Plaque Rupture, Compared With Plaque Erosion, Is Associated With a Higher Level of Pancoronary Inflammation

Nakajima, Ayako; Sugiyama, Tomoyo; Araki, Makoto; Seegers, Lena Marie; Dey, Damini; McNulty, Iris; Lee, Hang; Yonetsu, Taishi; Yasui, Yumi; Teng, Yun; Nagamine, Tatsuhiro; Nakamura, Sunao; Achenbach, Stephan; Kakuta, Tsunekazu; Jang, Ik–Kyung

doi:10.1016/j.jcmg.2021.10.014

Cited by 40 publications

(34 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current study demonstrated that (1) male sex, NSTEMI, lower ejection fraction, and lower level of HDL were more common in patients with high PCAT attenuation; and (2) lipid-rich plaque, macrophage, microchannels, plaque rupture, and layered plaque identified by OCT were significantly more prevalent in patients with high PCAT attenuation, compared with low PCAT attenuation. Previous studies also reported that characteristics, such as male sex and NSTEMI were more common in patients with high PCAT attenuation, 12,13 and the current study showed lower ejection fraction was also more frequent in those patients. However, the difference in ejection fraction between the 2 groups is minimal, hence, not clinically meaningful.…”

Section: Discussionsupporting

confidence: 74%

Coronary Inflammation and Plaque Vulnerability: A Coronary Computed Tomography and Optical Coherence Tomography Study

Jang

Sugiyama

Suzuki

et al. 2023

Circ: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Vascular inflammation plays a key role in atherogenesis and in the development of acute coronary syndromes. Coronary inflammation can be measured by peri-coronary adipose tissue (PCAT) attenuation on computed tomography angiography. We examined the relationships between the level of coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics by optical coherence tomography. METHODS: A total of 474 patients (198 acute coronary syndromes and 276 stable angina pectoris) who underwent preintervention coronary computed tomography angiography and optical coherence tomography were included. To compare the relationships between the level of coronary artery inflammation and detailed plaque characteristics, we divided the subjects into high (n=244) and low (n=230) PCAT attenuation groups using a threshold value of −70.1 Hounsfield units. RESULTS: The high PCAT attenuation group, compared with the low PCAT attenuation group, had more males (90.6% versus 69.6%; P <0.001), more non-ST-segment elevation myocardial infarction (38.5% versus 25.7%; P =0.003), and less stable angina pectoris (51.6% versus 65.2%; P =0.003). Aspirin, dual antiplatelet, and statins were less frequently used in the high PCAT attenuation group compared to the low PCAT attenuation group. Patients with high PCAT attenuation, compared with those with low PCAT attenuation, had lower ejection fraction (median 64% versus 65%; P =0.014) and lower levels of high-density lipoprotein cholesterol (median 45 versus 48 mg/dL; P =0.027). Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared to those with low PCAT attenuation, including lipid-rich plaque (87.3% versus 77.8%; P =0.006), macrophage (76.2% versus 67.8%; P =0.041), microchannels (61.9% versus 48.3%; P =0.003), plaque rupture (38.1% versus 23.9%; P <0.001), and layered plaque (60.2% versus 50.0%; P =0.025). CONCLUSIONS: Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared with those with low PCAT attenuation. Vascular inflammation and plaque vulnerability are intimately related in patients with coronary artery disease. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04523194.

show abstract

Section: Discussionsupporting

confidence: 74%

Coronary Inflammation and Plaque Vulnerability: A Coronary Computed Tomography and Optical Coherence Tomography Study

Jang

Sugiyama

Suzuki

et al. 2023

Circ: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…The repeated CTA + FFR CT investigation strategy in the FLOWPROMOTE study allows for comprehensive assessment of the temporal interplay between lipid lowering therapy, changes in disease morphology and physiology including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score. 25 , 30 , 31 …”

