Skip to main content
Top
Published in: Current Cardiovascular Imaging Reports 4/2010

01-08-2010

Intravascular Thermography for Assessing Vulnerable Plaques

Authors: Konstantinos Toutouzas, Maria Drakopoulou, Andreas Synetos, Christodoulos Stefanadis

Published in: Current Cardiovascular Imaging Reports | Issue 4/2010

Login to get access

Abstract

Atherosclerosis and its cardiovascular complications remain the leading cause of death in developed countries. Current knowledge of coronary artery disease progression has significantly evolved and the interest has been focused on the development of new imaging techniques for the early detection of vulnerable lesions. Intracoronary thermography is a method that detects local plaque inflammation. Clinical studies with intracoronary thermography have enlightened the diagnostic algorithm of high-risk or “vulnerable” plaque. The current shortcomings, however, of intracoronary thermography limit the clinical application of the method. Future technological achievements will hopefully lead to the detection of inflamed plaques, thus determining the role of inflammation in plaque destabilization and directing local and/or systemic therapy in patients with coronary artery disease.
Literature
1.
go back to reference Rosamond W, Flegal K, Furie K, et al.: Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008, 117:e25–e146.CrossRefPubMed Rosamond W, Flegal K, Furie K, et al.: Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008, 117:e25–e146.CrossRefPubMed
2.
go back to reference Honda Y, Fitzgerald PJ: Frontiers in intravascular imaging technologies. Circulation 2008, 117:2024–2037.CrossRefPubMed Honda Y, Fitzgerald PJ: Frontiers in intravascular imaging technologies. Circulation 2008, 117:2024–2037.CrossRefPubMed
4.
go back to reference Naghavi M, Libby P, Falk E, et al: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 2003, 108:1664–1672.CrossRefPubMed Naghavi M, Libby P, Falk E, et al: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 2003, 108:1664–1672.CrossRefPubMed
5.
go back to reference Stone GW: First presentation of the baseline features and plaque characteristics from the PROSPECT Trial. Transcatheter Cardiovascular Therapeutics. San Francisco, CA; September 21–25, 2009. Stone GW: First presentation of the baseline features and plaque characteristics from the PROSPECT Trial. Transcatheter Cardiovascular Therapeutics. San Francisco, CA; September 21–25, 2009.
7.
go back to reference Libby P, Ridker PM, Hansson GK: Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009, 54:2129–2138.CrossRefPubMed Libby P, Ridker PM, Hansson GK: Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009, 54:2129–2138.CrossRefPubMed
8.
9.
go back to reference Schoenhagen P: Plaque temperature, arterial remodeling, and inflammation: understanding “hot-spots” in the coronary arteries. J Am Coll Cardiol 2007, 49:2272–2273.CrossRefPubMed Schoenhagen P: Plaque temperature, arterial remodeling, and inflammation: understanding “hot-spots” in the coronary arteries. J Am Coll Cardiol 2007, 49:2272–2273.CrossRefPubMed
10.
go back to reference Madjid M, Naghavi M, Malik BA, et al.: Thermal detection of vulnerable plaque. Am J Cardiol 2002, 90:36L–39L.CrossRefPubMed Madjid M, Naghavi M, Malik BA, et al.: Thermal detection of vulnerable plaque. Am J Cardiol 2002, 90:36L–39L.CrossRefPubMed
11.
go back to reference Tenaglia AN, Peters KG, Sketch MH Jr, Annex BH: Neovascularization in atherectomy specimens from patients with unstable angina: implications for pathogenesis of unstable angina. Am Heart J 1998, 135:10–14.CrossRefPubMed Tenaglia AN, Peters KG, Sketch MH Jr, Annex BH: Neovascularization in atherectomy specimens from patients with unstable angina: implications for pathogenesis of unstable angina. Am Heart J 1998, 135:10–14.CrossRefPubMed
12.
go back to reference Heinle H: Metabolite concentration gradients in the arterial wall of experimental atherosclerosis. Exp Mol Pathol 1987, 46:312–320.CrossRefPubMed Heinle H: Metabolite concentration gradients in the arterial wall of experimental atherosclerosis. Exp Mol Pathol 1987, 46:312–320.CrossRefPubMed
13.
