Skip to main content
Erschienen in: Clinical Research in Cardiology 12/2014

01.12.2014 | Original Paper

Relationship between cholesterol crystals and culprit lesion characteristics in patients with stable coronary artery disease: an optical coherence tomography study

verfasst von: Shunichi Nakamura, Shigenobu Inami, Koji Murai, Masamichi Takano, Hitoshi Takano, Kuniya Asai, Masahiro Yasutake, Wataru Shimizu, Kyoichi Mizuno

Erschienen in: Clinical Research in Cardiology | Ausgabe 12/2014

Einloggen, um Zugang zu erhalten

Abstract

Aims

Some recent studies have reported the role of cholesterol crystals (ChCs) in plaque rupture in patients with coronary artery disease. We used optical coherence tomography (OCT) to investigate the characteristics of coronary plaques that were associated with derived ChCs.

Methods

We evaluated 101 subjects with stable coronary artery disease who underwent OCT. We compared the OCT findings of the culprit lesions with ChCs to those without ChCs and investigated the background characteristics.

Results

ChCs were observed in culprit lesions of 39 patients. The frequencies of spotty calcification, microchannel structure, and lipid-rich plaque were significantly higher in patients with ChCs than those without ChCs (64.1 vs. 27.4 %, p < 0.001; 69.2 vs. 38.7 %, p = 0.003; 53.8 vs. 29.0 %, p = 0.01, respectively). On the other hand, the frequencies of thrombus, disruption, and thin-cap fibroatheroma did not differ significantly between patients with and without ChCs (15.3 vs. 24.1 %, p = 0.3; 33.3 vs. 17.7 %, p = 0.07; and 33.3 vs. 24.1 %, p = 0.3, respectively). Among the possible clinical factors, multivariate analysis showed an elevated level of glycated hemoglobin as the sole significant factor associated with ChCs.

