Abstract 4027: Different CAD Risk Factors Have Different Effects on Plaque Composition: An In Vivo Virtual Histology Intravascular Ultrasound (VH-IVUS) Analysis of 880 Patients from the Global VH Registry
Virtual histology (VH) uses radiofrequency intravascular ultrasound (IVUS) to classify plaque composition as calcified, fibrotic, fibrofatty, and necrotic core. The global IVUS-VH registry began in the spring of 2004 and is collecting volumetric multivessel IVUS-VH data (using motorized transducer pullback @0.5mm/s) from 2000 unselected patients with coronary artery disease undergoing diagnostic or interventional coronary procedures. To date, 1992 pts have been enrolled at 42 centers; and clinical parameters, biomarkers, and conventional IVUS morphometric and volumetric IVUS-VH plaque composition analysis of the entire pullback length has been performed on 880 pts. 228 (26%) pts had diabetes mellitus (DM) of whom 58 were insulin-treated (7%); 589 were hypertensive (67%); and 208 were current smokers (24%).
Results: Of these three risk factors, only DM was associated with a larger plaque burden (Table⇓). DM, in particular insulin-treated DM had a larger necrotic core volume compared to non-insulin treated DM or non-DM (6.5% vs 5.7% of total plaque volume, p<0.024) with no difference in fibrotic, fibrofatty, or calcified plaque. Hypertension resulted in more calcified plaque (4.3% vs 3.4% of total plaque volume, p=0.012) with no difference in fibrotic or fibrofatty plaque or necrotic core. Current smokers had similar amounts of all four plaque components compared to non-smokers.
Conclusions: In vivo IVUS-VH analysis shows that different risk factors affect atherosclerotic plaque composition differently. In particular, insulin-dependent DM is associated with more plaque burden and a larger necrotic core.