Ryo Nakazato1, Hiromasa Otake2, Akihide Konishi3, Masamichi Iwasaki3, Bon-Kwon Koo4, Hiroyuki Fukuya5, Toshiro Shinke3, Ken-Ichi Hirata3, Jonathon Leipsic6, Daniel S Berman7, James K Min8. 1. Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan. 2. Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan hotake@med.kobe-u.ac.jp hiro_yuki15@yahoo.co.jp. 3. Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. 4. Department of Medicine, Seoul National University Hospital, Seoul, Korea. 5. Department of Cardiology, Kobe Circulation Clinic, Kobe, Japan. 6. Departments of Medicine and Radiology, St. Paul's Hospital, Vancouver, BC, Canada. 7. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 8. Departments of Medicine and Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, Dalio Institute of Cardiovascular Imaging, New York, NY, USA.
Abstract
AIMS: Adverse plaque characteristics (APCs) by coronary computed tomography (CT) angiography (CTA) are associated with myocardial ischaemia and future acute coronary syndromes. The overall objective was to determine whether APCs on non-invasive CTA are associated with vulnerable plaque features by invasive optical coherence tomography (OCT). METHODS AND RESULTS: Sixty-eight coronary plaques in 45 patients were evaluated by CTA and OCT. APCs by CTA were: positive remodelling (PR), remodelling index ≥1.10; low attenuation plaque (LAP), any intraplaque voxel <30 Hounsfield units; spotty calcification (SC), intraplaque calcification ≤3 mm; and 'napkin-ring' sign, low intraplaque attenuation surrounded by a higher attenuation rim. OCT evaluated plaques for thin-cap fibroatheroma (TCFA, ≤65 µm, lipid arch >90°) and macrophage infiltration. Increasing plaque vulnerability was graded by OCT as having no TCFA, TCFA without macrophage infiltration, and TCFA with macrophage infiltration. OCT lesions included those with no TCFA (n = 44), TCFA without macrophage infiltration (n = 7), and TCFA with macrophage infiltration (n = 17). Increasing plaque vulnerability grade by OCT was associated with higher diameter stenosis (43.6 vs. 40.7 vs. 57.3%, P = 0.01), and greater prevalence of PR (11 vs. 43 vs. 71%, P < 0.001), LAP (11 vs. 29 vs. 59%, P = 0.001), and SC (2 vs. 29 vs. 18%, P = 0.02), but not for napkin-ring sign (P = 0.18). In multivariable analysis, PR [odds ratio (OR) 16.9, 95% confidence interval (CI) 3.9-73.3, P < 0.001] and LAP (OR 11.2, 95% CI 2.8-44.3, P = 0.001) predicted TCFA with macrophage infiltration, whereas SC and napkin-ring sign did not. CONCLUSION: Plaques demonstrating PR and LAP by CTA are associated with TCFA with macrophage infiltration by OCT. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Adverse plaque characteristics (APCs) by coronary computed tomography (CT) angiography (CTA) are associated with myocardial ischaemia and future acute coronary syndromes. The overall objective was to determine whether APCs on non-invasive CTA are associated with vulnerable plaque features by invasive optical coherence tomography (OCT). METHODS AND RESULTS: Sixty-eight coronary plaques in 45 patients were evaluated by CTA and OCT. APCs by CTA were: positive remodelling (PR), remodelling index ≥1.10; low attenuation plaque (LAP), any intraplaque voxel <30 Hounsfield units; spottycalcification (SC), intraplaque calcification ≤3 mm; and 'napkin-ring' sign, low intraplaque attenuation surrounded by a higher attenuation rim. OCT evaluated plaques for thin-cap fibroatheroma (TCFA, ≤65 µm, lipid arch >90°) and macrophage infiltration. Increasing plaque vulnerability was graded by OCT as having no TCFA, TCFA without macrophage infiltration, and TCFA with macrophage infiltration. OCT lesions included those with no TCFA (n = 44), TCFA without macrophage infiltration (n = 7), and TCFA with macrophage infiltration (n = 17). Increasing plaque vulnerability grade by OCT was associated with higher diameter stenosis (43.6 vs. 40.7 vs. 57.3%, P = 0.01), and greater prevalence of PR (11 vs. 43 vs. 71%, P < 0.001), LAP (11 vs. 29 vs. 59%, P = 0.001), and SC (2 vs. 29 vs. 18%, P = 0.02), but not for napkin-ring sign (P = 0.18). In multivariable analysis, PR [odds ratio (OR) 16.9, 95% confidence interval (CI) 3.9-73.3, P < 0.001] and LAP (OR 11.2, 95% CI 2.8-44.3, P = 0.001) predicted TCFA with macrophage infiltration, whereas SC and napkin-ring sign did not. CONCLUSION: Plaques demonstrating PR and LAP by CTA are associated with TCFA with macrophage infiltration by OCT. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Hyuk-Jae Chang; Fay Y Lin; Sang-Eun Lee; Daniele Andreini; Jeroen Bax; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J W Chow; Edoardo Conte; Ricardo C Cury; Gudrun Feuchtner; Martin Hadamitzky; Yong-Jin Kim; Jonathon Leipsic; Erica Maffei; Hugo Marques; Fabian Plank; Gianluca Pontone; Gilbert L Raff; Alexander R van Rosendael; Todd C Villines; Harald G Weirich; Subhi J Al'Aref; Lohendran Baskaran; Iksung Cho; Ibrahim Danad; Donghee Han; Ran Heo; Ji Hyun Lee; Asim Rivzi; Wijnand J Stuijfzand; Heidi Gransar; Yao Lu; Ji Min Sung; Hyung-Bok Park; Daniel S Berman; Matthew J Budoff; Habib Samady; Leslee J Shaw; Peter H Stone; Renu Virmani; Jagat Narula; James K Min Journal: J Am Coll Cardiol Date: 2018-06-05 Impact factor: 24.094
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