Coronary Plaque Characterization with T1-weighted MRI and Near-Infrared Spectroscopy to Predict Periprocedural
Koji Isodono1, Hidenari Matsumoto1, Debiao Li1
1From the Departments of Cardiology (K.I., D.I., H.O., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology (H.M., S.H., H.T., M.N., T.S.) and Department of Radiological Technology (T.H.), Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., P.J.S., D.D., S.C., H.L.L., A.G.C., Y.X.); and MR Research & Collaboration Department, Siemens Healthcare, Tokyo, Japan (Y.K.).
Erythrocyte-derived materials in coronary plaque, detected by MRI plaque-to-myocardium signal intensity ratio (PMR), strongly predict periprocedural myocardial injury (PMI) after PCI, independent of lipid content.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomarkers of Atherosclerosis
Background:
- Periprocedural myocardial injury (PMI) is a complication following percutaneous coronary intervention (PCI).
- Identifying the specific plaque constituents that trigger PMI is crucial for risk stratification and prevention.
- Current methods like near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) assess lipid content, but plaque composition is complex.
Purpose of the Study:
- To determine whether erythrocyte-derived materials (indicated by plaque-to-myocardium signal intensity ratio [PMR] on CATCH MRI) or lipids (indicated by maximum 4-mm lipid core burden index [maxLCBI4 mm] on NIRS-IVUS) are the predominant cause of PMI after PCI.
- To compare the predictive capabilities of MRI, NIRS-IVUS, and their combination for PMI.
Main Methods:
- Retrospective study of 103 patients undergoing elective NIRS-IVUS-guided PCI.
- Coronary atherosclerosis T1-weighted characterization (CATCH) MRI was performed before PCI to assess PMR.
- PMI was defined as post-PCI troponin T > 5x upper reference limit; multivariable analysis identified PMI predictors.
Main Results:
- PMI occurred in 36 of 103 lesions.
- High PMR on CATCH MRI was the strongest independent predictor of PMI (P = .001), while maxLCBI4 mm was not significant (P = .07).
- The combination of MRI and NIRS-IVUS provided the best predictive performance (AUC = 0.86), outperforming NIRS-IVUS alone (AUC = 0.75) and MRI alone (AUC = 0.80).
Conclusions:
- Erythrocyte-derived materials within coronary plaques, identified by high PMR on CATCH MRI, are significantly associated with PMI, independent of lipid burden.
- CATCH MRI offers unique pathological insights into plaque composition, complementing NIRS-IVUS findings.
- MRI shows promise as a crucial tool for predicting PMI, potentially improving patient outcomes after PCI.
