PRESENCE OF ANGIOGENESIS IN ATHEROSCLEROTIC CORONARY VULNERABLE PLAQUES OF APPARENTLY MIDDLE-AGED HEALTHY HUMAN HEARTS

VIGLIANO C; GURFINKEL EP; CABEZA MECKERT P; LAGUENS R

Estocolmo

Congreso; European Society of Cardiology Congress 2010; 2010

European Society of Cardiology

Purpose: Micro vessels are present in the atherosclerotic plaque analyzed from autopsy or surgical studies of subjects who suffered a cardiovascular event. In the present study we explore the existence of angiogenesis in vulnerable lesions (American Heart Association consensus [A.H.A.]) of individuals who suffered a brain death. Methods: A total of 121 hearts from non-diabetic transplant donors collected between 1996 and 2007, were selected from apparently healthy individuals older than 40 year-old that died because of head trauma or stroke and had no evidence of prior vascular diseases. The coronary arteries were examined by serial sectioning at 3-mm intervals and all areas of cross-sectional luminal narrowing were processed for histological, immunohistochemical and morphometric studies. We used a semi-quantitative score (scale 0-3) for identification of angiogenesis. Multivariate analyses were applied for the present study, including demographic, macro and micro characteristics of the organs. Results: the mean age was 50.9±5.7 years. We found 143 plaques considered as high-risk lesions (American Heart Association Type IV, V, and VI). They were more frequently found in the left anterior descending artery (LAD, 46.3%) than in the Circumflex (Cx: 28.9%) or the right coronary vessel (RCA: 43%). A total of 21% of plaques with angiogenesis were found in the LAD, strongly associated with prior antecedent of hypertension, males, and the heart weight (P < 0.001). In the Cx artery we detected 6.6% of advanced lesions with angiogenesis mainly in men (p = 0.021). In the RCA we found a 19% of lesions with angiogenesis associated with the heart weight only (p = 0.043). The vascular occlusion value equal or more than 50%, inflammatory cells infiltration, the presence of a lipid core, fibrosis, and periarteritis were strongly associated with angiogenesis (p =< 0.001). No significant statistical association could be found with calcification or intraplaque hemorrhage. According with the A.H.A. classification we detected  angiogenesis in 1 lesion Type II; 5 in plaques Type III; 21 in lesions Type IV; 22 in Type V; and 7 in plaques Type VI. Conclusions: Angiogenesis in apparently healthy humans? hearts are statistically associated with the degree of vascular occlusion rate, inflammatory cells infiltration and the lipid core, particularly in the LAD. Conversely to prior reports we did not found a strong association with plaque hemorrhage or calcification, suggesting that this phenomenon may anticipate plaque ruptura.