Abstract 12856: High Prevalence of Healed Ruptured Plaques Detected by Optical Coherence Tomography in Coronary High-Intensity Plaques on Non-Contrast T1-Weighted Magnetic Resonance Imaging
Tomoaki KanayaTeruo NoguchiHideyasu AsaumiReiko FujiwaraMasashi FujinoTakafumi YamaneToshiyuki NagaiShouji KawakamiSatoshi HondaMasaharu IshiharaYouichi GotohHisao OgawaSatoshi Yasuda
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Background: We have shown that coronary high-intensity plaques (HIPs) on non-contrast T1-weighted imaging (T1WI) represent plaque vulnerability. However, it remains unclear whether HIPs are associated with vulnerable plaque features detected by optical coherence tomography (OCT) such as thin-cap fibroatheroma (TCFA), plaque rupture, or intra-coronary thrombus. Recently, healed ruptured plaques, comprised of a layered pattern underlying poor signaled region with diffuse border, is a novel feature for predicting plaque vulnerability. Method: Twenty-one patients with stable coronary artery disease (CAD) underwent non-contrast T1WI within 2 days prior to elective percutaneous coronary intervention (PCI) with OCT study to calculate the plaque-to-myocardium signal intensity ratio (PMR). CAD patients were categorized as HIP positive if any lesion identified plaque had a PMR>1.4. Results: Of the 22 lesions studied, 11 (50%) lesions were positive for HIP and 11 (50%) were negative for HIP (non-HIP). Figure shows a representative case having left anterior descending artery lesion (A, arrow) that was positive for HIP with 2.27 of PMR (B) and was characterized as healed ruptured plaque by OCT (C). There were no significant differences in age, male gender, and history of diabetes mellitus, hypertension, dyslipidemia, and current smoking. On OCT analysis, in the HIP group, the prevalence of healed rupture plaque was significantly higher (HIP, 82% vs. non-HIP, 27%, p=0.03) and the degree of lipid-arc was greater than non-HIP group (HIP, 201.0 ± 26.7° vs non-HIP, 171.5 ± 35.3°, p=0.034). However, no significant differences were observed in the prevalence of TCFA, lipid-rich plaque, ruptured plaque, thrombus, and calcification between the 2 groups (Table). Conclusions: The present OCT analysis showed that prevalence of healed ruptured plaque and degree of lipid-arc were high in plaques with HIPs, which are therefore associated with plaque vulnerability.Keywords:
Vulnerable plaque
Fibrous cap
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This study aimed to evaluate the correlation between coronary atherosclerosis and the phenotype of subclinical carotid artery plaque using 320-row computed tomography via an original single-injection protocol.A total of 122 patients with suspected coronary artery disease but free of transient ischemic attack and stroke underwent computed tomographic angiography of carotid and coronary artery simultaneously. The mean attenuation was measured at each artery. The plaques in either carotid or coronary were classified into noncalcified, calcified, and mixed. Coronary plaque was evaluated with plaque score. Logistic regression analysis was used to determine the predictive value of coronary plaque score to the phenotype of carotid plaque. The prevalence of each phenotype of carotid plaque in different coronary stenosis groups was also analyzed.The mean (SD) attenuation of carotid and coronary artery was 456.3 (81.7) Hounsfield units (HU), 466.0 (85.5) HU, 446.5 (84.1) HU, and 476.4 (90.0) HU, respectively. There was a significant correlation between the noncalcified coronary plaque score and noncalcified plaque in carotid artery (odds ratio [OR], 2.9; P < 0.05). The coronary calcified plaque scores were significantly correlated with carotid mixed (OR, 1.8; P < 0.05) and calcified plaque (OR, 2.0; P < 0.05). The noncalcified plaque of carotid artery was more frequent (72.5% vs 67%) in the nonsignificant coronary stenosis group.The subclinical carotid plaque phenotypes are significantly associated with coronary plaque score and defined grade of stenosis in patients with suspected coronary artery disease. Our tailored computed tomographic angiography protocol may have a positive impact on secondary prevention.
