A Clinical Study Of IMap-Intravascular Ultrasound And Biomarkers Of Vulnerable Plaques

Objective:The purpose of this study is to investigate relationships among high sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase-2(MMP-2), matrix metalloproteinase-9(MMP-9),lipoprotein associated phospholipase A2(Lp-PLA2),lmacrophage migration inhibitory factor (MIF) and vulnerable plaques by analysis of atherosclerotic plaque components using iMap-intravascular ultrasound.Methods:①39patients with acute coronary syndrome (ACS) and35patients with stable angina pectoris (SAP) were studied.All patients were collected the WBC, hs-CRP, triglyceride and total cholesterol, such as clinical data, centrifuging venous blood samples and measured supernatant fluid of MMP-2, MMP-9, the Lp-PLA2and MIF levels.②Patients’s three vessels were performed on intravascular ultrasound.Target lesions were identifiedon the basis of clinical manifestation, electrocardiography and coronary angiography data.③Analysis the relationships among hs-CRP, MMP-2, MMP-9,Lp-PLA2,MIF levels and the vulnerable plaques by the measurement of plaque components and other related indicators using IVUS post-processing software.Results:①The external elastic membrane area, plaque area and plaque burden of ACS group are lager than the SAP group (P=0.049, P=0.049, P=0.020) and with smaller lumen area (P=0.033). Compared with the SAP group, the ACS patients’ lesions are longer (P=0.001)and with a large necrotic core (P<0.001);The ACS group has higher calcified proportion than the SAP group (P=0.042).②Ruptured plaque and vulnerable plaques were found more in the ACS group (P<0.001);③Ruptured plaque group has greater external elastic membrane area (P=0.014) and plaque area (P=0.008),containing more lipid composition (P=0.009) and necrotic core (P<0.001), and with the longer lesion length (P<0.001) than the group without ruptured plaque; The vulnerable plaque group has more lipid composition (P<0.05) and necrotic core (P<0.001) than without vulnerable plaque group.The fibrous composition in vulnerable plaque group lesions component proportion is less than without vulnerable plaque group (P<0.001);④The ACS group with higher levels of hs-CRP, MMP-9and Lp- PLA2than that of patients with SAP group (P<0.001, P=0.042, P=0.013). MMP-2and MIF levesl have no statistical difference of the two groups(P>0.05);⑤Ruptured plaque group’s hs-CRP, MMP-9and Lp-PLA2levels are significantly higher than plaque without rupture group-(P<0.001, P<0.001, P=0.001), while levels of MMP-2and MIF have no statistical difference (P>0.05); Compared with the group without vulnerable plaque, the level of hs-CRP, MMP-9and Lp-PLA2increased significantly (P<0.001, P=0.001, P=0.001) in the vulnerable plaque group.The levels of MMP-2and MIF have no statistical difference between two groups(P>0.05).⑥hs-CRP level and necrotic core have a significant correlation (r=0.516, P<0.01);MMP-9is moderately correlated to the necrotic core (r=0.303, P<0.01);MMP-2and MIF have weak correlations with necrotic core (r=0.235, r=0.278, P<0.05), while the Lp-PLA2and necrotic core has no correlation (r=0.170, P>0.170);⑦hs-CRP level and vulnerable plaque’s quantity have a significant positive correlation (r=0.655, P<0.01);MMP-9and Lp-PLA2levels are moderately correlated to the TCFA (r=0.436, P<0.01and r=0.432, P<0.01),while MMP-2and MIF levels have no significant correlation with the quantity of TCFA(P>0.05).Conclusion:①The iMAP-IVUS can provide similar pathology image, not only research the plaque character accurately, but also be able to quantitative analysis of plaque composition.②The ruptured plaque and vulnerable plaque are found more in patients with ACS.③Ruptured plaque has larger external elastic membrane area and plaque area compared with plaque without ruptured.④Ruptured plaque and vulnerable plaque have more lipid plaque and necrotic core.⑤The hs-CRP, MMP-2,MMP-9and MIF levels are positively correlated with necrotic core area, suggesting that inflammations affect atheromatous plaque components.⑥The levels of hs-CRP, MMP-9and Lp-PLA2are positively correlated with the number of vulnerable plaque, which can reflect the plaque vulnerability.