Abstract 1721: Regression And Shift In Composition Of Coronary Atherosclerotic Plaques By Pioglitazone: Insight From An Intravascular Ultrasounds Analysis
Introduction: Recently several studies reported regression of coronary plaque volume with extensive use of statin therapy. Moreover effect of plaque reduction with the use of pioglitazone and statin combination therapy has been observed in carotid plaque. We sought to investigate the effect of combination therapy with statins and pioglitazone on coronary plaque regression and composition with the use of intravascular ultrasound (IVUS) and IVUS-Virtual HistologyTM (IVUS-VH).
Materials and methods: we analysed 45 plaques in 30 diabetic patients with angiographic evidence of non significant coronary lesions with IVUS-VH. A 20 MHz phased-array catheter (2.9 F Eagle Eye, Volcano Therapeutics, Rancho Cordova, California) was advanced > 10 mm beyond the investigated lesion and automated pullback (0,5mm/sec) was performed to a point > 10 mm proximal to the lesion. The electrocardiographically gated conventional IVUS images and radiofrequency signals were acquired and stored for off-line analysis (IVUSLab RF2, volcano Corp). Patients were treated with 80 mg of atorvastatin and 30 mg of pioglitazone daily for six months. After six months of therapy IVUS-VH of each lesion was reacquired.
Results: For plaque regression analysis we evaluated three IVUS parameters: the mean change in percent atheroma volume (−1.17%), the change in atheroma volume (−9,43 mm3) in the most diseased 10-mm subsegment and the change in total atheroma volume (−7,43%). Moreover the IVUS-VH analysis of the plaques showed a reduction of the fibrous volume (−2,33%) and fibro-fatty volume (−2,59). Not significant variation in dense calcium volume and necrotic core volume was observed.
Conlcusions: These data demonstrated that atorvastatin/pioglitazone association is able to induce significant regression of coronary atherosclerosis acting on plaque composition. Our findings are preliminary results and should be confirmed in a larger randomized placebo controlled multicenter trial.