Gender differences in coronary plaques characteristics

• Applicant: Dr. Lena Seegers
• Subject Area: Cardiology, Angiology
• Term: from 2020 to 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 449989494

Acute myocardial infarction is the leading cause of death in the world. Coronary arteries are the blood vessels which supply oxygen to the heart muscle. The blockage of a coronary artery leads to shortage of oxygen causing damage to the heart muscle, which can be associated with chest pain and life-threatening arrhythmias. This occlusion is mainly caused by rupture of atherosclerotic plaques, accumulations of lipids and calcium in the inner layer of the coronary artery. Atherosclerotic plaque which is susceptible to rupture with formation of a blood clot inside the vessel is called vulnerable plaque. Coronary angiography is widely used for coronary diagnosis but is limited to evaluate culprit lesions and identify thrombus in acute myocardial infarction. Intravascular ultrasound (IVUS) is commonly used and offers high depth of tissue penetration but it is not able to measure fibrous cap thickness of plaques, which is needed for accuracy vulnerable plaque identification. Optical coherence tomography (OCT) is an optical analogue of IVUS with extremely high resolution. Using near infrared light, OCT can visualize morphology and microstructures of coronary plaques as intimal thickening, fibrocalcification, inflammation and neovascularization. For this, it is the principal imaging to detect vulnerable plaques. Germany has one of the highest rates of percutaneous coronary intervention (PCI). Currently there is no evidence of lower cardiac event rates in patients treated with PCI and is still challenging to identify vulnerable plaques prior to onset of major cardiovascular complications. Several studies have shown that gender has an important role in myocardial infarction. Sex difference exists in clinical presentation and influences the impact of cardiovascular risk factors. In this project, the variety of phenotypes in atherosclerotic plaques and vessel alterations will be compared for men and woman by OCT analysis. The project will be conducted at the Cardiac Research OCT laboratory at Massachusetts General Hospital in Boston (MA, USA). The Cardiac Research OCT laboratory is leading the largest optical coherence tomography (OCT) registry of the world, which contains an international database of several thousand patients who have received OCT. Gender influence on vulnerable plaque characteristics will be analyzed in patients with acute coronary sindrome compared to patients with stable angina. Furthermore plaque characteristics will be analyzed in patients with cardiovascular risks as diabetes, hyperlipidemia, hypertension, family history, obesity and smoking. The main goal is to provide knowledge to prevent acute myocardial infarction and sudden cardiac death. The identification of different gender plaque phenotypes could allow more understanding about the underlying mechanism of vulnerable plaques characteristics and might be a new approach for specific pharmacological and interventional treatment of coronary artery diseases.

• DFG Programme: WBP Fellowship
• International Connection: USA
• Host: Ik-Kyung Jang, Ph.D.