Combined techniques predict plaque rupture in angina pectoris

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6 November 2007
MedWire News: Coronary plaque rupture in patients with angina pectoris can be predicted by combining high-frequency ultrasound imaging of the coronary and carotid arteries with measurements of serum inflammatory markers, Chinese scientists have discovered.

The exact morphologic and biochemical features that best predict plaque rupture in angina pectoris patients are not known, explain Yun Zhang and colleagues from Shandong University Qilu Hospital in Jinan.

They examined whether combined high-frequency vascular ultrasound imaging and serum inflammatory marker measurement may provide a useful approach in 20 patients with stable angina pectoris and 40 with unstable disease.

High-frequency vascular ultrasound was used to measure intima-media thickness, the plaque acoustic density of the common carotid arteries, and the flow-mediated dilation of the brachial arteries. In addition, all patients had their serum lipid profile and inflammatory biomarkers measured. A list of coronary imaging parameters was also developed using intravascular ultrasound.

In all, 139 coronary artery plaques were identified on intravascular ultrasound, of which 48 developed ruptures. Nine of the ruptures occurred in patients with stable angina pectoris, the team reports in the American Journal of Cardiology.

Patients with unstable angina pectoris had, in comparison with those who had stable disease, significantly higher values for carotid intima-media thickness, coronary external elastic membrane area, plaque area, plaque burden, plaque eccentric index, and remodeling index. In addition, they had significantly higher serum levels of high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1.

Multivariate logistic regression revealed that significant predictors of coronary plaque rupture were carotid intima-media thickness, serum high-sensitivity C-reactive protein levels, and the coronary remodeling index, at respective odds ratios of 9.51, 3.02, and 0.01.

The researchers write: \"Our results demonstrate for the first time that combined high-frequency ultrasound vascular imaging and measurements of serum inflammatory markers provide a feasible and reliable approach to predicting plaque rupture in patients with angina pectoris.\"

Noting the ability of high-sensitivity C-reactive protein levels to predict coronary plaque rupture, the team adds that the finding \"confirms that an inflammatory process indeed plays a major role in the development of coronary plaque vulnerability, and high-sensitivity C-reactive protein is superior to other inflammatory markers as such a predictor.\"

Am J Cardiol 2007; 100: 1341-1346
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