Conclusion

ChCs are frequently associated with the major findings of vulnerable plaque, and are often seen in poorly controlled diabetic patients. Thus, ChCs might be one of the features of vulnerable plaque.
Literatur
1.
Zurück zum Zitat Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47:C13–C18PubMedCrossRef Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47:C13–C18PubMedCrossRef
2.
Zurück zum Zitat Suh WM, Seto AH, Margey RJ, Cruz-Gonzalez I, Jang IK (2011) Intravascular detection of the vulnerable plaque. Circ Cardiovasc Imaging 4:169–178PubMedCrossRef Suh WM, Seto AH, Margey RJ, Cruz-Gonzalez I, Jang IK (2011) Intravascular detection of the vulnerable plaque. Circ Cardiovasc Imaging 4:169–178PubMedCrossRef
3.
Zurück zum Zitat Abela GS (2010) Cholesterol crystals piercing the arterial plaque and intima trigger local and systemic inflammation. J Clin Lipidol 4:156–164PubMedCrossRef Abela GS (2010) Cholesterol crystals piercing the arterial plaque and intima trigger local and systemic inflammation. J Clin Lipidol 4:156–164PubMedCrossRef
4.
Zurück zum Zitat Abela GS, Aziz K, Vedre A, Pathak DR, Talbott JD, Dejong J (2009) Effect of cholesterol crystals on plaques and intima in arteries of patients with acute coronary and cerebrovascular syndromes. Am J Cardiol 103:959–968PubMedCrossRef Abela GS, Aziz K, Vedre A, Pathak DR, Talbott JD, Dejong J (2009) Effect of cholesterol crystals on plaques and intima in arteries of patients with acute coronary and cerebrovascular syndromes. Am J Cardiol 103:959–968PubMedCrossRef
5.
Zurück zum Zitat Frink RJ (2010) Parallel cholesterol crystals: a sign of impending plaque rupture? J Invasive Cardiol 22:406–411PubMed Frink RJ (2010) Parallel cholesterol crystals: a sign of impending plaque rupture? J Invasive Cardiol 22:406–411PubMed
6.
Zurück zum Zitat Vedre A, Pathak DR, Crimp M, Lum C, Koochesfahani M, Abela GS (2009) Physical factors that trigger cholesterol crystallization leading to plaque rupture. Atherosclerosis 203:89–96PubMedCrossRef Vedre A, Pathak DR, Crimp M, Lum C, Koochesfahani M, Abela GS (2009) Physical factors that trigger cholesterol crystallization leading to plaque rupture. Atherosclerosis 203:89–96PubMedCrossRef
7.
Zurück zum Zitat Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275PubMedCrossRef Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275PubMedCrossRef
8.
Zurück zum Zitat Abela GS, Aziz K (2005) Cholesterol crystals cause mechanical damage to biological membranes: a proposed mechanism of plaque rupture and erosion leading to arterial thrombosis. Clin Cardiol 28:413–420PubMedCrossRef Abela GS, Aziz K (2005) Cholesterol crystals cause mechanical damage to biological membranes: a proposed mechanism of plaque rupture and erosion leading to arterial thrombosis. Clin Cardiol 28:413–420PubMedCrossRef
9.
Zurück zum Zitat Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol 59:1058–1072PubMedCrossRef Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol 59:1058–1072PubMedCrossRef
10.
Zurück zum Zitat Liu L, Gardecki JA, Nadkarni SK, Toussaint JD, Yagi Y, Bouma BE, Tearney GJ (2011) Imaging the subcellular structure of human coronary atherosclerosis using micro-optical coherence tomography. Nat Med 17:1010–1014PubMedCentralPubMedCrossRef Liu L, Gardecki JA, Nadkarni SK, Toussaint JD, Yagi Y, Bouma BE, Tearney GJ (2011) Imaging the subcellular structure of human coronary atherosclerosis using micro-optical coherence tomography. Nat Med 17:1010–1014PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Komukai K, Kataiwa H, Okouchi K, Kashiwaghi M, Ishibashi K, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T (2009) Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-st-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J 30:1348–1355PubMedCrossRef Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Komukai K, Kataiwa H, Okouchi K, Kashiwaghi M, Ishibashi K, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T (2009) Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-st-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J 30:1348–1355PubMedCrossRef
12.
Zurück zum Zitat Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, Farb A, Guerrero LJ, Hayase M, Kutys R, Narula J, Finn AV, Virmani R (2003) Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349:2316–2325PubMedCrossRef Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, Farb A, Guerrero LJ, Hayase M, Kutys R, Narula J, Finn AV, Virmani R (2003) Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349:2316–2325PubMedCrossRef
13.
Zurück zum Zitat Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D, Nakamura Y, Yamashita H, Yamagishi H, Takeuchi K, Naruko T, Haze K, Becker AE, Yoshikawa J, Ueda M (2004) Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation 110:3424–3429PubMedCrossRef Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D, Nakamura Y, Yamashita H, Yamagishi H, Takeuchi K, Naruko T, Haze K, Becker AE, Yoshikawa J, Ueda M (2004) Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation 110:3424–3429PubMedCrossRef
14.
Zurück zum Zitat Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the American heart association. Circulation 107:499–511PubMedCrossRef Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the American heart association. Circulation 107:499–511PubMedCrossRef
15.