go back to reference Casscells W, Hathorn B, David M, et al.: Thermal detection of cellular infiltrates in living atherosclerotic plaques: possible implications for plaque rupture and thrombosis. Lancet 1996, 347:1447–1451.CrossRefPubMed Casscells W, Hathorn B, David M, et al.: Thermal detection of cellular infiltrates in living atherosclerotic plaques: possible implications for plaque rupture and thrombosis. Lancet 1996, 347:1447–1451.CrossRefPubMed
14.
go back to reference Naghavi M, John R, Naguib S, et al.: pH Heterogeneity of human and rabbit atherosclerotic plaques; a new insight into detection of vulnerable plaque. Atherosclerosis 2002, 164:27–35.CrossRefPubMed Naghavi M, John R, Naguib S, et al.: pH Heterogeneity of human and rabbit atherosclerotic plaques; a new insight into detection of vulnerable plaque. Atherosclerosis 2002, 164:27–35.CrossRefPubMed
15.
go back to reference Madjid M, Willerson T, Casscells, W: Intracoronary thermography for detection of high risk vulnerable plaques. J Am Coll Cardiol 2006, 47:C80–C85.CrossRefPubMed Madjid M, Willerson T, Casscells, W: Intracoronary thermography for detection of high risk vulnerable plaques. J Am Coll Cardiol 2006, 47:C80–C85.CrossRefPubMed
16.
go back to reference Toutouzas K, Spanos V, Ribichini F: A correlation of coronary plaque temperature with inflammatory markers obtained from atherectomy specimens in humans. Am J Cardiol 2003, 92:476. Toutouzas K, Spanos V, Ribichini F: A correlation of coronary plaque temperature with inflammatory markers obtained from atherectomy specimens in humans. Am J Cardiol 2003, 92:476.
17.
go back to reference Naghavi M, Madjid M, Gul K, et al.: Thermography basket catheter: in vivo measurement of the temperature of atherosclerotic plaques for detection of vulnerable plaques. Catheter Cardiovasc Interv 2003, 59:52–59.CrossRefPubMed Naghavi M, Madjid M, Gul K, et al.: Thermography basket catheter: in vivo measurement of the temperature of atherosclerotic plaques for detection of vulnerable plaques. Catheter Cardiovasc Interv 2003, 59:52–59.CrossRefPubMed
18.
go back to reference Zarrabi A, Gul K, Willerson JT, et al.: Intravascular thermography: a novel approach for detection of vulnerable plaque. Curr Opin Cardiol 2002, 17:656–662.CrossRefPubMed Zarrabi A, Gul K, Willerson JT, et al.: Intravascular thermography: a novel approach for detection of vulnerable plaque. Curr Opin Cardiol 2002, 17:656–662.CrossRefPubMed
19.
go back to reference Verheye S, De Meyer GR, Van Langenhove G, et al.: In vivo temperature heterogeneity of atherosclerotic plaques is determined by plaque composition. Circulation 2002, 105:1596–1601.CrossRefPubMed Verheye S, De Meyer GR, Van Langenhove G, et al.: In vivo temperature heterogeneity of atherosclerotic plaques is determined by plaque composition. Circulation 2002, 105:1596–1601.CrossRefPubMed
20.
go back to reference Krams R, Verheye S, van Damme LC, et al.: In vivo temperature heterogeneity is associated with plaque regions of increased MMP-9 activity. Eur Heart J 2005, 26:2200–2205.CrossRefPubMed Krams R, Verheye S, van Damme LC, et al.: In vivo temperature heterogeneity is associated with plaque regions of increased MMP-9 activity. Eur Heart J 2005, 26:2200–2205.CrossRefPubMed
21.
