Wen Liu1,2, Sijing Wu3, Zhenjia Wang1, Yanni Du1, Zhaoyang Fan4, Li Dong1, Yonghe Guo3, Yi Liu1, Xiaoming Bi5, Jing An6, Yujie Zhou3, Wei Liu7, Debiao Li8, Wei Yu9, Yibin Xie8. 1. Department of Radiology, Anzhen Hospital, Affiliated to Capital Medical University, 2 Anzhen Road, ChaoYang District, Beijing, 100029, China. 2. Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Hai Dian District, Beijing, 100142, China. 3. Department of Cardiology, Beijing AnZhen Hospital, Affiliated to Capital Medical University, Anzhen Road, ChaoYang District, Beijing, 100029, China. 4. Department of Biomedical Sciences, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA. 5. MR R&D, Siemens Healthineers, Los Angeles, CA, USA. 6. MR Collaborations NE Asia, Siemens Healthineers, Beijing, China. 7. Department of Cardiology, Beijing AnZhen Hospital, Affiliated to Capital Medical University, Anzhen Road, ChaoYang District, Beijing, 100029, China. liuwei525@hotmail.com. 8. Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA. 9. Department of Radiology, Anzhen Hospital, Affiliated to Capital Medical University, 2 Anzhen Road, ChaoYang District, Beijing, 100029, China. yuweimd@163.com.
Abstract
BACKGROUND: Coronary hyper-intense plaque (CHIP) detected on T1-weighted cardiovascular magnetic resonance (CMR) has been shown to associate with vulnerable plaque features and worse outcomes in low- and intermediate-risk populations. However, the prevalence of CHIP and its clinical significance in the higher-risk acute coronary syndrome (ACS) population have not been systematically studied. This study aims to assess the relationship between CHIP and ACS clinical severity using intracoronary optical coherence tomography (OCT) as the reference. METHODS: A total of 62 patients with known or suspected coronary artery disease were prospectively enrolled including a clinically diagnosed ACS group (n = 50) and a control group with stable angina pectoris (n = 12). The ACS group consisted of consecutive patients including unstable angina pectoris (n = 27), non-ST-segment-elevation myocardial infarction (non-STEMI) (n = 8), and ST-segment-elevation myocardial infarction (STEMI) (n = 15), respectively. All patients underwent non-contrast coronary CMR to determine the plaque-to-myocardium signal intensity ratio (PMR). RESULTS: Among the four groups of patients, a progressive increase in the prevalence of CHIPs (stable angina, 8%; unstable angina, 26%; non-STEMI, 38%; STEMI, 67%; p = 0.009), and PMR values (stable angina, 1.1; unstable angina, 1.2; non-STEMI, 1.3; STEMI, 1.6; median values, P = 0.004) were observed. Thrombus (7/8, 88% vs. 4/22, 18%, p = 0.001) and plaque rupture (5/8, 63% vs. 2/22, 9%, p = 0.007) were significantly more prevalent in CHIPs than in plaques without hyper-intensity. Elevated PMR was associated with high-risk plaque features including plaque rupture, thrombus, and intimal vasculature. A positive correlation was observed between PMR and the number of high-risk plaque features identified by OCT (r = 0.44, p = 0.015). CONCLUSIONS: The prevalence of CHIPs and PMR are positively associated with the disease severity and high-risk plaque morphology in ACS.
BACKGROUND: Coronary hyper-intense plaque (CHIP) detected on T1-weighted cardiovascular magnetic resonance (CMR) has been shown to associate with vulnerable plaque features and worse outcomes in low- and intermediate-risk populations. However, the prevalence of CHIP and its clinical significance in the higher-risk acute coronary syndrome (ACS) population have not been systematically studied. This study aims to assess the relationship between CHIP and ACS clinical severity using intracoronary optical coherence tomography (OCT) as the reference. METHODS: A total of 62 patients with known or suspected coronary artery disease were prospectively enrolled including a clinically diagnosed ACS group (n = 50) and a control group with stable angina pectoris (n = 12). The ACS group consisted of consecutive patients including unstable angina pectoris (n = 27), non-ST-segment-elevation myocardial infarction (non-STEMI) (n = 8), and ST-segment-elevation myocardial infarction (STEMI) (n = 15), respectively. All patients underwent non-contrast coronary CMR to determine the plaque-to-myocardium signal intensity ratio (PMR). RESULTS: Among the four groups of patients, a progressive increase in the prevalence of CHIPs (stable angina, 8%; unstable angina, 26%; non-STEMI, 38%; STEMI, 67%; p = 0.009), and PMR values (stable angina, 1.1; unstable angina, 1.2; non-STEMI, 1.3; STEMI, 1.6; median values, P = 0.004) were observed. Thrombus (7/8, 88% vs. 4/22, 18%, p = 0.001) and plaque rupture (5/8, 63% vs. 2/22, 9%, p = 0.007) were significantly more prevalent in CHIPs than in plaques without hyper-intensity. Elevated PMR was associated with high-risk plaque features including plaque rupture, thrombus, and intimal vasculature. A positive correlation was observed between PMR and the number of high-risk plaque features identified by OCT (r = 0.44, p = 0.015). CONCLUSIONS: The prevalence of CHIPs and PMR are positively associated with the disease severity and high-risk plaque morphology in ACS.
Authors: M V McConnell; V C Khasgiwala; B J Savord; M H Chen; M L Chuang; R R Edelman; W J Manning Journal: AJR Am J Roentgenol Date: 1997-05 Impact factor: 3.959
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