High-risk plaque features and perivascular inflammation
Daisuke Kinoshita1, Keishi Suzuki1, Daichi Fujimoto1
1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
High-risk plaque (HRP) with positive remodeling (PR) on coronary CTA is linked to perivascular inflammation. This association highlights PR as a key indicator of plaque vulnerability and inflammation levels.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- The relationship between high-risk plaque (HRP) features on coronary computed tomography angiography (CTA) and perivascular inflammation requires further investigation.
- Perivascular inflammation is increasingly recognized as a factor in atherosclerotic plaque development and instability.
Purpose of the Study:
- To investigate the association between specific HRP features identified by CTA and the degree of perivascular inflammation.
- To determine if positive remodeling (PR) is independently associated with perivascular inflammation.
Main Methods:
- Patients undergoing both CTA and optical coherence tomography (OCT) were analyzed.
- Pericoronary adipose tissue (PCAT) attenuation was measured to quantify perivascular inflammation.
- HRP features including positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC) were assessed.
Main Results:
- Lesion-specific PCAT attenuation was significantly higher in lesions with PR, LAP, and NRS compared to those without.
- After adjusting for confounders, only PR remained significantly associated with higher lesion-specific PCAT attenuation.
- The number of lesions with PR correlated with the level of perivascular inflammation and was associated with higher lipid index and macrophage grade.
Conclusions:
- Positive remodeling (PR) is the primary HRP feature associated with increased lesion-specific perivascular inflammation.
- The extent of PR in coronary plaques correlates with the degree of perivascular inflammation and plaque vulnerability.
Background:
The association between high-risk plaque (HRP) on coronary computed tomography angiography (CTA) and the level of perivascular inflammation has not been fully investigated.
Methods:
Patients who underwent both CTA and optical coherence tomography (OCT) were included. The level of perivascular inflammation was assessed by pericoronary adipose tissue (PCAT) attenuation at two levels: lesion-specific and the proximal segment of the culprit vessel. HRP features included positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC).
Results:
OCT features of plaque vulnerability were evaluated in culprit vessels. A total of 1360 lesions (413 culprit lesions and 947 non-culprit lesions) from 413 patients were evaluated. Lesion-specific PCAT attenuation was higher in lesions with any HRP feature except SC (present vs. absent: PR -71.3 ± 10.1 vs. -74.1 ± 11.7, P < 0.001; LAP -71.7 ± 9.9 vs. -73.0 ± 11.4, P = 0.025; NRS -70.3 ± 9.6 vs. -72.9 ± 11.1, P = 0.001; and SC -71.9 ± 9.9 vs. -73.0 ± 11.5, P = 0.082). After adjusting for confounders, only PR was associated with higher lesion-specific PCAT attenuation. The number of lesions with PR significantly correlated with higher levels of perivascular inflammation measured by culprit vessel PCAT attenuation. The number of lesions with PR was associated with higher lipid index and macrophage grade at culprit vessels.
Conclusions:
Among 4 HRP features, only PR was significantly associated with higher lesion-specific PCAT attenuation. The number of plaques with PR correlated with the level of perivascular inflammation and vulnerability.
Trial Registration:
clinicaltrials.gov Identifier: NCT04523194.