go back to reference Stefanadis C, Diamantopoulos L, Vlachopoulos C, et al.: Thermal heterogeneity within human atherosclerotic coronary arteries detected in vivo: A new method of detection by application of a special thermography catheter. Circulation 1999, 99:1965–1971.PubMed Stefanadis C, Diamantopoulos L, Vlachopoulos C, et al.: Thermal heterogeneity within human atherosclerotic coronary arteries detected in vivo: A new method of detection by application of a special thermography catheter. Circulation 1999, 99:1965–1971.PubMed
22.
go back to reference Toutouzas K, Vaina S, Tsiamis E, et al.: Detection of increased temperature of the culprit lesion after recent myocardial infarction: the favorable effect of statins. Am Heart J 2004, 148:783–788.CrossRefPubMed Toutouzas K, Vaina S, Tsiamis E, et al.: Detection of increased temperature of the culprit lesion after recent myocardial infarction: the favorable effect of statins. Am Heart J 2004, 148:783–788.CrossRefPubMed
23.
go back to reference Schmermund A, Rodermann J, Erbel R: Intracoronary thermography. Herz 2003, 28:505–512. Schmermund A, Rodermann J, Erbel R: Intracoronary thermography. Herz 2003, 28:505–512.
24.
go back to reference Wainstein M, Costa M, Ribeiro J, et al.: Vulnerable plaque detection by temperature heterogeneity measured with a guidewire system: clinical, intravascular ultrasound and histopathologic correlates. J Invasive Cardiol 2007, 19:49–54.PubMed Wainstein M, Costa M, Ribeiro J, et al.: Vulnerable plaque detection by temperature heterogeneity measured with a guidewire system: clinical, intravascular ultrasound and histopathologic correlates. J Invasive Cardiol 2007, 19:49–54.PubMed
25.
go back to reference Worthley S, Farouque MO, Worthley M, et al.: The RADI PressureWire high-sensitivity thermistor and culprit lesion temperature in patients with acute coronary syndromes. J Invasive Cardiol 2006, 18:528–531.PubMed Worthley S, Farouque MO, Worthley M, et al.: The RADI PressureWire high-sensitivity thermistor and culprit lesion temperature in patients with acute coronary syndromes. J Invasive Cardiol 2006, 18:528–531.PubMed
26.
go back to reference Cuisset T, Beauloye C, Melikian N, et al.: In vitro and in vivo studies on thermistor-based intracoronary temperature measurements: effect of pressure and flow. Catheter Cardiovasc Interv 2009, 73:224–230.CrossRefPubMed Cuisset T, Beauloye C, Melikian N, et al.: In vitro and in vivo studies on thermistor-based intracoronary temperature measurements: effect of pressure and flow. Catheter Cardiovasc Interv 2009, 73:224–230.CrossRefPubMed
27.
go back to reference • Takumi T, Lee S, Hamasaki S, et al.: Limitation of angiography to identify the culprit plaque in acute myocardial infarction with coronary total occlusion utility of coronary plaque temperature measurement to identify the culprit plaque. J Am Coll Cardiol 2007, 50:2197–2203. This interesting study demonstrated that angiographic evaluation of the culprit plaque is of limited utility, whereas temperature measurement enables accurate identification of the culprit plaque in patients with acute myocardial infarction and coronary total occlusion.CrossRefPubMed • Takumi T, Lee S, Hamasaki S, et al.: Limitation of angiography to identify the culprit plaque in acute myocardial infarction with coronary total occlusion utility of coronary plaque temperature measurement to identify the culprit plaque. J Am Coll Cardiol 2007, 50:2197–2203. This interesting study demonstrated that angiographic evaluation of the culprit plaque is of limited utility, whereas temperature measurement enables accurate identification of the culprit plaque in patients with acute myocardial infarction and coronary total occlusion.CrossRefPubMed
28.
go back to reference Webster M, Stewart J, Ruygrok P: Intracoronary thermography with a multiple thermocouple catheter: initial human experience. Am J Cardiol 2002, 90(Suppl 6A):24H. Webster M, Stewart J, Ruygrok P: Intracoronary thermography with a multiple thermocouple catheter: initial human experience. Am J Cardiol 2002, 90(Suppl 6A):24H.