Section: Discussionmentioning

confidence: 99%

“…Thus, relative to traditional FFR CT metrics, FFR CT ‐AUC may add important information on the impact of lipid lowering therapy on flow both in vessels with or without FFR CT ≤ 0.80 at baseline. The repeated CTA + FFR CT investigation strategy in the FLOWPROMOTE study allows for comprehensive assessment of the temporal interplay between lipid lowering therapy, changes in disease morphology and physiology including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score 25,30,31 …”

Section: Discussionmentioning

confidence: 99%

“…Given the many beneficial changes in plaque phenotype characteristics that are observed with lipid lowering therapies, including reduction in LAP volumes [15][16][17][18][38][39][40] and recent data demonstrating that such features are independent predictors of lesion-specific ischemia expressed by abnormal FFR including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score. 25,30,31 In the FLOWPROMOTE study, patients are randomized to two with previous studies demonstrating that the extent of plaque volume regression is greater in patients who achieve the lowest LDL cholesterol values. 38,39 Importantly, these previous studies have not indicated that there is a lower LDL threshold beyond which further LDL lowering would not yield additional plaque regression.…”

Section: Discussionmentioning

confidence: 99%

“…Together with the pericoronary adipose tissue (PCAT) attenuation as a marker of coronary artery inflammation, plaque analyses will be performed at a core-lab in vessel segments with diameter ≥2 mm using a semiautomated software (Autoplaque, Cedars-Sinai Medical Center) as previously described. [18][19][20][25][26][27][28] In brief, automated attenuation thresholds will be used for scan-specific plaque differentiation, 26,27 and the vessel lumen, wall and plaque are defined automatically with manual input as required. Total plaque, calcified, and noncalcified (including LAP < 30 HU) will be measured (mm 3 ), and aggregate plaque volume (APV%) will be computed as total plaque volume/vessel volume × 100%.…”

Section: Coronary Plaque Analysismentioning

confidence: 99%

See 2 more Smart Citations

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Mortensen

Sand²,

Busk

et al. 2022

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFR CT ) shows high diagnostic performance when compared to invasively measured FFR. Presence and extent of low attenuation plaque density have been shown to be associated with abnormal physiology by measured FFR. Moreover, it is well established that statin therapy reduces the rate of plaque progression and results in morphology alterations underlying atherosclerosis. However, the interplay between lipid lowering treatment, plaque regression, and the coronary physiology has not previously been investigated. Aim To test whether lipid lowering therapy is associated with significant improvement in FFR CT , and whether there is a dose–response relationship between lipid lowering intensity, plaque regression, and coronary flow recovery. Methods Investigator driven, prospective, multicenter, randomized study of patients with stable angina, coronary stenosis ≥50% determined by clinically indicated first‐line CTA, and FFR CT ≤ 0.80 in whom coronary revascularization was deferred. Patients are randomized to standard (atorvastatin 40 mg daily) or intensive (rosuvastatin 40 mg + ezetimibe 10 mg daily) lipid lowering therapy for 18 months. Coronary CTA scans with blinded coronary plaque and FFR CT analyses will be repeated after 9 and 18 months. The primary endpoint is the 18‐month difference in FFR CT using (1) the FFR CT value 2 cm distal to stenosis and (2) the lowest distal value in the vessel of interest. A total of 104 patients will be included in the study. Conclusion The results of this study will provide novel insights into the interplay between lipid lowering, and the pathophysiology in coronary artery disease.

show abstract

Prognostic value of coronary CT angiography in heart failure patients with preserved ejection fraction

Zuo

Zhao

et al. 2023

Eur Radiol

View full text Add to dashboard Cite

Plaque Rupture, Compared With Plaque Erosion, Is Associated With a Higher Level of Pancoronary Inflammation

Cited by 40 publications

References 32 publications

Coronary Inflammation and Plaque Vulnerability: A Coronary Computed Tomography and Optical Coherence Tomography Study

Coronary Inflammation and Plaque Vulnerability: A Coronary Computed Tomography and Optical Coherence Tomography Study

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Prognostic value of coronary CT angiography in heart failure patients with preserved ejection fraction

Contact Info

Product

Resources

About