useful, we developed a diagnostic algorithm, based on a first set of 97 samples, that demonstrated a strong correlation of the relative weights of cholesterol and calcium salts with histological diagnoses of the same locations. This algorithm was then prospectively tested on a second set of 68 samples. The algorithm correctly classified 64 of these new samples, thus demonstrating the accuracy and robustness of the method.
  
  
  CONCLUSIONS
  The pathological state of a given human coronary artery may be assessed by quantifying its chemical composition, which can be done rapidly with Raman spectroscopic techniques. When Raman spectra are obtained clinically via optical fibers, Raman spectroscopy may be useful in monitoring the progression and regression of atherosclerosis, predicting plaque rupture, and selecting proper therapeutic intervention.
authors.affiliation: Leiden University Medical Center, The Netherlands. romer@cardio.azl.nl
authors.forename: T J
authors.initials: TJ
authors.lastname: Römer
authors.forename: J F
authors.initials: JF
authors.lastname: Brennan
authors.forename: M
authors.initials: M
authors.lastname: Fitzmaurice
authors.forename: M L
authors.initials: ML
authors.lastname: Feldstein
authors.forename: G
authors.initials: G
authors.lastname: Deinum
authors.forename: J L
authors.initials: JL
authors.lastname: Myles
authors.forename: J R
authors.initials: JR
authors.lastname: Kramer
authors.forename: R S
authors.initials: RS
authors.lastname: Lees
authors.forename: M S
authors.initials: MS
authors.lastname: Feld
mesh_terms: D000465:Algorithms; D002114:Calcinosis / Q000473:pathology*; D002118:Calcium / Q000032:analysis*; D002784:Cholesterol / Q000032:analysis*; D003324:Coronary Artery Disease / Q000145:classification / Q000473:pathology*; D003331:Coronary Vessels / Q000737:chemistry* / Q000473:pathology; D006801:Humans; D010743:Phospholipids / Q000032:analysis; D011237:Predictive Value of Tests; D013059:Spectrum Analysis, Raman; D014280:Triglycerides / Q000032:analysis
chemical_list: D010743:Phospholipids; D014280:Triglycerides; D002784:Cholesterol; D002118:Calcium