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Optical technique identifies vulnerable plaques in cardiac patients

undergo cardiac catheterization for whom angiograms or other imaging techniques had identified the arterial lesion responsible for their symptoms. Participants either had experienced a recent heart attack or had acute coronary syndrome (ACS), a set of symptoms associated with reduced blood supply to the heart muscle. A third group had stable angina, chest pain that occurs with physical or mental stress, which is not usually related to plaque rupture. Clear OCT images of the suspicious lesions were obtained for 20 heart attack patients, 20 with ACS and 17 with stable angina.

Vulnerable plaques are believed to have three major characteristics a deposit of lipids (fats), a thin cap of fibrous material covering the lipid pool, and infiltration of the immune cells called macrophages. The OCT images showed that the heart attack and ACS patients had more lipid in their plaques and significantly thinner fibrous caps than did the stable angina patients. Overall, vulnerable plaques were identified in 72 percent of the heart attack patients, 50 percent of those with ACS and only 20 percent of stable angina patients.

"This is the first technique that allows us to study the structural changes underlying vulnerable plaques in living patients, and it supports the conclusions of previously reported postmortem studies," says Jang. "We still need to gather more data to confirm these characteristics, and our group will carry out further studies of how plaques develop and rupture. Someday OCT may provide information that will guide treatments to prevent plaque rupture and its disastrous consequences." Jang is an associate professor of Medicine at Harvard Medical School.

Along with the study's senior author Bouma and Tearney, additional co-authors are Briain MacNeill, MD, Masamichi Takano, MD, and Fabian Moselewski, of the MGH Cardiology Division; Nicusor Iftima, PhD, and Milen Shishkov, PhD, of the Wellman Center; Stuart Houser, MD, and Thomas Aretz
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Contact: Sue McGreevey
smcgreevey@partners.org
617-724-2764
Massachusetts General Hospital
25-Mar-2005


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