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Updated: Aug 30, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Independent contribution of plaque complexity to myocardial ischemia during dobutamine stress echocardiography
Robert Fathi1, Leanne Short, Brian Haluska
1University of Queensland, Brisbane, Australia.
Insights
Complex plaque morphology independently predicts ischemia extent in patients undergoing stress testing. This finding highlights the importance of plaque characteristics in assessing demand-induced ischemia risk.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Biology
Background:
- The relationship between complex coronary plaque morphology and demand-induced ischemia is not fully understood.
- Assessing the functional significance of lesion characteristics is crucial for patient management.
Purpose of the Study:
- To investigate the functional significance of coronary plaque morphology on the extent of ischemia.
- To determine if complex plaque morphology is an independent predictor of ischemia in unselected patients.
Main Methods:
- 196 patients underwent coronary angiography and dobutamine stress echocardiography (DSE) within 6 months.
- Angiography included stenosis severity, jeopardized myocardium assessment, and Ambrose plaque classification.
- DSE evaluated wall motion score index (WMSI) and coronary territories involved.
Main Results:
- Complex plaque morphology was present in 32% of patients and associated with prior myocardial infarction and smoking.
- Patients with complex lesions had higher coronary jeopardy scores and more extensive ischemia on DSE (higher WMSI, more territories involved).
- Multivariate regression identified coronary artery jeopardy score and complex plaque morphology as independent predictors of ischemic extent (R(2) = 34%).
Conclusions:
- Complex plaque morphology is an independent predictor of the extent of ischemia during stress.
- Patients with complex plaques exhibit more extensive coronary artery disease and greater ischemic burden.
- Plaque morphology provides significant functional information beyond stenosis severity.
Abstract:
The influence of complex plaque morphology on the extent of demand-induced ischemia in unselected patients is not well defined. We sought to investigate the functional significance of lesion morphology in patients who underwent coronary angiography and dobutamine stress echocardiography (DSE). Angiography and DSE were performed within a 6-month period (mean 1 +/- 1 month) in 196 patients. Angiographic assessments involved quantification of stenosis severity, assessment of the extent of jeopardized myocardium, and categorization of plaque morphology according to the Ambrose classification. DSE was interpreted by separate investigators with respect to wall motion score index (WMSI) and number of coronary territories involved. A general linear model was constructed to assess the independent contribution of patient characteristics and angiographic and DSE results with respect to extent of ischemic myocardium. Complex lesion morphology was seen in 62 patients (32%). Patients with complex lesions were more likely to have had prior myocardial infarction (p <0.001) and be current smokers (p = 0.03). During angiography, they exhibited a trend toward a greater number of diseased vessels, had a greater coronary jeopardy score (p <0.001) and more frequent collateral flow (p = 0.03). During echocardiography, patients had a higher stress WMSI (p <0.001) and were more likely to show ischemia in all 3 arterial territories (p <0.01). On multivariate regression, the coronary artery jeopardy score and the presence of complex plaque morphology were independent predictors of the extent of ischemic myocardium (R(2) = 34%, p <0.001). Thus, patients with complex plaque morphology are older, more likely to smoke, and more likely to have had prior myocardial infarction. They exhibit more extensive disease with higher coronary jeopardy scores and a higher resting and peak stress WMSI. Despite these differences, complex plaque morphology remains an independent predictor of the extent of ischemia during stress.
