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S23-4 Optical Coherence Tomography for Vulnerable Plaque
S36
Abstracts of the 17th Asian Pacific Congress of Cardiology
rupture and acute coronary syndrome.However, the imaging of vulnerable plaque characteristics is still limited invivo. Multi-slice computed tomography(MSCT) is a rapidly developing technique and allow reliable evaluation of the coronary arteries in a non-invasive manner.Coronary artery lesions were identified by MSCT as calcified plaque,noncalcified plaque,low-density plaque and vessel positive remodeling. From plaque density(HU) and lesion morphologies identified by MSCT, it will provide new non-invasive imaging for evaluation of vulnerable plaque.However,MSCT as current new non-invasive imaging technology has very limited resolution to characterize vulnerable lesions in coronary arteries. Compared with non-invasive imaging technology of MSCT, optical coherence tomography(OCT) shows considerable promise as a method for high resolution catheter-based imaging. It gives longitudinal resolution and lateral spatial resolution at 2 30 mm and 5 30 mm respectively. There are several potential applications of OCT for detection of vulnerable plaques because of its high resolution and unique characteristics. OCT can detect the most frequent variant of a vulnerable plaque such as lipid pool, thin fibrous cap, and increased macrophages infiltration.The MSCT as a new non-invasive imaging, and OCT as the highest resolution of intracoronary imaging,these two new imaging technologies will play important role in detecting vulnerable plaque in the near future. S23-4 Optical Coherence Tomography for Vulnerable Plaque Atsushi Tanaka. Department of Cardiovascular Medicine, Wakayama Medical University, Japan Background: Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men suffering sudden death. The aim of this study was to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient’s activity at the onset of ACS using optical coherence tomography (OCT). Methods and Results: Our population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent OCT and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. Broken fibrous-cap thickness correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% vs. exertion 93%, p = 0.014). Broken fibrous-cap thickness in the exertion group was significantly higher than in the rest group (rest 50[15] mm vs. exertion 90[65] mm, p < 0.01). Conclusions: The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest or during the patient’s day-to day activity.
Symposium 24. Takotsubo Disease S24-1 Pathogenesis of “Panic Myocardium” Characterized by Transient Left Ventricular Asynergy in Acute Phase of Subarachnoid Hemorrhage Takashi Masuda. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Japan Obvious cardiac dysfunction, including electrocardiographic abnormalities and left ventricular (LV) asynergy, is known to develop after subarachnoid hemorrhage (SAH). We investigated the pathogenesis of LV asynergy based on the clinical observation of 717 patients in the acute phase of SAH. In the evaluation of a two-dimensional echocardiogram or left ventriculogram on admission, a transient LV asynergy was detected in 9.6% of SAH patients, which showed diffuse segmental wall motion abnormalities with reduced LV ejection fraction and improved within 1 to 2 weeks. The massive secretion of catecholamine from the sympathetic nervous ends into the myocardium was suggested as one of the reasons for the myocardial damage following SAH. In addition to these clinical findings, to clarify whether the elevated activity of sympathetic nervous system contributed to the development of “Panic Myocardium” after SAH, a novel experimental animal model that simulated the rupture of a cerebral aneurysm was employed. The experimental study demonstrated that SAH activated the sympathetic nervous system and then decreased cardiac function with an increase of serum CK-MB. Accordingly, it is concluded that elevated activity of the sympathetic nervous system induces myocardial damage in the acute phase of SAH and contributes to the development of “Panic Myocardium”. S24-2 Stress-Induced Transient Left Ventricular Apical Ballooning Makoto Kodama, Hiroshi Watanabe, Wataru Mitsuma, Shinpei Kimura, Masahiro Ito, Satoru Hirono, Haruo Hanawa, Yoshifusa Aizawa. Division of Cardiology, Internal Medicine 1, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan Emotional stresses occasionally provoke cardiovascular diseases. Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) is characterized by ballooning of the apical left ventricle. The disorder is restricted to elder female. Natural disaster, especially earthquake, delivers sudden and heavy stresses on people. We investigated cardiovascular events around Niigata Chuetsu earthquake. Sudden death and Takotsubo cardiomyopathy were increased significantly after the disaster. Twenty-four of the 25 cases with Takotsubo cardiomyopathy were female. Mean age was 71.0 years-old. Supposed pathogenesis of the disease was coronary vasospasm and toxic effects of catecholamines. Genetic predisposition and occult myocardial damage may precede this disorder. Wall stress caused by intra-ventricular obstruction may also affect the generation of apical ballooning. We analyzed serial ECG in sporadic cases. The ECG change was composed of 4 phases. Phase 1 was ST elevation immediately after onset, phase 2 was T wave inversion from day 1 to 3, then inverted T waves improved transiently from day 2 to 6 (phase 3), finally giant negative T waves with QT prolongation appeared (phase 4). Four phases of ECG change will assist diagnosis and may imply the pathogenesis of Takotsubo cardiomyopathy.
