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Progression from normal vessel wall to atherosclerotic plaque: lessons from an optical coherence tomography study with follow-up of over 5 years

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Abstract

The initial process of atherosclerotic development has not been systematically evaluated. This study aimed to observe atherosclerotic progression from normal vessel wall (NVW) to atherosclerotic plaque and examine local factors associated with such progression using > 5-year long-term follow-up data obtained by serial optical coherence tomography (OCT). A total of 49 patients who underwent serial OCT for lesions with NVW over 5 years (average: 6.9 years) were enrolled. NVW was defined as a vessel wall with an OCT-detectable three-layer structure and intimal thickness ≤ 300 μm. Baseline and follow-up OCT images were matched, and OCT cross sections with NVW > 30° were enrolled. Cross sections were diagnosed as “progression” when the NVW in these cross sections was reduced by > 30° at > 5-year follow-up. Atherogenic progression from NVW to atherosclerotic plaque was observed in 40.8% of enrolled cross sections. The incidence of microchannels in an adjacent atherosclerotic plaque within the same cross section (6.7 vs. 3.3%; p = 0.046) and eccentric distribution of atherosclerotic plaque (25.0 vs. 12.6%; p < 0.001) at baseline was significantly higher in cross sections with progression than in those without. Cross sections with progression exhibited significantly higher NVW intimal thickness at baseline than cross sections without progression (200.1 ± 53.7 vs. 180.2 ± 59.6 μm; p < 0.001). Multivariate analysis revealed that the presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness at baseline were independently associated with progression at follow-up. The presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness were potentially associated with initial atherosclerotic development from NVW to atherosclerotic plaque.

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Abbreviations

CAG:

Coronary angiography

DIT:

Diffuse intimal thickening

ESS:

Endothelial shear stress

FD-OCT:

Frequency-domain optical coherence tomography

hsCRP:

High-sensitivity C-reactive protein

LDLc:

Low-density lipoprotein cholesterol

NVW:

Normal vessel wall

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

SMCs:

Smooth muscle cells

TD-OCT:

Time-domain optical coherence tomography

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Acknowledgements

The OCT core laboratory in Kobe University, Japan served as the independent core lab for data analysis.

Funding

No grants were received from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Ryo Takeshige, Hiromasa Otake, Hiroyuki Kawamori, Takayoshi Toba, Yuichiro Nagano, Yoshiro Tsukiyama, Ken-ichi Yanaka, Hiroyuki Yamamoto, Akira Nagasawa, Hiroyuki Onishi, Yoichiro Sugizaki, Shinsuke Nakano, Yoichiro Matsuoka, Kosuke Tanimura & Ken-ichi Hirata

Authors
  1. Ryo Takeshige
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  2. Hiromasa Otake
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  3. Hiroyuki Kawamori
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  4. Takayoshi Toba
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  13. Yoichiro Matsuoka
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  15. Ken-ichi Hirata
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Contributions

RT: conceptualization, resources, formal analysis, investigation, Methodology, writing—original draft, visualization. HO: conceptualization, methodology, writing—review and editing, supervision. HK: data curation. TT: resources. YN: resources. YT: resources. KY: resources. HY: resources. AN: investigation. HO: resources. YS: investigation. SN: resources. YM: resources. KT: resources. KH: project administration, supervision.

Corresponding author

Correspondence to Hiromasa Otake.

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Conflict of interest

H.O. and T.T. received a lecture fee from Abbott Vascular. K.H. received grant support from Abbott Vascular. Other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Takeshige, R., Otake, H., Kawamori, H. et al. Progression from normal vessel wall to atherosclerotic plaque: lessons from an optical coherence tomography study with follow-up of over 5 years. Heart Vessels 37, 1–11 (2022). https://doi.org/10.1007/s00380-021-01889-w

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