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| Relation between neutrophil count and vulnerable plaque components in patients with coronary artery disease: virtual histology-intravascular ultrasound analysis |
| 성가롤로병원 순환기내과¹ , 전남대학교병원 순환기내과² |
| 최윤하² , 조장현¹ , 김수현¹ , 최승¹ , 윤명호¹ , 박재영¹ , 홍영준² ,정명호² 김동한² 이기홍² , Futoshi Yamanaka², 이민구² , 박근호² ,심두선² , 윤남식² ,윤현주² ,김계훈² ,박형욱² ,김주한² ,안영근² ,조정관² ,박종춘² ,강정채² |
Background: Neutrophils, together with platelets, have recently been described as predictors of impaired left ventricular function and worse clinical prognosis in patients with acute coronary syndrome (ACS). However, the virtual histology-intravascular ultrasound (VH-IVUS) findings which are associated with neutrophil were not well known. So we used VH-IVUS to evaluate the relation between neutrophil count and plaque components in 471 patients with CAD.
Methods: We classified the patients into three groups according to the tertiles of neutrophil count on admission: Group I [neutrophil count < 5,300/mm3 (n=368)]; Group II [neutrophil count = 5,300-7,600/mm3 (n=54)]; Group III [neutrophil count > 7,600/mm3 (n=49)]. Thin-cap fibroatheroma (TCFA) was defined as a necrotic core (NC) ≥ 10% of plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of ≥ 40% least 3 plaque burden.
Results: ACS was most prevalent in Group III (10% vs. 33% vs. 80%, p<0.001), and Group III had highest white blood cell (6.8±1.8 103/mm3 vs. 9.5±1.6 103/mm3 vs. 13.2±2.9 103/mm3, p<0.001), and had highest creatine kinase-MB (7.7±20.9 U/dl vs. 8.5±11.4 U/dl vs. 59.2±106.6 U/dl, p<0.001), and had highest troponin-I (1.6±8.8 ng/ml vs. 3.1±6.9 ng/ml vs. 32.6±71.5 ng/ml, p<0.001). At the minimum lumen site, Group III had greatest plaque plus media cross sectional area and plaque burden (10.2±4.0 mm2 vs. 11.5±5.2 mm2 vs. 12.2±5.3 mm2, p=0.003, and 69±9% vs. 72±7% vs. 73±8%, p=0.005, respectively), and had greatest absolute NC area (23.1±11.6 mm2 vs. 21.8±12.4 mm2 vs. 26.4±13.5 mm2, p=0.012). By volumetric analysis, the absolute and relative NC volumes were greatest in Group III (23.2±19.3 mm3 vs. 29.2±28.3 mm3 vs. 33.4±26.3 mm3, p=0.002, and 20.4±8.5% vs. 19.0±8.7% vs. 23.2±11.1%, p=0.047, respectively). Also TCFA were observed most frequently in Group III (19% vs. 20% vs. 37%, p=0.017).
Conclusions: CAD patients with high neutrophil count had more vulnerable plaque components (greater NC containing plaques) than those with low neutrophil count.
Key Words: Neutrophil count, Plaque, Intravascular Ultrasound
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