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Carotid artery atherosclerosis: effect of intensive lipid therapy on the vasa vasorum--evaluation by using dynamic
Li Dong1, Williams S Kerwin, Huijun Chen
1Department of Radiology, University of Washington School of Medicine, 815 Mercer St, Seattle, WA 98109, USA.
Insights
Intensive lipid therapy significantly reduced microvascular changes in atherosclerotic plaque, as shown by dynamic contrast-enhanced MRI. This imaging technique may help assess treatment effectiveness in patients with atherosclerosis.
Area of Science:
- Cardiovascular Imaging
- Vascular Biology
- Medical Diagnostics
Background:
- Atherosclerotic plaque progression involves changes in vasa vasorum (VV) microvasculature.
- Assessing VV response to therapy is crucial for managing cardiovascular disease.
Purpose of the Study:
- To evaluate if short-term, intensive lipid therapy alters microvascular characteristics in atherosclerotic plaque.
- To utilize dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for this assessment.
Main Methods:
- Carotid artery DCE-MR imaging was performed at baseline and 1 year in patients receiving intensive lipid therapy.
- Kinetic modeling assessed the transfer constant (K(trans)) in plaque lesions.
- Statistical analysis compared K(trans) changes and correlated them with other markers.
Main Results:
- Twenty-eight patients completed the study with interpretable DCE-MR imaging.
- A significant reduction in mean K(trans) was observed after 1 year of lipid therapy (P = .02).
- K(trans) reduction did not correlate with changes in necrotic core size or high-sensitivity C-reactive protein (HsCRP).
Conclusions:
- Dynamic contrast-enhanced (DCE) MR imaging shows potential for assessing the therapeutic response of vasa vasorum in atherosclerotic plaque.
- This method may offer a novel approach to monitor treatment efficacy in cardiovascular disease.
Purpose:
To investigate whether short-term, intensive lipid therapy leads to changes in microvascular characteristics, as measured by using dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging.
Materials And Methods:
Institutional review board approval and informed consent were obtained for this HIPAA-compatible study. Subjects with established coronary artery disease or carotid artery stenosis of 15% or greater determined by using ultrasonography and with levels of apolipoprotein B of 120 mg/dL (1.2 g/L) or greater were enrolled in an ongoing study (clinical trial NCT00715273). All received intensive lipid therapy to achieve targeted high- and low-density lipoprotein cholesterol levels and underwent serial serum monitoring including high-sensitivity C-reactive protein (HsCRP) level measurements. Carotid artery MR imaging examinations including morphologic and DCE MR images were obtained at baseline and 1 year after treatment. In subjects with advanced lesions (>2 mm thick), MR image analysis was performed, including measurement of lipid-rich necrotic core size and kinetic modeling of DCE MR images to assess changes in the transfer constant (K(trans)). The differences in K(trans) between baseline and 1-year follow-up were compared by using the Wilcoxon signed rank test, and associations were assessed by using the Spearman rank correlation coefficient.
Results:
Twenty-eight subjects with interpretable DCE MR imaging results at both baseline and 1-year follow-up were included. After 1 year of treatment, a significant reduction was found in mean K(trans) (0.085 min(-1) ± 0.037 [standard deviation] to 0.067 min(-1) ± 0.028, P = .02). Reduction in K(trans) was not significantly correlated with observed reductions in lipid-rich necrotic core size or reductions in HsCRP level.
Conclusion:
These findings suggest that DCE MR imaging may be a useful imaging method for the assessment of the therapeutic response of the vasa vasorum in patients with atherosclerotic plaque.
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