Objectives: The purpose of this study was to investigate the possible correlation between morphologic and functional characteristics of culprit lesions (CL) in patients with acute coronary syndromes (ACS) and chronic stable angina (CSA).
Background: Intravascular ultrasound (IVUS) provides morphologic assessment and intracoronary thermography (ICT) evaluates the local inflammatory activation of CL.
Methods: Eighty-one consecutive patients, 48 with ACS and 33 with CSA, were enrolled. Ratio of lesion to reference external elastic membrane area, indicated by IVUS, was defined as positive remodeling index (pRi) (> or =1) or negative remodeling index (nRi) (<1). We also investigated the existence of ruptured plaque (rp) in the CL. By ICT temperature difference (DeltaT) between the CL and the proximal vessel wall was measured.
Results: Patients with ACS had greater remodeling index than patients with CSA (1.15 +/- 0.18 vs. 0.90 +/- 0.12; p < 0.01), as well as increased DeltaT (0.08 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.01). Patients with pRi had higher DeltaT than patients with nRi (0.07 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.001). In patients with nRi there was no difference in DeltaT between ACS and CSA (p = 0.22). Patients with rp had increased DeltaT compared with patients without rp (0.09 +/- 0.03 degrees C vs. 0.05 +/- 0.02 degrees C; p < 0.01). Multivariate analysis showed that DeltaT was independently correlated with the presence of rp, pRi, and ACS.
Conclusions: The present study showed that culprit lesions with plaque rupture and positive arterial remodeling have increased thermal heterogeneity, although in certain patients a discrepancy between morphogic and functional characteristics was observed. A combination of morphologic and functional examination may offer additional diagnostic and prognostic information.