Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury

Abela, George S.; Kalavakunta, Jagadeesh K; Janoudi, Abed; Leffler, Dale; Dhar, Gaurav; Salehi, Negar; Cohn, Joel M.; Shah, Ibrahim; Karve, Milind; Kotaru, Veera Pavan; Gupta, Vishal; David, Shukri; Narisetty, Keerthy; Rich, Michael J.; Vanderberg, Abigail; Pathak, Dorothy R.; Shamoun, Fadi

doi:10.1016/j.amjcard.2017.07.075

Cited by 56 publications

(26 citation statements)

References 28 publications

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“…We would like to think that such CCs in their report may imply classic AE, not fCCE described herein. In addition to concerns of CC emboli mentioned by those authors, the triggering of inflammation by CCs may be relevant to myocardial injury during acute myocardial infarction, and another unique finding of the study was the apparent interaction between macrophages and CCs, whereby macrophages appeared to be adherent to and eroding crystals 5. We reported no definite inflammatory cell or macrophage infiltration in the capillaries and arterioles with fCCE, but we could not verify the role of fCCE in triggering inflammation 15…”

Section: Discussionmentioning

confidence: 59%

“…According to Abela et al ,5 the release of CCs into the circulation has been known to induce end-organ injury and inflammation in several clinical syndromes, including amaurosis fugax, livedo reticularis, kidney injury during renal artery interventions and stroke. Myocardial injury could reasonably be added to this list, as coronary aspirates in the vast majority of patients presenting with acute myocardial infarction had CCs, with more than half of those having moderate-to-extensive amounts of crystals.…”

Section: Discussionmentioning

confidence: 99%

“…The number of released fCCE and their role in ACS have not been documented yet. PCI does not necessarily guarantee the recovery of postprocedure left ventricular dysfunction and relief of symptoms 5. Furthermore, fCCE manifesting in the coronary lumen following plaque rupture have been historically overlooked because the standard tissue preparation for light microscopy uses ethanol as a dehydrating agent that can dissolve fCCE, leaving behind empty tissue 5–7.…”

Section: Introductionmentioning

confidence: 99%

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Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

Yutani¹,

Nagano

Komatsu

2018

BMJ Case Reports

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The number of released free cholesterol crystal emboli (fCCE) and their role during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have not been documented yet. Furthermore, fCCE manifesting in the coronary lumen following plaque rupture has been historically overlooked owing to the standard tissue preparation for light microscopy which uses ethanol as a dehydrating agent that can dissolve fCCE, leaving behind empty tissue. In this case report, we evaluated fCCE released during PCI for ACS and their relationship with myocardial injury and coronary artery obstruction on the H&E-stained sections by using polarised light microscopy. To our knowledge, there has been no mention of the visibility of fCCE on H&E-stained frozen polarised sections before.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

Yutani¹,

Nagano

Komatsu

2018

BMJ Case Reports

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“…Altogether these observations suggest that, although trained immunity may represent a valuable way to protect the host against recurrent infections, it might contribute and even accelerate the development of atherosclerosis. Cholesterol crystals accumulation in the extracellular space may damage and activate intimal surface, thus resulting in the production of pro-inflammatory cytokines that promote the growth as well as atherosclerotic plaque destabilization [25][26][27].…”

Section: Inflammation Immune Response and Atherosclerosis: Which Rolmentioning

confidence: 99%

The Interplay of Lipids, Lipoproteins, and Immunity in Atherosclerosis

Pirillo

Bonacina

Norata

et al. 2018

Curr Atheroscler Rep

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Meta-inflammation, a condition of low-grade immune response caused by metabolic dysregulation, immunological memory of innate immune cells (referred to as "trained immunity"), cholesterol homeostasis in dendritic cells, and immunometabolism, i.e., the interplay between immunological and metabolic processes, have all emerged as new actors during atherogenesis. These observations reinforced the interest in directly targeting inflammation to reduce cardiovascular disease. The novel acquisitions in pathophysiology of atherosclerosis reinforce the tight link between lipids, inflammation, and immune response, and support the benefit of targeting LDL-C as well as inflammation to decrease the CVD burden. How this will translate into the clinic will depend on the balance between costs (monoclonal antibodies either to PCSK9 or to IL-1ß), side effects (increased incidence of death due to infections for anti-IL-1ß antibody), and the benefits for patients at high CVD risk.

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“…Cardiac ischemic disease and myocardial infarction are disabling conditions that result in the appearance of scar fibrosis and loss of myocardial contractile function. The chronic intermittent cardiac ischemia following this event is one of the main causes of death among human population (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

Dormant cardiac stem cells: A promising tool in cardiac regeneration

et al. 2020

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Stem cells represent an old niche with various new potential therapeutics. Besides drug treatment, reperfusion procedures and surgical revascularization, stem cell therapy could be a good option in ischemic cardiac diseases. A study was performed on a small group of cases who died of cardiac arrhythmia secondary to scarring myocardial infarctions. Tissue cardiac samples were taken from these cases (from the anterior and lateral wall of the left ventricle), for microscopy examination, in order to investigate the presence of cardiac stem cells (CSC). Multiple series of histological sections were also performed and examined, along with immunohistochemical analysis (IHC). The cells were identified in close contact with the residual ischemic cardiomyocytes, in the proximity of the myocardial collagenous scar, in old myocardial infarctions. They were activated by hypoxic ischemia and were influenced by the capillary microvascular density and the interstitial micro-environment conditions. In chronic intermittent ischemia they seem to turn themselves from dormant quiescent cells into activated progenitor committed cells.

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Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury

Cited by 56 publications

References 28 publications

Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

The Interplay of Lipids, Lipoproteins, and Immunity in Atherosclerosis

Dormant cardiac stem cells: A promising tool in cardiac regeneration

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