29.
go back to reference Toutouzas K, Drakopoulou M, Markou V, et al.: Correlation of systemic inflammation with local inflammatory activity in non-culprit lesions: beneficial effect of statins. Int J Cardiol 2007, 119:368–373.CrossRefPubMed Toutouzas K, Drakopoulou M, Markou V, et al.: Correlation of systemic inflammation with local inflammatory activity in non-culprit lesions: beneficial effect of statins. Int J Cardiol 2007, 119:368–373.CrossRefPubMed
30.
go back to reference Dudek D, Rzeszutko L, Legutko J, et al.: High-risk coronary artery plaques diagnosed by intracoronary thermography. Kardiol Pol 2005, 62:383–389.PubMed Dudek D, Rzeszutko L, Legutko J, et al.: High-risk coronary artery plaques diagnosed by intracoronary thermography. Kardiol Pol 2005, 62:383–389.PubMed
31.
go back to reference Toutouzas K, Drakopoulou M, Mitropoulos J, et al.: Elevated plaque temperature in non-culprit de novo atheromatous lesions of patients with acute coronary syndromes. J Am Coll Cardiol 2006, 47:301–306.CrossRefPubMed Toutouzas K, Drakopoulou M, Mitropoulos J, et al.: Elevated plaque temperature in non-culprit de novo atheromatous lesions of patients with acute coronary syndromes. J Am Coll Cardiol 2006, 47:301–306.CrossRefPubMed
32.
go back to reference Toutouzas K, Drakopoulou M, Markou V, et al.: Increased coronary sinus blood temperature: correlation with systemic inflammation. Eur J Clin Invest 2006, 36:218–223.CrossRefPubMed Toutouzas K, Drakopoulou M, Markou V, et al.: Increased coronary sinus blood temperature: correlation with systemic inflammation. Eur J Clin Invest 2006, 36:218–223.CrossRefPubMed
33.
go back to reference Stefanadis C, Tsiamis E, Vaina S, et al.: Temperature of blood in the coronary sinus and right atrium in patients with and without coronary artery disease. Am J Cardiol 2004, 93:207–210.CrossRefPubMed Stefanadis C, Tsiamis E, Vaina S, et al.: Temperature of blood in the coronary sinus and right atrium in patients with and without coronary artery disease. Am J Cardiol 2004, 93:207–210.CrossRefPubMed
34.
go back to reference Toutouzas K, Tsiamis E, Drakopoulou M, et al.: Impact of type 2 diabetes mellitus on diffuse inflammatory activation of de novo atheromatous lesions: implications for systemic inflammation. Diabetes Metab 2009, 35:299–304.CrossRefPubMed Toutouzas K, Tsiamis E, Drakopoulou M, et al.: Impact of type 2 diabetes mellitus on diffuse inflammatory activation of de novo atheromatous lesions: implications for systemic inflammation. Diabetes Metab 2009, 35:299–304.CrossRefPubMed
35.
go back to reference Toutouzas K, Markou V, Drakopoulou M, et al.: Increased heat generation from atherosclerotic plaques in patients with type 2 diabetes: an increased local inflammatory activation. Diabetes Care 2005, 28:1656–1661.CrossRefPubMed Toutouzas K, Markou V, Drakopoulou M, et al.: Increased heat generation from atherosclerotic plaques in patients with type 2 diabetes: an increased local inflammatory activation. Diabetes Care 2005, 28:1656–1661.CrossRefPubMed
36.
go back to reference Toutouzas K, Markou V, Drakopoulou M, et al.: Patients with type two diabetes mellitus: increased local inflammatory activation in culprit atheromatous plaques. Hellenic J Cardiol 2005, 46:283–288.PubMed Toutouzas K, Markou V, Drakopoulou M, et al.: Patients with type two diabetes mellitus: increased local inflammatory activation in culprit atheromatous plaques. Hellenic J Cardiol 2005, 46:283–288.PubMed
37.
