comprehensive assessment of interconnection between brain emotional activity and coronary plaque instability

Conditions: Atherosclerosis, Coronary; Emotional Stress; Inflammation; Hematopoiesis; Atherosclerosis Coronary Artery With Angina Pectoris; Atheroma; Heart; Atherosclerosis; Acute Coronary Syndrome

Summary: emotional stress is associated with future cardiovascular events. however, the biological interconnection between brain emotional neural activity and acute plaque instability is not fully understood. optical coherence tomography-fluorescence lifetime (oct-flim) dual modal intravascular imaging is a novel technique that enables comprehensive assessment of structural and biochemical characteristics of coronary atheroma and estimates the level of plaque instability. 18f-fluorodeoxyglucose-positron emission tomography/computed tomography (18f-fdg-pet/ct) enables simultaneous estimation of multi-system activities including emotional stress, arterial inflammation, and hematopoiesis. the present study aims to prospectively investigate mechanistic linkage between coronary plaque instability, stress-associated neurobiological activity, and macrophage hematopoiesis using oct-flim and 18f-fdg pet/ct imaging assessment.

thirty two patients with multivessel coronary artery disease (including both stable angina and acute coronary syndrome), who have at least one severe obstructive lesion (\>70% diameter stenosis) that is considered suitable for percutaneous coronary intervention (pci), will be included in the study. structural/biochemical characteristics of coronary culprit plaque (with or without mild to moderate stenotic non-culprit plaque) will be assessed comprehensively using oct-flim dual modal intravascular imaging. after coronary revascularization with pci, subjects will undergo serial 18f-fdg-pet/ct molecular imaging at baseline admission and 6-month follow-up to measure pet signal activities at target tissues including amygdala, carotid artery, aorta, bone marrow, and spleen. correlation between oct-flim parameters and baseline pet signals will be assessed to provide insight into the mechanistic linkage between multi-system metabolic activities and coronary plaque instability. serial pet/ct imaging after 6 month will enable estimation of natural course of multi-system pet signal activities according to different levels of coronary plaque instability.

Eligibility criteria:
inclusion criteria: * age: greater than 20, less than 75 * patients with severe coronary atherosclerosis (diameter stenosis \>70%) requiring coronary revascularization * reference vessel diameter: between 2.5 and 4.0 mm * obtained informed consent from voluntary participants before study enrollment exclusion criteria: * complex coronary lesion (ostial lesion, unprotected left main lesion, chronic total occlusion, grafted vessels, etc) * reference vessel diameter: less than 2.5 mm, greater than 4.0 mm * coronary lesion with heavy calcification * hemodynamic instability during coronary intervention * contraindication to antithrombotic therapy * chronic renal insufficiency (serum creatinine \>2.0mg/dl) * severe liver dysfunction (aspartate transaminase or alanine transferase \> 5 times of upper normal limit) * pregnancy or potential pregnancy * life expectancy less than 1 year * patient refused to sign the informed consent at enrollment

Keywords: pet-ct fluorescence lifetime imaging optical coherence tomography high-risk plaque amygdalar activity arterial inflammation hematopoietic activity biochemical imaging