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JACC Cardiovasc Imaging. 2019 Aug 8. pii: S1936-878X(19)30599-6. doi: 10.1016/j.jcmg.2019.06.015. [Epub ahead of print]

Intravascular Polarimetry in Patients With Coronary Artery Disease.

Author information

1
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
2
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece.
3
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
4
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology of Radboud UMC, Nijmegen, the Netherlands.
5
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
6
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Heart Center, University Hospital Zurich, Zurich, Switzerland.
7
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. Electronic address: bouma@mgh.harvard.edu.

Abstract

OBJECTIVES:

The aims of this first-in-human pilot study of intravascular polarimetry were to investigate polarization properties of coronary plaques in patients and to examine the relationship of these features with established structural characteristics available to conventional optical frequency domain imaging (OFDI) and with clinical presentation.

BACKGROUND:

Polarization-sensitive OFDI measures birefringence and depolarization of tissue together with conventional cross-sectional optical frequency domain images of subsurface microstructure.

METHODS:

Thirty patients undergoing polarization-sensitive OFDI (acute coronary syndrome, n = 12; stable angina pectoris, n = 18) participated in this study. Three hundred forty-two cross-sectional images evenly distributed along all imaged coronary arteries were classified into 1 of 7 plaque categories according to conventional OFDI. Polarization features averaged over the entire intimal area of each cross section were compared among plaque types and with structural parameters. Furthermore, the polarization properties in cross sections (n = 244) of the fibrous caps of acute coronary syndrome and stable angina pectoris culprit lesions were assessed and compared with structural features using a generalized linear model.

RESULTS:

The median birefringence and depolarization showed statistically significant differences among plaque types (p < 0.001 for both, 1-way analysis of variance). Depolarization differed significantly among individual plaque types (p < 0.05), except between normal arteries and fibrous plaques and between fibrofatty and fibrocalcified plaques. Caps of acute coronary syndrome lesions and ruptured caps exhibited lower birefringence than caps of stable angina pectoris lesions (p < 0.01). In addition to clinical presentation, cap birefringence was also associated with macrophage accumulation as assessed using normalized standard deviation.

CONCLUSIONS:

Intravascular polarimetry provides quantitative metrics that help characterize coronary arterial tissues and may offer refined insight into coronary arterial atherosclerotic lesions in patients.

KEYWORDS:

atherosclerosis; collagen; inflammation; macrophage; optical coherence tomography; polarized light

PMID:
31422135
DOI:
10.1016/j.jcmg.2019.06.015
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