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Background: Atherosclerotic cardiovascular diseases are the leading cause of death worldwide (30% of the mortalities).Coronary atherosclerotic plaques are classified into stable and unstable.Unstable plaques increase the risk of acute coronary syndrome and early detection will help prevention.Evaluation of plaque vulnerability is done best by invasive intravascular ultrasound and so, this study aims to evaluate the possible use of non invacive CT for plaque characterization.Aim of the work: Determine the role of multidetector CT in the assessment of plaque composition and configuration.This will improve risk stratification thus, decreasing the incidence of sudden death.Patients and methods: This study included 46 patients with coronary atherosclerotic plaques.The most expansive or solitary lesion was selected for each patient.Results: Forty-six atherosclerotic plaques were evaluated by multi-slice coronary CT; 30 patients were unstable clinically and 16were stable.Dyslipidemia was found in 40 patients while diabetes was found in 22 patients.69.6% of the lesions were found in the proximal LAD.Most of unstable patients showed mixed plaques and soft plaques.In a stable group, most of the plaques were calcified.As for the attenuation pattern 18/46 of the plaque with heterogeneous attenuation were in the unstable clinical group.28/46 of the plaques with homogenous attenuation were stable.Regarding the Napkin ring sign it was positive in 18/46 of the plaques and the 18 patients on follow up were found to be unstable.All patients with spotty calcification proved to be unstable clinically.Remodeling index, low hounse field unit and plaque burden were higher in the unstable group..No association between stability and degree of stenosis. Conclusion:A strong correlation between plaque characteristics and clinical presentation: Multislice coronary CT angiography detect high-risk plaque criteria.
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Background: Carotid artery temperature heterogeneity (ΔΤ) measured by microwave radiometry (MWR) has been associated with future cardiovascular events including acute coronary syndromes. The vulnerable plaques of the coronary arterial tree, that can be ideally depicted by intracoronary imaging such as optical coherence tomography (OCT) have anatomical characteristics such as the thin fibrous cap (TCFA), that make them vulnerable to rupture. The scope of the study was to assess the implication of the carotid artery temperature heterogeneity on the culprit coronary plaque morphology in patients presenting with acute myocardial infarction. Methods: 34 patients presented with an acute myocardial infarction were enrolled in the study. All patients underwent percutaneous coronary intervention (PCI) and OCT for the evaluation of the anatomical characteristics of the culprit lesion. After the completion of the PCI all patients underwent carotid ultrasound and MWR of both carotid arteries and thermal heterogeneity of the carotid arteries was assessed. Blood samples were collected for high sensitivity C-reactive protein (CRP) analysis. Results: Thirty four patients, 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI, were included in the study. Patients with ruptured plaques had significantly increased hsCRP compared to patients that did not have a ruptured plaque (14.41±4.02 vs 9.9±2.5, P<0.005). Thermal heterogeneity, was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 vs 0.51±0.14°C, P=0.001), and in plaques with TCFA compared to those without a TCFA (0.82±0.37 vs 0.60±0.05°C, P=0.001). Diabetes mellitus, ΔΤ and hsCRP, were entered in the multivariate analysis, from which DM (OR 4.12; 95% CI 0.77-22.07; P=0.07) and ΔΤ (OR for 0.1°C increase 1.43; 95% CI 1.03-1.98; P=0.03) remained in the final analysis, and only ΔΤ was independently associated with the presence of the TCFA. Regarding plaque rupture, STEMI, hsCRP, and ΔT were entered in the multivariate analysis from which hsCRP (OR 1.51; 95% CI 0.99-2.28; P=0.051) and ΔΤ (OR for 0.1°C increase 3.40; 95% CI 1.29-8.96; P=0.013) remained in the final analysis with the ΔT being the only variable.
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The purposes of this study were to compare the presence, extent and composition of coronary plaques in asymptomatic patients with newly diagnosed type 2 diabetes to age- and sex-matched controls.Patients with newly diagnosed (<1 year) type 2 diabetes ( n = 44) and controls ( n = 44) underwent contrast-enhanced coronary computed tomography angiography. Advanced plaque analysis including total plaque volume and volumes of plaque components (calcified plaque and non-calcified plaque, including low-attenuation [low-density non-calcified plaque]) was performed using validated semi-automated software.Coronary artery calcification was more often seen in patients with type 2 diabetes (66%) versus controls (48%), p < 0.05. Both the absolute volume (median; interquartile range) of low-density non-calcified plaque (7.9 mm3; 0-50.5 mm3 vs 0; 0-34.3 mm3, p < 0.05) and the increase in low-density non-calcified plaque ratio in relation to total plaque volume ( τ = 0.5, p < 0.001) were significantly higher in patients with type 2 diabetes. More patients with type 2 diabetes had spotty calcification (31% vs 0%, p < 0.05). By multivariate analysis, the presence of any low-density non-calcified plaque was higher in males (odds ratio: 4.06, p < 0.05), who also demonstrated a larger low-density non-calcified plaque volume ( p < 0.001). The presence and extent of low-density non-calcified plaque increased with age, smoking, hypertension and hyperglycaemia, all p < 0.05.Asymptomatic patients with newly diagnosed type 2 diabetes had plaque features associated with increased vulnerability as compared with age- and sex-matched controls.
