Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Imamura

et al. 2020

JCM

This study investigated the effects of evolocumab on vulnerable coronary plaques and factors associated with the change in stability and size of plaques in patients taking statins. Vulnerable coronary plaques were defined using coronary computed tomography (CT) angiography as having a density of <50 HU within the region of interest and a remodeling index ≥1.1. The changes in minimum CT density, remodeling index, and percent stenosis of vulnerable coronary plaques after six months of evolocumab administration were retrospectively analyzed in 136 vulnerable coronary plaques from 98 patients (68 men and 30 women; mean age: 72.9 ± 8.7 years) treated with a statin. The administration of evolocumab significantly increased the minimum CT density (39.1 ± 8.1 HU to 84.9 ± 31.4 HU, p < 0.001), reduced the remodeling index (1.29 ± 0.11 to 1.19 ± 0.10, p < 0.001), and decreased the percent stenosis (27.0 ± 10.4% to 21.2 ± 9.8%, p < 0.001). Multiple linear regression analysis revealed that baseline percent stenosis (standard coefficient (β) = −0.391, p = 0.002) independently correlated with the change in minimum CT density, whereas the baseline remodeling index (β = −0.368, p < 0.001) independently correlated with a change in the remodeling index. Evolocumab stabilized vulnerable coronary plaques and reduced their size. These results suggest that evolocumab protects against coronary artery disease progression in patients taking statins.

Section: Discussionmentioning

confidence: 99%

Effect of Evolocumab on Vulnerable Coronary Plaques: A Serial Coronary Computed Tomography Angiography Study

Imamura

et al. 2020

JCM

“…Coronary artery disease is defined as clinically significant when luminal narrowing is present, typically at the 50% diameter reduction threshold. However, in early atherosclerosis, the first arterial changes consisted of compensatory enlargement of both the outer wall of the vessel as well as the lumen, termed compensatory enlargement or positive remodeling [7].…”

Section: Discussionmentioning

confidence: 99%

“…The data of correlation of remodeling index with demographic and risk factors were variable; Burke et al [15] found that positive remodeling was more in men and older group but Abdeldayem et al [7] found that no correlation was noted between either age, sex, and coronary risk factors with remodeling index, but the latter result can be explained by the small number of the study population (35 patients) and so less prevalence of risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…We should consider that most acute coronary syndromes were initiated by sudden changes of mildly stenotic lesions, commonly found in positively remodeled arterial regions, rather than from progression of lesions already causing significant luminal narrowing; so, the identification of mildly stenotic but vulnerable atherosclerotic lesions and the overall plaque burden could provide better markers of coronary risk than measuring of luminal stenosis [7].…”

Section: Discussionmentioning

confidence: 99%

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Multi-slice CT coronary angiography assessment of remodeling index in patients with low- to intermediate-risk stable angina

et al. 2019

BackgroundEarly identification of vulnerable plaques by remodeling index prior to rupture and development of acute event is of considerable importance especially by a reliable non-invasive method as CT coronary angiography (CTA), so we aim to evaluate coronary artery remodeling index in patients with low- to intermediate-risk stable angina by CTA.ResultsThis single-center, cross-sectional, observational study included 150 patients with stable angina with normal resting ECG, negative markers, normal systolic function by 2D echocardiography (EF > 50%), and without regional wall motion abnormality at rest who were referred to MSCT evaluation of the coronary artery tree; the mean age was 56.8 ± 6.4 years, 83.3% had one-vessel disease, and 16.7% had two-vessel diseases. The mean remodeling index (RI) was 1.04 ± 0.28, 38% had significant positive remodeling, LAD was the most affected vessel (55.3), and proximal lesions were predominant in 48.5%; there was a statistically significant positive correlation between RI and cholesterol, triglyceride, LDL, duration of DM, HBA1c, and plaque burden (P < 0.001) and a statistically significant negative correlation with HDL (P < 0.001). Predictors of higher RI were positive family history, diabetes mellitus, low HDL, HBA1c, and plaque burden% (P < 0.001). Patients with remodeling index > 1.1 were diabetic, hypertensive, smoker, with longer duration of diabetes mellitus, higher HBA1c, cholesterol, triglyceride, LDL, plaque burden, wall lumen ratio, stenosis area, and lower HDL.ConclusionCTA was able to detect the presence and extent of early, non-obstructive but significant coronary artery-positive remodeling in patients with low- to intermediate-risk stable angina patients.Trial registrationNCT03963609, 22 May 2019

“… 4 Positive remodelling (expansion) of early lesions maintains lumen size despite plaque accumulation. 5 This explains why these lesions might pass undetected by conventional angiography. Coronary artery plaques with positive remodelling have a higher lipid content and macrophage count, both markers of plaque vulnerability.…”

Section: Introductionmentioning

confidence: 99%

High-risk coronary plaque in SLE: low-attenuation non-calcified coronary plaque and positive remodelling index

Stojan

Budoff

et al. 2020

Lupus Sci Med

BackgroundPositive remodelling index and presence of low-attenuation non-calcified plaque (LANCP) are characteristic vessel changes in unstable coronary plaques. We sought to characterise these high-risk plaque features in patients with systemic lupus erythematosus (SLE) and to compare them with controls.MethodsA total of 72 patients who satisfied the SLICC classification criteria for SLE had coronary CT angiography (CCTA) studies, 30 of which had follow-up CCTA, as screening for occult coronary atherosclerotic disease in asymptomatic individuals. A total of 100 consecutive controls with no known history of lupus, heart disease or revascularisation who had two coronary CT angiograms at least 1 year apart were included in the study. These were asymptomatic patients referred by their primary physicians for screening of coronary artery disease and the screening interval was decided by the primary physicians. The methodology for image acquisition was identical.ResultsLANCP burden at baseline was significantly greater in patients with SLE compared with controls. LANCP volume was significantly greater in patients over 60 years of age (p<0.05) and in those with current prednisone dose >10 mg/day. LANCP burden remained stable over follow-up. There were no significant differences in remodelling index compared with controls.ConclusionThis is the first study describing high-risk CCTA features of coronary plaque in patients with SLE. Both LANCP and positive remodelling are common in SLE. These characteristic vessel changes may identify patients with SLE at increased risk of cardiovascular events and those in need for more frequent cardiac monitoring.