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Published on: January 15, 2022
Heavy macrophage infiltration identified by optical coherence tomography relates to plaque rupture
1Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
This study introduces optical coherence tomography (OCT) algorithms for detecting heavy macrophage infiltration (HMC) in carotid arteries. These findings offer new criteria for identifying vulnerable plaques and improving atherosclerotic risk stratification.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Pathology
Background:
- Asymptomatic carotid atherosclerotic stenosis requires effective risk stratification.
- Heavy macrophage infiltration (HMC) is a key factor in plaque destabilization.
- Current in vivo imaging and screening for HMC are limited.
Purpose of the Study:
- To develop algorithms for in vivo detection of macrophage infiltration using optical coherence tomography (OCT).
- To establish a threshold for HMC and assess its association with plaque vulnerability.
Main Methods:
- Co-registration of ex vivo OCT images with histopathology from carotid endarterectomy specimens.
- Development and validation of an OCT-based algorithm for macrophage detection.
- Clinical analysis of 93 patients to evaluate HMC prevalence and association with plaque rupture.
Main Results:
- The OCT algorithm demonstrated 88.0% sensitivity and 74.9% specificity for macrophage detection.
- Ruptured plaques showed significantly higher HMC prevalence (83.7%) compared to non-ruptured plaques (32.0%).
- HMC, defined by a macrophage index >60.2, and multiple calcifications were independent risk factors for plaque rupture.
Conclusions:
- A novel OCT-based approach for in vivo detection of HMC is presented.
- Established screening criteria for HMC can aid in identifying vulnerable carotid plaques.
- This method may enhance risk stratification for patients with carotid atherosclerotic stenosis.
Objective:
Risk stratification plays a critical role in patients with asymptomatic carotid atherosclerotic stenosis. Heavy macrophage infiltration (HMC) is an important factor of plaque destabilization. However, in vivo imaging technologies and screening criteria for HMC remain limited. We aimed to (i) introduce algorithms for in vivo detection of macrophage infiltrations using optical coherence tomography (OCT) and (ii) to investigate the threshold of HMC and its association with plaque vulnerability.
Methods:
Ex vivo OCT images were co-registered with histopathology in 282 cross-sectional pairs from 19 carotid endarterectomy specimens. Of these, 197 randomly selected pairs were employed to define the parameters, and the remaining 85 pairs were used to evaluate the accuracy of the OCT-based algorithm in detecting macrophage infiltrations. Clinical analysis included 93 patients receiving carotid OCT evaluation. The prevalence and burden of macrophage infiltration were analyzed. Multivariable and subgroup analysis were performed to investigate the association between HMC and plaque rupture.
Results:
The sensitivity and specificity of algorithm for detecting macrophage infiltration were 88.0% and 74.9%, respectively. Of 93 clinical patients, ruptured plaques exhibited higher prevalence of macrophage infiltration than nonruptured plaques (83.7% [36/43] vs 32.0% [16/50], p < 0.001). HMC was identified when the macrophage index was greater than 60.2 (sensitivity = 74.4%, specificity = 84.0%). Multivariable analysis showed that HMC and multiple calcification were independent risk factors for non-lipid-rich plaque rupture.
Interpretation:
This study provides a novel approach and screening criteria for HMC, which might be valuable for atherosclerotic risk stratification.
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