38.
go back to reference Stefanadis C, Toutouzas K, Vavuranakis M, et al.: Statin treatment is associated with reduced thermal heterogeneity in human atherosclerotic plaques. Eur Heart J 2002, 23:1664–1669.PubMed Stefanadis C, Toutouzas K, Vavuranakis M, et al.: Statin treatment is associated with reduced thermal heterogeneity in human atherosclerotic plaques. Eur Heart J 2002, 23:1664–1669.PubMed
39.
go back to reference • Toutouzas K, Synetos A, Stefanadi E, et al.: Correlation between morphologic characteristics and local temperature differences in culprit lesions of patients with symptomatic coronary artery disease. J Am Coll Cardiol 2007, 49:2264–2271. This article demonstrated a correlation between vulnerable plaque morphologic characteristics assessed by intravascular ultrasound with functional characteristics assessed by intracoronary thermography.CrossRefPubMed • Toutouzas K, Synetos A, Stefanadi E, et al.: Correlation between morphologic characteristics and local temperature differences in culprit lesions of patients with symptomatic coronary artery disease. J Am Coll Cardiol 2007, 49:2264–2271. This article demonstrated a correlation between vulnerable plaque morphologic characteristics assessed by intravascular ultrasound with functional characteristics assessed by intracoronary thermography.CrossRefPubMed
40.
go back to reference Toutouzas K, Riga M, Vaina S, et al.: Acute coronary syndromes, thin fibrous cap and ruptured plaques are associated with increased local inflammatory activation: A combination of intravascular optical coherence tomography and intracoronary thermography study. J Am Coll Cardiol 2008, 51:1033. Toutouzas K, Riga M, Vaina S, et al.: Acute coronary syndromes, thin fibrous cap and ruptured plaques are associated with increased local inflammatory activation: A combination of intravascular optical coherence tomography and intracoronary thermography study. J Am Coll Cardiol 2008, 51:1033.
41.
go back to reference Toutouzas K, Riga M, Synetos A, et al.: Optical coherence tomography analysis of culprit lesions of patients with acute myocardial infarction in combination with intracoronary thermography: excessive macrophage infiltration of thin fibrous caps are associated with increased local temperature. J Am Coll Cardiol 2009, 53:2523. Toutouzas K, Riga M, Synetos A, et al.: Optical coherence tomography analysis of culprit lesions of patients with acute myocardial infarction in combination with intracoronary thermography: excessive macrophage infiltration of thin fibrous caps are associated with increased local temperature. J Am Coll Cardiol 2009, 53:2523.
42.
go back to reference Riga M, Toutouzas K, Tsiamis E, et al.: Increased local inflammatory activation is associated with thin fibrous caps in culprit lesions of patients with acute myocardial infarction. New insights by optical coherence tomography. Eur Heart J 2008, 29:P4825. Riga M, Toutouzas K, Tsiamis E, et al.: Increased local inflammatory activation is associated with thin fibrous caps in culprit lesions of patients with acute myocardial infarction. New insights by optical coherence tomography. Eur Heart J 2008, 29:P4825.
43.
go back to reference Stefanadis C, Diamantopoulos L, Dernellis J, et al.: Heat production of atherosclerotic plaques and inflammation assessed by the acute phase proteins in acute coronary syndromes. J Mol Cell Cardiol 2000, 32:43–52.CrossRefPubMed Stefanadis C, Diamantopoulos L, Dernellis J, et al.: Heat production of atherosclerotic plaques and inflammation assessed by the acute phase proteins in acute coronary syndromes. J Mol Cell Cardiol 2000, 32:43–52.CrossRefPubMed
44.
go back to reference Verheye S, De Meyer GR, Krams R, et al.: Intravascular thermography: Immediate functional and morphological vascular findings. Eur Heart J 2004, 25:158–165.CrossRefPubMed Verheye S, De Meyer GR, Krams R, et al.: Intravascular thermography: Immediate functional and morphological vascular findings. Eur Heart J 2004, 25:158–165.CrossRefPubMed
45.