Abstracts of the 17th Asian Pacific Congress of Cardiology
rupture and acute coronary syndrome.However, the imaging of vulnerable plaque characteristics is still limited invivo. Multi-slice computed tomography(MSCT) is a rapidly developing technique and allow reliable evaluation of the coronary arteries in a non-invasive manner.Coronary artery lesions were identified by MSCT as calcified plaque,noncalcified plaque,low-density plaque and vessel positive remodeling. From plaque density(HU) and lesion morphologies identified by MSCT, it will provide new non-invasive imaging for evaluation of vulnerable plaque.However,MSCT as current new non-invasive imaging technology has very limited resolution to characterize vulnerable lesions in coronary arteries. Compared with non-invasive imaging technology of MSCT, optical coherence tomography(OCT) shows considerable promise as a method for high resolution catheter-based imaging. It gives longitudinal resolution and lateral spatial resolution at 2 30 mm and 5 30 mm respectively. There are several potential applications of OCT for detection of vulnerable plaques because of its high resolution and unique characteristics. OCT can detect the most frequent variant of a vulnerable plaque such as lipid pool, thin fibrous cap, and increased macrophages infiltration.The MSCT as a new non-invasive imaging, and OCT as the highest resolution of intracoronary imaging,these two new imaging technologies will play important role in detecting vulnerable plaque in the near future. S23-4 Optical Coherence Tomography for Vulnerable Plaque Atsushi Tanaka. Department of Cardiovascular Medicine, Wakayama Medical University, Japan Background: Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men suffering sudden death. The aim of this study was to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient’s activity at the onset of ACS using optical coherence tomography (OCT). Methods and Results: Our population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent OCT and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. Broken fibrous-cap thickness correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% vs. exertion 93%, p = 0.014). Broken fibrous-cap thickness in the exertion group was significantly higher than in the rest group (rest 50[15] mm vs. exertion 90[65] mm, p < 0.01). Conclusions: The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest or during the patient’s day-to day activity.
Symposium 24. Takotsubo Disease S24-1 Pathogenesis of “Panic Myocardium” Characterized by Transient Left Ventricular Asynergy in Acute Phase of Subarachnoid Hemorrhage Takashi Masuda. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Japan Obvious cardiac dysfunction, including electrocardiographic abnormalities and left ventricular (LV) asynergy, is known to develop after subarachnoid hemorrhage (SAH). We investigated the pathogenesis of LV asynergy based on the clinical observation of 717 patients in the acute phase of SAH. In the evaluation of a two-dimensional echocardiogram or left ventriculogram on admission, a transient LV asynergy was detected in 9.6% of SAH patients, which showed diffuse segmental wall motion abnormalities with reduced LV ejection fraction and improved within 1 to 2 weeks. The massive secretion of catecholamine from the sympathetic nervous ends into the myocardium was suggested as one of the reasons for the myocardial damage following SAH. In addition to these clinical findings, to clarify whether the elevated activity of sympathetic nervous system contributed to the development of “Panic Myocardium” after SAH, a novel experimental animal model that simulated the rupture of a cerebral aneurysm was employed. The experimental study demonstrated that SAH activated the sympathetic nervous system and then decreased cardiac function with an increase of serum CK-MB. Accordingly, it is concluded that elevated activity of the sympathetic nervous system induces myocardial damage in the acute phase of SAH and contributes to the development of “Panic Myocardium”. S24-2 Stress-Induced Transient Left Ventricular Apical Ballooning Makoto Kodama, Hiroshi Watanabe, Wataru Mitsuma, Shinpei Kimura, Masahiro Ito, Satoru Hirono, Haruo Hanawa, Yoshifusa Aizawa. Division of Cardiology, Internal Medicine 1, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan Emotional stresses occasionally provoke cardiovascular diseases. Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) is characterized by ballooning of the apical left ventricle. The disorder is restricted to elder female. Natural disaster, especially earthquake, delivers sudden and heavy stresses on people. We investigated cardiovascular events around Niigata Chuetsu earthquake. Sudden death and Takotsubo cardiomyopathy were increased significantly after the disaster. Twenty-four of the 25 cases with Takotsubo cardiomyopathy were female. Mean age was 71.0 years-old. Supposed pathogenesis of the disease was coronary vasospasm and toxic effects of catecholamines. Genetic predisposition and occult myocardial damage may precede this disorder. Wall stress caused by intra-ventricular obstruction may also affect the generation of apical ballooning. We analyzed serial ECG in sporadic cases. The ECG change was composed of 4 phases. Phase 1 was ST elevation immediately after onset, phase 2 was T wave inversion from day 1 to 3, then inverted T waves improved transiently from day 2 to 6 (phase 3), finally giant negative T waves with QT prolongation appeared (phase 4). Four phases of ECG change will assist diagnosis and may imply the pathogenesis of Takotsubo cardiomyopathy.