Zurück zum Zitat Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM (2004) Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350:1495–1504PubMedCrossRef Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM (2004) Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350:1495–1504PubMedCrossRef
16.
Zurück zum Zitat Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the miracle study: a randomized controlled trial. JAMA 285:1711–1718PubMedCrossRef Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the miracle study: a randomized controlled trial. JAMA 285:1711–1718PubMedCrossRef
17.
Zurück zum Zitat Byington RP, Jukema JW, Salonen JT, Pitt B, Bruschke AV, Hoen H, Furberg CD, Mancini GB (1995) Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the pravastatin atherosclerosis intervention program. Circulation 92:2419–2425PubMedCrossRef Byington RP, Jukema JW, Salonen JT, Pitt B, Bruschke AV, Hoen H, Furberg CD, Mancini GB (1995) Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the pravastatin atherosclerosis intervention program. Circulation 92:2419–2425PubMedCrossRef
18.
Zurück zum Zitat Takarada S, Imanishi T, Kubo T, Tanimoto T, Kitabata H, Nakamura N, Tanaka A, Mizukoshi M, Akasaka T (2009) Effect of statin therapy on coronary fibrous-cap thickness in patients with acute coronary syndrome: assessment by optical coherence tomography study. Atherosclerosis 202:491–497PubMedCrossRef Takarada S, Imanishi T, Kubo T, Tanimoto T, Kitabata H, Nakamura N, Tanaka A, Mizukoshi M, Akasaka T (2009) Effect of statin therapy on coronary fibrous-cap thickness in patients with acute coronary syndrome: assessment by optical coherence tomography study. Atherosclerosis 202:491–497PubMedCrossRef
19.
Zurück zum Zitat Duewell P, Kono H, Rayner KJ, Sirois CM, Vladimer G, Bauernfeind FG, Abela GS, Franchi L, Nunez G, Schnurr M, Espevik T, Lien E, Fitzgerald KA, Rock KL, Moore KJ, Wright SD, Hornung V, Latz E (2010) Nlrp3 inflammasomes are required for atherogenesis and activated by cholesterol crystals. Nature 464:1357–1361PubMedCentralPubMedCrossRef Duewell P, Kono H, Rayner KJ, Sirois CM, Vladimer G, Bauernfeind FG, Abela GS, Franchi L, Nunez G, Schnurr M, Espevik T, Lien E, Fitzgerald KA, Rock KL, Moore KJ, Wright SD, Hornung V, Latz E (2010) Nlrp3 inflammasomes are required for atherogenesis and activated by cholesterol crystals. Nature 464:1357–1361PubMedCentralPubMedCrossRef
20.
Zurück zum Zitat Rajamaki K, Lappalainen J, Oorni K, Valimaki E, Matikainen S, Kovanen PT, Eklund KK (2010) Cholesterol crystals activate the nlrp3 inflammasome in human macrophages: a novel link between cholesterol metabolism and inflammation. PLoS ONE 5:e11765PubMedCentralPubMedCrossRef Rajamaki K, Lappalainen J, Oorni K, Valimaki E, Matikainen S, Kovanen PT, Eklund KK (2010) Cholesterol crystals activate the nlrp3 inflammasome in human macrophages: a novel link between cholesterol metabolism and inflammation. PLoS ONE 5:e11765PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Abela GS, Vedre A, Janoudi A, Huang R, Durga S, Tamhane U (2011) Effect of statins on cholesterol crystallization and atherosclerotic plaque stabilization. Am J Cardiol 107:1710–1717PubMedCrossRef Abela GS, Vedre A, Janoudi A, Huang R, Durga S, Tamhane U (2011) Effect of statins on cholesterol crystallization and atherosclerotic plaque stabilization. Am J Cardiol 107:1710–1717PubMedCrossRef
22.
Zurück zum Zitat Garcia MJ, McNamara PM, Gordon T, Kannel WB (1974) Morbidity and mortality in diabetics in the framingham population. Sixteen year follow-up study. Diabetes 23:105–111PubMed Garcia MJ, McNamara PM, Gordon T, Kannel WB (1974) Morbidity and mortality in diabetics in the framingham population. Sixteen year follow-up study. Diabetes 23:105–111PubMed
23.
Zurück zum Zitat Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRef Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRef
24.
Zurück zum Zitat Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC (2009) Plaque characteristics in culprit lesions and inflammatory status in diabetic acute coronary syndrome patients. JACC Cardiovasc Imaging 2:339–349PubMedCrossRef Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC (2009) Plaque characteristics in culprit lesions and inflammatory status in diabetic acute coronary syndrome patients. JACC Cardiovasc Imaging 2:339–349PubMedCrossRef
25.
Zurück zum Zitat Kato K, Yonetsu T, Kim SJ, Xing L, Lee H, McNulty I, Yeh RW, Sakhuja R, Zhang S, Uemura S, Yu B, Mizuno K, Jang IK (2012) Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study. JACC Cardiovasc Interv 5:1150–1158PubMedCrossRef Kato K, Yonetsu T, Kim SJ, Xing L, Lee H, McNulty I, Yeh RW, Sakhuja R, Zhang S, Uemura S, Yu B, Mizuno K, Jang IK (2012) Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study. JACC Cardiovasc Interv 5:1150–1158PubMedCrossRef
Metadaten
Titel
Relationship between cholesterol crystals and culprit lesion characteristics in patients with stable coronary artery disease: an optical coherence tomography study
verfasst von
Shunichi Nakamura
Shigenobu Inami
Koji Murai
Masamichi Takano
Hitoshi Takano
Kuniya Asai
Masahiro Yasutake
Wataru Shimizu
Kyoichi Mizuno
Publikationsdatum
01.12.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 12/2014
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-014-0748-5

Weitere Artikel der Ausgabe 12/2014

Clinical Research in Cardiology 12/2014 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.