Relation Between Coronary Plaque Composition Assessed by Intravascular Ultrasound Virtual Histology and Myocardial Ischemia Assessed by Quantitative Flow Ratio

The American Journal of Cardiology, vol. 186, pp. 228–235

Abstract

Coronary plaque composition may play an important role in the induction of myocardial ischemia. Our objective was to further clarify the relation between coronary plaque composition and myocardial ischemia in patients with chest pain symptoms. The study population consisted of 103 patients who presented to the outpatient clinic or emergency department with chest pain symptoms and were referred for diagnostic invasive coronary angiography. Intravascular ultrasound virtual histology was used for the assessment of coronary plaque composition. A noncalcified plaque was defined as a combination of necrotic core and fibrofatty tissue. Quantitative flow ratio (QFR), which is a coronary angiography-based technique used to calculate fractional flow reserve without the need for hyperemia induction or for a pressure wire, was used as the reference standard for the evaluation of myocardial ischemia. Coronary artery plaques with QFR of ≤0.80 were considered abnormal-that is, ischemia-generating. In total, 149 coronary plaques were analyzed, 21 of which (14%) were considered abnormal according to QFR. The percentage of noncalcified tissue was significantly higher in plaques with abnormal QFR (38.2 ± 6.5% vs 33.1 ± 9.0%, p = 0.014). After univariable analysis, both plaque load (odds ratio [OR] per 1% increase 1.081, p <0.001) and the percentage of noncalcified tissue (OR per 1% increase 1.070, p = 0.020) were significantly associated with reduced QFR. However, after multivariable analysis, only plaque load remained significantly associated with abnormal QFR (OR per 1% increase 1.072, p <0.001). In conclusion, the noncalcified plaque area was significantly higher in hemodynamically significant coronary lesions than in nonsignificant lesions. Although an increase in the noncalcified plaque area was significantly associated with a reduced QFR, this association lost significance after adjustment for localized plaque load.

Authors 11

1. Jeff M. Smit Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

2. Mohammed El Mahdiui Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

3. Michiel Alexander De Graaf Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

4. José Manuel Montero-Cabezas Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

5. Johan H. C. Reiber Aachen Departments of Radiology

   Leiden University Medical Center

   Affiliation as printed

   Medis Medical Imaging, Leiden, The Netherlands; Departments of Radiology, Leiden University Medical Center, Leiden, The Netherlands

   Departments of Radiology, Leiden University Medical Center, Leiden, The Netherlands

   Medis Medical Imaging, Leiden, The Netherlands

6. J. Wouter Jukema Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

7. Arthur J.H.A. Scholte Aachen

   Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

8. Juhani M. Knuuti

   University of Turku · Turku University Hospital

   Affiliation as printed

   Heart Center, University of Turku and Turku University Hospital, Turku, Finland

9. William C. Wijns

   Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Saolta University Health Care Group

   Affiliation as printed

   Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland

10. Jagat Narula

    Icahn School of Medicine at Mount Sinai

    Affiliation as printed

    Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York

11. Jeroen Joost Bax corresponding Aachen

    University of Turku · Leiden University Medical Center · Turku University Hospital

    Affiliation as printed

    Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland. Electronic address: j.j.bax@lumc.nl

    Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands

    Heart Center, University of Turku and Turku University Hospital, Turku, Finland