go back to reference Stefanadis C, Toutouzas K, Tsiamis E, et al.: Thermal heterogeneity in stable human coronary atherosclerotic plaques is underestimated in vivo: the “cooling effect” of blood flow. J Am Coll Cardiol 2003, 41:403–408.CrossRefPubMed Stefanadis C, Toutouzas K, Tsiamis E, et al.: Thermal heterogeneity in stable human coronary atherosclerotic plaques is underestimated in vivo: the “cooling effect” of blood flow. J Am Coll Cardiol 2003, 41:403–408.CrossRefPubMed
46.
go back to reference Courtney BK, Nakamura M, Tsugita R, et al.: Validation of a thermographic guidewire for endoluminal mapping of atherosclerotic disease: an in vitro study. Catheter Cardiovasc Interv 2004, 62:221–229.CrossRefPubMed Courtney BK, Nakamura M, Tsugita R, et al.: Validation of a thermographic guidewire for endoluminal mapping of atherosclerotic disease: an in vitro study. Catheter Cardiovasc Interv 2004, 62:221–229.CrossRefPubMed
47.
go back to reference ten Have AG, Draaijers EB, Gijsen FJ, et al.: Influence of catheter design on lumen wall temperature distribution in intracoronary thermography. J Biomech 2007, 40:281–288.CrossRefPubMed ten Have AG, Draaijers EB, Gijsen FJ, et al.: Influence of catheter design on lumen wall temperature distribution in intracoronary thermography. J Biomech 2007, 40:281–288.CrossRefPubMed
48.
go back to reference Stefanadis C, Toutouzas K, Vavuranakis M, et al.: New balloon-thermography catheter for in vivo temperature measurements in human coronary atherosclerotic plaques: a novel approach for thermography? Catheter Cardiovasc Interv 2003, 58:344–350.CrossRefPubMed Stefanadis C, Toutouzas K, Vavuranakis M, et al.: New balloon-thermography catheter for in vivo temperature measurements in human coronary atherosclerotic plaques: a novel approach for thermography? Catheter Cardiovasc Interv 2003, 58:344–350.CrossRefPubMed
49.
go back to reference Rzeszutko L, Legutko J, Kaluza GL, et al.: Assessment of culprit plaque temperature by intracoronary thermography appears inconclusive in patients with acute coronary syndromes. Arterioscler Thromb Vasc Biol 2006, 26:1889–1894.CrossRefPubMed Rzeszutko L, Legutko J, Kaluza GL, et al.: Assessment of culprit plaque temperature by intracoronary thermography appears inconclusive in patients with acute coronary syndromes. Arterioscler Thromb Vasc Biol 2006, 26:1889–1894.CrossRefPubMed
50.
go back to reference Belardi JA, Albertal M, Cura FA, et al.: Intravascular thermographic assessment in human coronary atherosclerotic plaques by a novel flow-occluding sensing catheter: a safety and feasibility study. J Invasive Cardiol 2005, 17:663–666.PubMed Belardi JA, Albertal M, Cura FA, et al.: Intravascular thermographic assessment in human coronary atherosclerotic plaques by a novel flow-occluding sensing catheter: a safety and feasibility study. J Invasive Cardiol 2005, 17:663–666.PubMed
51.
go back to reference Stefanadis C, Toutouzas K, Tsiamis E, et al.: Increased local temperature in human coronary atherosclerotic plaques: an independent predictor of clinical outcome in patients undergoing a percutaneous coronary intervention. J Am Coll Cardiol 2001, 37:1277–1283.CrossRefPubMed Stefanadis C, Toutouzas K, Tsiamis E, et al.: Increased local temperature in human coronary atherosclerotic plaques: an independent predictor of clinical outcome in patients undergoing a percutaneous coronary intervention. J Am Coll Cardiol 2001, 37:1277–1283.CrossRefPubMed
Metadata
Title
Intravascular Thermography for Assessing Vulnerable Plaques
Authors
Konstantinos Toutouzas
Maria Drakopoulou
Andreas Synetos
Christodoulos Stefanadis
Publication date
01-08-2010
Publisher
Current Science Inc.
Published in
Current Cardiovascular Imaging Reports / Issue 4/2010
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-010-9032-x

Other articles of this Issue 4/2010

Current Cardiovascular Imaging Reports 4/2010 Go to the issue