High-risk coronary plaque of sudden cardiac death victims: postmortem CT angiographic features and histopathologic findings.

Autor: Michaud K; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland. katarzyna.michaud@chuv.ch., Rotzinger DC; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Faouzi M; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland.; Center for Primary Care and Public Health, Division of Biostatistics, Lausanne, Switzerland., Grabherr S; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland., Qanadli SD; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.; Riviera-Chablais Hospital, Rennaz, 1847, Switzerland., van der Wal AC; Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.; Maastricht University Medical Center (MUMC), Maastricht, The Netherlands., Magnin V; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland.
Jazyk: angličtina
Zdroj: International journal of legal medicine [Int J Legal Med] 2024 Sep; Vol. 138 (5), pp. 1845-1856. Date of Electronic Publication: 2024 Apr 10.
DOI: 10.1007/s00414-024-03228-w
Abstrakt: High-risk coronary plaques (HRP) are characterized in clinical radiological imaging by the presence of low plaque attenuation, a napkin-ring sign (NRS), spotty calcifications (SC) and a positive remodeling index (RI). To evaluate if these signs are detectable in postmortem imaging by a multi-phase postmortem CT angiography (MPMCTA), a retrospective study of a series of autopsy well-documented coronary plaques related to sudden cardiac death (SCD) was performed. Then correlations between histological and radiological findings were described. Fourty SCD cases due to acute coronary syndrome based on clinical history and confirmed at autopsy were selected (28 men and 12 women, age 53.3 ± 10.9). The culprit lesion was mainly situated in the proximal segments of coronary arteries, in the right coronary artery in 23 cases (57.5%), the left anterior descending artery in 13 cases (32.5%), the circumflex artery in 3 cases (7.5%) and in one case in the left main stem. MPMCTA showed a positive RI (≥ 1.1) in 75% of cases with a mean RI 1.39 ± 0.71. RI values were lower in cases with fibrotic plaques. NRS was observed in 40% of cases, low attenuation plaque in 46.3%, and SC in 48.7% of cases. There were significant correlations of the radiological presence of NRS for fibrolipid composition of the plaque (p-value 0.007), severe intraplaque inflammation (p-value 0.017), severe adventitial inflammation (p-value 0.021) and an increased vasa vasorum (p-value 0.012). A significant correlation (p-value 0.002) was observed between the presence of SC at radiological examination and the presence of punctuate/fragmented calcification at histology. In addition, in 58.3% of cases, plaque enhancement was observed, which correlated with plaque inflammation and the fibrolipid composition of the plaque. The coronary artery calcium score was 314 (± 455). There was a poor agreement between stenosis of the lumen at histology versus radiology. Our study shows that the various radiological signs of HRP can be detected in all plaques by MPMCTA, but individually only to a variable extent; plaque enhancement appeared as a new sign of vulnerability. In the postmortem approach, these radiological markers of HRP, should always be applied in combination, which can be useful for developing a predictive model for diagnosing coronary SCD.
(© 2024. The Author(s).)
Databáze: MEDLINE
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