Circulating Levels of High-sensitivity C-reactive protein are Associated with Intra-plaque Neovascularization and Intra-plaque Hemorrhage as Evaluated by Contrast-enhanced Ultrasonography and Magnetic Resonance Imaging

抄録

Background: Intra-plaque hemorrhage in carotid atheromatous plaque is a recognized high-risk state for ischemic events. Intra-plaque neovascularization can now be visualized by contrast-enhanced carotid ultrasonography (CEUS). These neovessels appear prone to rupture and may be a marker for high-risk of intra-plaque hemorrhage. This study aimed to investigate relationships among circulating biomarkers associated with carotid plaque instability and the presence of intra-plaque hemorrhage on magnetic resonance imaging (MRI) and intra-plaque neovascularization on CEUS in patients with advanced atherosclerotic plaques.
Methods: Fifty-one patients with mild to severe carotid stenosis were prospectively enrolled, and carotid ultrasonography, CEUS, and MRI were performed. Circulating levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), pentraxin 3 (PTX3), myeloperoxidase (MPO), matrix metalloproteinase (MMP)-9, and high-sensitivity- C-reactive protein (hs-CRP) were also measured.
Results: Carotid plaques were categorized into 3 groups based on MRI findings: fibrous tissue, n=13; lipid/necrotic core, n=30; and intra-plaque hemorrhage, n=8. Regarding plaque echogenicity, 24 plaques were hypoechoic, and 27 were non-hypoechoic. Intra-plaque neovascularization on CEUS was observed in 14 plaques. Multivariate logistic regression analysis identified hypoechoic plaque (odds ratio, 63.126; 95% confidence interval, 1.102–3616.91) and serum hs-CRP (1.064; 1.002–1.130) as factors significantly associated with intra-plaque hemorrhage. Hypoechoic plaque (30.362; 2.462–374.37), and serum hs-CRP (1.066; 1.003–1.132) were revealed as factors significantly associated with intra-plaque neovascularization.
Conclusions: Hypoechoic plaque and hs-CRP levels were identified as common predictors of intra-plaque hemorrhage and intra-plaque neovascularization. Longitudinal studies are warranted to clarify the roles of intra-plaque neovascularization on CEUS and hs-CRP levels in intra-plaque hemorrhage and ischemic stroke.