INTRAPLAQUE ANGIOGENESIS IS CLOSELY RELATED WITH FIBROSIS AND INFLAMMATION IN NON-COMPLICATED VULNERABLE CORONARY LESIONS OF MIDDLE-AGED NORMAL SUBJECTS

GURFINKEL EP; VIGLIANO C; FAZZI L; CABEZA MECKERT P; DURONTO E; LAGUENS R

París

Congreso; European Society of Cardiology Congress 2011; 2011

European Society of Cardiology

Purpose: The existence of micro vessels in coronary atherosclerotic plaques is very well known through specimens obtained from autopsies of subjects who died suddenly or as a result of a cardiovascular event. This data allowed speculating that these phenomena may occur in advanced stages. The objective of the present study was to establish the temporal sequences of appearance of angiogenesis prior to the vulnerability criteria of atherosclerotic plaques in accordance with the American Heart Association [A.H.A] classification. Methods: A total of 121 hearts of non-diabetic transplant donors from apparently healthy individuals, 40 years old or over to be used for homograft were selected. The coronary arteries were examined by serial sectioning at 3-mm intervals and all areas of cross-sectional luminal narrowing were processed for histological, immuno histochemical and morphometric studies. We used a semi-quantitative score (scale 0-3) in order to detect angiogenesis. Multivariate analyses were applied for the present study, including demographic, macro and micro characteristics of the organs. Results: The age of the population was 50.9±5.7 years. We found a total of 363 lesions (A.H.A.). We detected angiogenesis in 56 (15.43%) plaques. Those lesions had a relative thickness (intima thickness/total thickness) of 0.74±0.07 microns vs. 0.62±0.12 not presenting neovessels. (P<0.001). The vascular occlusion value equal or higher than 50%, CD68 and CD45RO inflammatory cells infiltration, the presence of a lipid core, fibrosis, and peri- arteritis were strongly associated with angiogenesis (p = < 0.001), including miofibroblastic hyperplasia (P=0.006). We did not find a significant association of neo vessels with intraplaque haemorrhage and, or calcification. When we applied the multivariate analyses, the existence of fibrosis (Odds ratio (IC95%) 6.18 (2.94-13.0; p<0.001) and intimal inflammatory infiltration: 2.94 (1.65-5.23; P<0.001) showed a statistical significant association with angiogenesis. Conclusions: Angiogenesis in apparently healthy human hearts is preceded by inflammatory cells infiltration and the presence of a lipid core motivating lumen reduction. We did not find a strong association with intraplaque haemorrhage or calcification, suggesting that angiogenesis may anticipate plaque rupture.