title: Near-infrared spectroscopy for intracoronary detection of lipid-rich plaques to understand atherosclerotic plaque biology in man and guide clinical therapy.
abstract: Ischaemic heart disease is the leading cause of death worldwide. The common denominator for plaques causing acute coronary syndrome (ACS) is lipid accumulation, either as a lipid core or lipid pools. An intracoronary imaging device to detect lipid-rich plaques (LRPs) could therefore identify most of the plaques causing ACS and sudden death. Near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) is a promising new intracoronary imaging method that is able to specifically quantify lipid accumulation measured as the lipid core burden index (LCBI). NIRS-IVUS is highly specific for the identification of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) culprit plaques usually in the form of a circular LRP. NIRS-IVUS may assist in defining the aetiology of coronary events. The effect of cholesterol-lowering therapy on the lipid core can be measured in coronary plaques in patients, and NIRS-IVUS may be a useful tool for drug development in phase II studies as a surrogate end-point for future ACS. Plaques with a high LCBI have an increased risk of peri-procedural events. NIRS-IVUS can help to define the diameter and length of stents to avoid procedure-related complications. Increased coronary LCBI predicts a higher risk of future cardiovascular events. Lipid core detection using NIRS may help to identify vulnerable plaques to treat them before they cause ACS or sudden death.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D003331:Coronary Vessels / Q000737:chemistry*; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000378:metabolism; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
chemical_list: D008055:Lipids
keywords: acute coronary syndromes; intravascular ultrasound; lipid-rich plaque; myocardial infarction; near-infrared spectroscopy; sudden death