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Background
Accelerated atherosclerosis leading to premature coronary artery disease remains the major cause of late death in SLE. Coronary plaques with a large necrotic/lipid core and/or a thin fibrous cap are prone to rupture, leading to acute coronary events. In coronary CT angiography, plaque lipid content correlates with lower CT attenuation values when compared with fibrotic tissue. Positive (or outward) vessel remodelling has been postulated to explain the finding of atherosclerosis that does not encroach on the arterial lumen. Positive remodelling index and presence of low attenuation noncalcified plaque (<30 Haunsfield units) are characteristic vessel changes in unstable coronary plaques.Objectives
We sought to characterise noncalcified plaque lesions in patients with systemic lupus erythematosus and to identify high risk lesions.Methods
A total of 66 patients who meet the American College of Rheumatology classification criteria for SLE were included in the study. Of these, 30 patients had two studies. All patients underwent coronary CT angiography. Coronary plaque area was measured by manual tracing for the difference between the area within the external elastic membrane and the area of the vessel lumen at the site of maximal luminal narrowing as observed on a cross-sectional coronary CT angiography image. Each noncalcified plaque detected within the vessel wall was evaluated with the minimum CT density and vascular remodelling index (RI). Total low density plaque volume per patient and low density/high density noncalcified plaque ratio were then compared by patient characteristics which included age, sex, ethnicity, BMI, smoking, SLEDAI, PGA, anti-dsDNA, low complement, current prednisone, current hydroxychloroquine, current NSAID use, history of cardiovascular event, hypertension, lupus anticoagulant, anticardiolipin, hypercholesterolemia, and methotrexate use.Results
All patients had at least one plaque with a positive remodelling index (>10%), and 83.1%(n=271) of total identified plaques had a positive remodelling index. Low density noncalcified plaque volume was associated with age (p<0.01) and body mass index (p<0.01). African Americans had significantly more (p<0.05) low density noncalcified plaque compared to patients of other ethnicities. The low density/high density noncalcified plaque ratio did not correlate with any patient characteristics and was on average 46% (SD=10). There were only cardiovascular events in the studied group and there were no differences in remodelling index or low density noncalcified plaque observed in this group, but the number of events was small.Conclusions
Positive remodelling index and low attenuation noncalcified plaques are characteristic vessel changes seen in unstable coronary plaques. They are common in patients with lupus and are significantly more likely to be seen among African American patients, patients with a BMI>30, and the elderly (age over 60).Disclosure of Interest
None declaredCoronary atherosclerosis
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Objective
To explore the characteristics of attenuated plaque (AP) in culprit lesions for acute coronary syndrome (ACS) in elderly patients.
Methods
This study included 166 ACS patients meeting the conditions from Jan. 1, 2013 to Sep. 31, 2014. Clinical data, vascular lesions determined by coronary angiography and intravenous ultrasound (IVUS)-demonstrated characteristics of culprit plaque, which included presence of AP, maximum attenuation arc, extravascular elastic membrane area, lumen area, plaque area, plaque burden and remodeling index, were recorded.
Results
Compared with non-elderly group, elderly group had a higher proportion of multiple coronary-artery lesions (50.0% vs. 35.1%, χ2=6.525, P=0.038), more attenuation plaques (62.0% vs. 45.9%, χ2=4.245, P=0.039), a larger maximum attenuation arc〔(142±80)° vs. (115±54)°, t=5.254, P=0.000〕, larger plaque area〔(14.2±3.9)mm2vs. (12.3±4.1)mm2,t=2.325, P=0.022〕, more plaque burden 〔(81.1±14.2)% vs. (76.4±13.5)%, t=2.025, P=0.042〕 and higher remodeling index 〔(1.19±0.17) vs. (1.09±0.13), t=4.245, P=0.031〕.
Conclusions
The onset of ACS is more closely related with the unstable plaque in elderly patients, and strengthening the measures for plaque stabilization will be helpful in the prevention and treatment of ACS in the elderly.
Key words:
Acute coronary syndrome; Coronary angiography; Ultrasonography; Attenuated plaque
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Recent studies suggested plaque erosion with noncritical stenosis could be treated distinctly from that with critical stenosis, but their morphological features remained largely unknown. The present study aimed to investigate morphological features of eroded plaques with different lumen stenosis using optical coherence tomography (OCT).
