Relationship between coronary hyper-intensive plaques identified by cardiovascular magnetic resonance and clinical severity of acute coronary syndrome - PubMed (original) (raw)

Comparative Study

doi: 10.1186/s12968-021-00706-7.

Sijing Wu 3, Zhenjia Wang 1, Yanni Du 1, Zhaoyang Fan 4, Li Dong 1, Yonghe Guo 3, Yi Liu 1, Xiaoming Bi 5, Jing An 6, Yujie Zhou 3, Wei Liu 7, Debiao Li 8, Wei Yu 9, Yibin Xie 8

Affiliations

Comparative Study

Relationship between coronary hyper-intensive plaques identified by cardiovascular magnetic resonance and clinical severity of acute coronary syndrome

Wen Liu et al. J Cardiovasc Magn Reson. 2021.

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.

Keywords: Acute coronary syndrome; Cardiovascular magnetic resonance; Coronary hyper-intense plaque (CHIP); Optical coherence tomography; Thrombus.

PubMed Disclaimer

Conflict of interest statement

I confirm that I have read BioMed Central's guidance on competing interests and have included a statement indicating that none of the authors have any competing interests in the manuscript.

Figures

Fig. 1

Fig. 1

Flowchart of the study design for patient recruitment and inclusion. a A total of 67 patients with coronary artery disease (CAD) in the Department of Cardiology were prospectively enrolled. Overall, 50 patients with acute coronary syndrome (ACS) and 12 patients with stable angina were included in the final analysis. Proven ACS was classified into 3 subgroups, including unstable angina (n = 27), non-ST elevation myocardial infarction (NSTEMI) (n = 8), and ST elevation myocardial infarction (STEMI) (n = 15). CHIPs were observed in 1 (8%) stable angina, 7 (26%) unstable angina, and 3 (38%) NSTEMI, and 10 (67%) STEMI patients, respectively. b Of the 50 ACS patients, 24 patients (including 30 lesions; 8 lesions with CHIPs and 22 lesions with non-CHIPs) were included in the final analysis

Fig. 2

Fig. 2

A comparison of plaque hyper-intensity (in plaque to myocardium signal intensity ratio (PMR)) between different severities of coronary artery disease. Results are expressed as a box and whisker diagram with minimum, first quartile, median, third quartile, maximum and all individual data points. A progressive increase in PMR was observed among patients with stable angina, unstable angina, non-STEMI, and STEMI (p = 0.004, ANOVA). Post hoc tests showed PMR values of STEMI group was significantly higher than stable angina group (P = 0.007) (*) and unstable angina groups (P = 0.006) (**). However, it has not reached statistic differences between other groups

Fig. 3

Fig. 3

A representative ACS case with a CHIP on CATCH compared with invasive coronary imaging. A 58-year-old male subject with unstable angina pectoris. Coronary plaque images acquired with CATCH are shown (a, bright blood image; b, dark blood image; c, fusion image). CATCH dark blood image (b) and fusion image (c) showed high signal intensity in the proximal left anterior descending coronary artery with a PMR of 1.5 (arrows). Invasive coronary angiography (d) showed high-grade stenosis in the segment corresponding to the hyper-intensive plaque on the CATCH images (circle). OCT examination (e and f) showed intraluminal thrombus (red star) and microvessel in the corresponding lesion (circle)

Fig. 4

Fig. 4

Relationship between high-risk plaque features and plaque to myocardium ratio (PMR) in ACS. High-risk plaque features such as plaque rupture (P = 0.003), thrombus (P = 0.037) and intimal vasculature (P = 0.031) were associated with significantly higher PMR; no significant differences were found in other plaque features including the presence of TCFA (P = 0.625), lipid-rich plaques (P = 0.771), absence of calcification (P = 0.706) and macrophage infiltration (P = 0.498)

References

    1. Go AS, Mozaffarian D, Roger VL, American Heart Association Statistics Committee and Stroke Statistics Subcommittee et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292. -PMC -PubMed
    1. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992;326(4):242–250. doi: 10.1056/NEJM199201233260406. -DOI -PubMed
    1. Matsumoto K, Ehara S, Hasegawa T, et al. Localization of coronary high-intensity signals on T1-weighted MR imaging: relation to plaque morphology and clinical severity of angina pectoris. JACC Cardiovasc Imaging. 2015;8(10):1143–1152. doi: 10.1016/j.jcmg.2015.06.013. -DOI -PubMed
    1. Jansen CH, Perera D, Makowski MR, et al. Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 2011;124(4):416–424. doi: 10.1161/CIRCULATIONAHA.110.965442. -DOI -PubMed
    1. Xie Y, Kim Y-J, Pang J, et al. Coronary atherosclerosis T1-weighed characterization with integrated anatomical reference (CATCH) JACC Cardiovasc Imaging. 2017;10(6):637–648. doi: 10.1016/j.jcmg.2016.06.014. -DOI -PMC -PubMed

Publication types

MeSH terms

LinkOut - more resources