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137 inflammatory cells in non ruptured atherosclerotic plaques

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Publicada em: Saúde e medicina
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137 inflammatory cells in non ruptured atherosclerotic plaques

  1. 1. Editorial Slides VP Watch, March 13, 2002, Volume 2, Issue 10 The prevalence of inflammatory cells in non ruptured atherosclerotic plaques By: Gerard Pasterkamp, M.D., Ph.D. Inter University Cardiology Institute of the Netherlands
  2. 2. Background  Plaque rupture and subsequent plaque thrombosis is found to be associated with the presence of inflammatory cells. 1-3
  3. 3. Plaque Rupture
  4. 4. Question Is the presence of inflammatory cells: A- Specific for plaque rupture or B- A commonly observed phenomenon in atherosclerotic lesions? What is the prevalence of moderate/heavy local inflammation in non ruptured atherosclerotic lesions?
  5. 5.  Atherosclerotic femoral (n=50) and coronary arteries (n=74) from patients that did not die of cardiovascular disease.  In each artery, 4-6 non ruptured cross-sections revealing atherosclerosis were studied for the presence of macrophages (CD 68) and T- lymphocytes (CD45RO). Post Mortem Study:
  6. 6. Positive Negative
  7. 7. Positive Negative
  8. 8. Femoral Artery  45% of all cross-sections revealed moderate or heavy staining for macrophages in the cap or shoulder of non ruptured plaques.
  9. 9. Question If one would randomly stain 5-6 cross-sections obtained from an atherosclerotic artery for inflammatory cells, how often would at least one cross-section reveal moderate to heavy staining for inflammatory cells?
  10. 10. Positive Negative
  11. 11. Positive Negative
  12. 12. Femoral Arteries In 84% of all femoral arteries at least one cross-section revealed moderate or haevy staining for macrophages or T-lymphocytes in cap or shoulder of the non ruptured athertosclerotic plaque.
  13. 13. Questions If one would find many cross-sections with inflammation in one coronary artery: would that be predictive for the occurrence of plaque inflammation in another coronary artery? Right and left coronary arteries were compared within the individual (next slide)
  14. 14. No relation was observed between the degree of staining for inflammatory cells between the left and right coronary artery. - = No Staining, + = Moderate Staining, ++ = Heavy Staining Left coronary artery Right coronary artery - + ++ - 3 4 0 + 2 11 2 ++ 0 3 0
  15. 15. Conclusion: 1. The presence of inflammatory cells is a common phenomenon in non ruptured atherosclerotic lesions. 2. The degree of local inflammation is locally determined and has no/low predictive value for the presence of inflammation in other arteries.
  16. 16. Discussion I. Considering these results: what is the predictive value of local inflammation for the occurrence of plaque rupture? II. Visualization of the vulnerable plaque when inflammation is used as marker: - Specificity for local plaque rupture or predictive value for plaque rupture may be disappointing.
  17. 17. Suggestion: VP.org Editorial Suggestion: - Please email your thoughts to: Discussion-Group@VP.org or DG@VP.org
  18. 18. 1. Davies et al. Br Heart J 1985;53:363-373 2. Van der Wal et al. Circulation 1994;89:36-44 3. Moreno et al. Circulation 1994;90:775-778 4. Pasterkamp et al. ATVB 1999, Vink et al JACC 2001 References

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