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<b><i>Objective:</i></b> This study aimed to evaluate the relationship between plaque morphology and the plaque progression (PP) that occurs despite routine medical therapy and better risk-factor control. <b><i>Methods:</i></b> A total of 183 patients who received baseline and follow-up coronary angiography were divided into 2 groups, the PP group (n = 78) and the non-PP group (n = 105). Optical coherence tomography (OCT) was performed after baseline coronary angiography. The plaque characteristics were noted and the fibrous cap thickness was measured at the thinnest point of each plaque. Macrophages in the fibrous cap were detected, and the macrophage content was measured based on the signal attenuation. <b><i>Results:</i></b> The level of high-sensitivity C-reactive protein was higher in the PP group (p = 0.001). The OCT examination showed that the proportion of lipid-rich plaques in the PP group was higher than that in the non-PP group (p < 0.001). Calcified plaques were detected frequently in the non-PP group (p < 0.001). Macrophages in the fibrous cap were detected frequently in the PP group (p < 0.001), and the macrophage content was significantly greater than that in the non-PP group (p < 0.001). <b><i>Conclusion:</i></b> Lipid-rich plaques with large numbers of macrophages were prone to PP, whereas the progression of calcified plaques was rare.
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To compare optical coherence tomography (OCT)-derived plaque characteristics of coronary target lesions between diabetic patients with acute coronary syndrome (ACS) versus stable angina pectoris (SAP).In vivo assessment of plaque composition of coronary culprit lesions in a cardiovascular high-risk population with diabetes mellitus is incompletely elucidated.102 diabetic patients with coronary de novo lesions were enrolled and categorized into an ACS-group (40 patients) and a SAP-group (62 patients) according to their clinical presentation. Assessment of clinical data, angiographic, and OCT imaging including the analysis of plaque composition and lipid content of the target lesions were performed prior to percutaneous coronary intervention and compared between the two groups.Plaque characteristics of patients in the ACS-group compared with the SAP-group showed a higher incidence of lipid-rich plaque [33 (82.5%) vs. 25 (40.3%)], thin-capped fibroatheroma [29 (72.5%) vs. 10 (16.1%)], macrophage infiltration [32 (80.0%) vs. 21 (33.9%)], thrombus [23 (57.5%) vs. 2 (3.2%)], and plaque rupture [27 (67.5%) vs. 2 (3.2%)] (all P < 0.001). Moreover, there was a wider lipid arc (174.5 ± 33.8° vs. 122.9 ± 43.9°), a longer lipid plaque length (6.52 ± 2.04 mm vs. 3.73 ± 2.16 mm), a greater lipid volume index (1117.2 ± 349.9 vs. 504.8 ± 379.3), and a smaller minimal fibrous cap thickness (51.52 ± 9.14 µm vs. 80.33 ± 26.71 µm) within lipid-rich lesions of ACS patients (all P < 0.001).Diabetic patients with ACS exhibit more vulnerable plaque features in coronary culprit lesions compared with diabetic patients with SAP. This may provide rationale for a specific therapeutic strategy either by pharmacological plaque stabilization or coronary intervention in any lesion with vulnerable plaque morphology in patients with diabetes.
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The purpose of this study was to assess the prevalence and to quantify the thin-cap fibroatheroma (TCFA) and ruptured plaques in patients with coronary artery disease using optical coherence tomography (OCT).TCFA lesions are the most prevalent precursors of plaque rupture, and are responsible for acute coronary syndromes (ACS). There are limited data regarding the frequency and distribution of TCFA in diseased coronary arteries.Coronary artery OCT was performed in 78 vessels in 47 patients, with stable angina (SA) or ACS. OCT plaque characteristics were derived using criteria that had been validated earlier. TCFA was defined as rich in lipid (two or more quadrants) with thin fibrous cap (<65 μm). Comparison was made between SA and unstable angina, and culprit and nonculprit vessels.There was a higher incidence of TCFA and plaque rupture (65 vs. 24%, P=0.003, and 40 vs. 15%, P=0.04) in ACS patients. This was reflected in a higher lipid pool (2.66 vs. 2.26 quadrants, P=0.04) and minimum fibrous cap thickness (52 vs. 74 μm, P=0.001) in ACS patients. The mean numbers of TCFA (2.5) were similar in patients with SA and ACS. However, the maximal length of TCFA (2.63 vs. 5.54 mm, P=0.026) and plaque rupture sites (P=0.046) were higher in ACS vessels. No relationship was found between baseline characteristics and TCFA incidence and plaque rupture. We identified ACS (P=0.002), higher mean lipid pool (P=0.002), longer TCFA length (P=0.007) and higher number of TCFA (P=0.02) as predictors of plaque rupture sites.In this in-vivo study, we identified a higher incidence of longer TCFAs and plaque rupture sites associated with ACS.
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