Abstract 16003: Association of Endothelial Function with Plaque Vulnerability Assessed by Optical Coherence Tomography in Patients with Acute Coronary Syndrome
Background Thinning of fibrous cap in atherosclerotic plaques is associated with plaque vulnerability. The high resolution of optical coherence tomography (OCT) provides an accurate measurement of fibrous cap thickness. Endothelial dysfunction is a key component of vulnerable plaque and digital reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a non-invasive automatic and quantitative method to evaluate endothelial function. We investigated the association between endothelial function assessed by RH-PAT and plaque vulnerability determined by OCT-derived thin-cap fibroatheroma (TCFA).
Methods and Results Fifty eight consecutive patients with acute coronary syndrome (ACS) who underwent both OCT examination for the culprit lesion prior to percutaneous coronary intervention and RH-PAT examination were enrolled. Age-, gender-, hypertension and diabetes mellitus-matched patients without coronary artery disease (CAD) were also enrolled (n = 15). OCT examination was performed to observe the culprit lesion before percutaneous coronary intervention, and endothelial function was measured using RH-PAT before discharge. The RH-PAT indexes (RHIs) were significantly attenuated in ACS patients compared to non-CAD patients (0.53 ± 0.26 versus 0.74 ± 0.22, P = 0.004). Furthermore, RHIs of ACS patients with TCFA (n=35) were significantly lower than those of ACS patients without TCFA (n = 23) (0.46 ± 0.22 versus 0.63 ± 0.27, P = 0.01), while ACS patients without TCFA had comparable RHIs to non-CAD patients. There was a weak but significant correlation between RHI and fibrous cap thickness (r = 0.28, P = 0.03). Multivariable logistic regression analysis identified lower RHI as an independent associated factor of TCFA in ACS patients (odds ratio per 0.1 0.77 [95% confidence interval: 0.60 to 0.99], P = 0.04).
Conclusions Advanced endothelial dysfunction significantly correlates with thin fibrous cap of coronary plaques in patients with ACS. The assessment of endothelial functions by RH-PAT potentially provides clinically important information to identify vulnerable atherosclerotic plaques.
- © 2012 by American Heart Association, Inc.