Systemic involvement in ACS: Using CMR imaging to compare the aortic wall in patients with and without acute coronary
Elizabeth Chandy1, Alexander Ivanov1, Devindra S Dabiesingh1
1Division of Cardiology, Institute for Cardiology and Cardiac Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
Insights
Inflammation in acute coronary syndrome (ACS) affects the aorta. Cardiac MRI showed reduced aortic wall thickness and area in ACS patients, indicating systemic vascular inflammation.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Acute coronary syndrome (ACS) is linked to inflammation in coronary and cerebrovascular systems.
- Previous studies suggest simultaneous plaque destabilization and vessel edema in ACS.
- The extension of these inflammatory processes to the descending aorta in ACS is not well understood.
Purpose of the Study:
- To investigate if inflammatory vascular processes in ACS extend to the descending aorta.
- To assess changes in aortic wall dimensions in ACS patients compared to non-ACS patients.
Main Methods:
- Prospective enrollment of 111 patients (56 ACS, 55 non-ACS) with coronary artery disease.
- Cardiac magnetic resonance imaging (MRI) of the thoracic aorta at baseline and 3-month follow-up.
- Primary outcomes: change in aortic wall area (AWA) and thickness (AWT); Secondary outcomes: C-reactive protein (CRP) levels.
Main Results:
- ACS patients showed significant reductions in mean AWA (p=0.01) and AWT (p=0.01) from baseline to follow-up.
- Non-ACS patients exhibited no significant changes in AWA or AWT (p>0.1).
- Both groups had significant CRP reductions (p<0.01), with a greater reduction in ACS patients (p<0.01).
Conclusions:
- Patients with ACS experience a reduction in aortic wall size, area, and thickness.
- These changes suggest that inflammatory vascular processes during ACS impact the descending aorta.
- The findings highlight a systemic inflammatory response in ACS affecting major arteries.
Background/Objectives:
Previous studies have demonstrated that in acute coronary syndrome (ACS), plaque destabilization and vessel inflammation, represented by vessel edema, often occur simultaneously in multiple coronaries, as well as extend to the cerebrovascular system. Our aim was to determine whether the inflammatory vascular processes occurring within the coronaries during ACS extend simultaneously to the descending aorta.
Methods:
We prospectively enrolled 111 patients (56 ACS patients and 55 non-ACS patients with known coronary artery disease) to undergo cardiac magnetic resonance of the thoracic aortic wall at presentation and at three-month follow-up. The primary outcome was change in aortic wall area (AWA) and maximal aortic wall thickness (AWT) from baseline to three-month follow-up. Secondary outcomes were baseline and follow-up differences in AWA and AWT, and changes in C-reactive protein (CRP).
Results:
There was a significant reduction in mean AWA (p = 0.01) and AWT (p = 0.01) between index and follow up scans in ACS group, with no significant changes in non ACS group (both p>0.1) and no difference between ACS and non-ACS groups (p = 0.22). There was no significant difference in AWA and AWT at baseline (p>0.36) and follow-up (p>0.2) between groups. There was a significant reduction in CRP in both groups (p<0.01), with higher reduction in ACS patients (p<0.01).
Conclusions:
There was a reduction in aortic wall size, aortic wall area, and aortic wall thickness in patients presenting with ACS, and no change in non-ACS patients. There were no interval between-group differences in these measurements. We observed a reduction in C-reactive protein in both groups, with higher reduction noted in ACS patients.
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