title: Clinical utility of quantitative bright spots analysis in patients with acute coronary syndrome: an optical coherence tomography study.
abstract: To investigate the clinical significance of bright spots in coronary plaque detected by optical coherence tomography (OCT) in patients with coronary artery disease. We identified 112 patients [acute coronary syndromes (ACS): n = 50, stable angina pectoris (SAP): n = 62] who underwent OCT imaging of the culprit lesion. A novel OCT algorithm was applied to detect bright spots representing the juxtaposition of a variety of plaque components including macrophages. The density of bright spots within the most superficial 250 μm of the vessel wall was measured at the site of culprit lesion. Bright spot density in the culprit lesion was significantly higher in patients presenting with ACS compared to those presenting with SAP (0.51 ± 0.43% vs. 0.37 ± 0.26%, P = 0.04), particularly in the subgroup with ruptured culprit plaque (0.59 ± 0.52%). Thin-cap fibroatheroma (TCFA) was associated with a trend towards a higher density of bright spots compared to non-TCFA plaques (0.57 ± 0.50% vs. 0.41 ± 0.31%, P = 0.08). Similar results were also obtained within 1000 μm depth. Positive linear correlation was demonstrated between bright spot density and hsCRP level (r = 0.45, P = 0.002). Using a novel algorithm, we demonstrated a significantly higher density of bright spots in the culprit lesions of patients presenting with ACS, particularly in case of plaque rupture, compared to those presenting with SAP. The density of bright spots also correlates with inflammatory status. These results suggest that the quantitative assessment of bright spot density may be useful in evaluating plaque vulnerability.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Phipps
authors.affiliation: University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Hoyt
authors.affiliation: Department of Biomedical Engineering, University of Texas, Austin, 107 W Dean Keeton Street Stop, Austin, TX, 78712, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Milner
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ong
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.affiliation: University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.|Veterans Administration Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Feldman
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA, 02114, USA. IJANG@mgh.harvard.edu.|Division of Cardiology, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea. IJANG@mgh.harvard.edu.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology*; D000368:Aged; D000465:Algorithms; D060050:Angina, Stable / Q000473:pathology*; D016009:Chi-Square Distribution; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence
keywords: Acute coronary syndrome; Optical coherence tomography; Plaque rupture; Stable coronary artery disease