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Plaque vulnerability index predicts cardiovascular events : A histological study of an endarterectomy cohort

Goncalves, Isabel LU orcid ; Sun, Jiangming LU orcid ; Tengryd, Christoffer LU ; Nitulescu, Mihaela LU ; Persson, Ana F. LU ; Nilsson, Jan LU and Edsfeldt, Andreas LU (2021) In Journal of the American Heart Association 10(15).
Abstract

BACKGROUND: The balance between stabilizing and destabilizing atherosclerotic plaque components is used in experimental studies and in imaging studies to identify rupture prone plaques. However, we lack the evidence that this balance predicts future cardiovascular events. Here we explore whether a calculated histological ratio, referred to as vulnerability index (VI), can predict patients at higher risk to suffer from future cardiovascular events. METHODS AND RESULTS: Carotid plaques and clinical information from 194 patients were studied. Tissue sections were used for histological analysis to calculate the VI (CD68 [cluster of differentiation 68], alpha-actin, Oil red O, Movat pentachrome, and glycophorin A). Postoperative... (More)

BACKGROUND: The balance between stabilizing and destabilizing atherosclerotic plaque components is used in experimental studies and in imaging studies to identify rupture prone plaques. However, we lack the evidence that this balance predicts future cardiovascular events. Here we explore whether a calculated histological ratio, referred to as vulnerability index (VI), can predict patients at higher risk to suffer from future cardiovascular events. METHODS AND RESULTS: Carotid plaques and clinical information from 194 patients were studied. Tissue sections were used for histological analysis to calculate the VI (CD68 [cluster of differentiation 68], alpha-actin, Oil red O, Movat pentachrome, and glycophorin A). Postoperative cardiovascular events were identified through the Swedish National Inpatient Health Register (2005-2013). During the follow-up (60 months) 45 postoperative cardiovascular events were registered. Patients with a plaque VI in the fourth quartile compared with the first to third quartiles had significantly higher risk to suffer from a future cardiovascular event (P=0.0002). The VI was an independent predictor and none of the 5 histological variables analyzed separately predicted events. In the 13 patients who underwent bilateral carotid endarterectomy, the VI of the right plaque correlated with the VI of the left plaque and vice versa (r=0.7, P=0.01). CONCLUSIONS: Our findings demonstrate that subjects with a high plaque VI have an increased risk of future cardiovascular events, independently of symptoms and other known cardiovascular risk factors. This strongly supports that techniques which image such plaques can facilitate risk stratification for subjects in need of more intense treatment.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atherosclerosis, Histopathology, Plaque rupture, Vulnerable plaque
in
Journal of the American Heart Association
volume
10
issue
15
article number
e021038
publisher
Wiley-Blackwell
external identifiers
  • pmid:34325529
  • scopus:85112219906
ISSN
2047-9980
DOI
10.1161/JAHA.120.021038
language
English
LU publication?
yes
id
d5d7032b-707e-409d-bcb0-5b1cf7e9d225
date added to LUP
2021-09-20 11:11:26
date last changed
2024-06-15 16:33:19
@article{d5d7032b-707e-409d-bcb0-5b1cf7e9d225,
  abstract     = {{<p>BACKGROUND: The balance between stabilizing and destabilizing atherosclerotic plaque components is used in experimental studies and in imaging studies to identify rupture prone plaques. However, we lack the evidence that this balance predicts future cardiovascular events. Here we explore whether a calculated histological ratio, referred to as vulnerability index (VI), can predict patients at higher risk to suffer from future cardiovascular events. METHODS AND RESULTS: Carotid plaques and clinical information from 194 patients were studied. Tissue sections were used for histological analysis to calculate the VI (CD68 [cluster of differentiation 68], alpha-actin, Oil red O, Movat pentachrome, and glycophorin A). Postoperative cardiovascular events were identified through the Swedish National Inpatient Health Register (2005-2013). During the follow-up (60 months) 45 postoperative cardiovascular events were registered. Patients with a plaque VI in the fourth quartile compared with the first to third quartiles had significantly higher risk to suffer from a future cardiovascular event (P=0.0002). The VI was an independent predictor and none of the 5 histological variables analyzed separately predicted events. In the 13 patients who underwent bilateral carotid endarterectomy, the VI of the right plaque correlated with the VI of the left plaque and vice versa (r=0.7, P=0.01). CONCLUSIONS: Our findings demonstrate that subjects with a high plaque VI have an increased risk of future cardiovascular events, independently of symptoms and other known cardiovascular risk factors. This strongly supports that techniques which image such plaques can facilitate risk stratification for subjects in need of more intense treatment.</p>}},
  author       = {{Goncalves, Isabel and Sun, Jiangming and Tengryd, Christoffer and Nitulescu, Mihaela and Persson, Ana F. and Nilsson, Jan and Edsfeldt, Andreas}},
  issn         = {{2047-9980}},
  keywords     = {{Atherosclerosis; Histopathology; Plaque rupture; Vulnerable plaque}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{15}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Plaque vulnerability index predicts cardiovascular events : A histological study of an endarterectomy cohort}},
  url          = {{http://dx.doi.org/10.1161/JAHA.120.021038}},
  doi          = {{10.1161/JAHA.120.021038}},
  volume       = {{10}},
  year         = {{2021}},
}