Abstract 2783: Metabolic Syndrome Enhances The Formation Of Large Coronary Plaques With Fibro-fatty Lesions Leading To Impaired Microcirculation And Myocardial Perfusion During Coronary Intervention
Background: Metabolic syndrome (MetS) has been associated with risks of developing cardiovascular diseases. Recently, spectral analysis of intravascular ultrasound (IVUS) radio-frequency (IVUS-Virtual Histology [VH]) data demonstrated a potential to provide detailed quantitative information on plaque component. We assessed the hypothesis that IVUS-VH was clinically effective in evaluating coronary plaque characterization of MetS and MetS was associated with impaired microcirculation and myocardial perfusion during coronary intervention.
Methods and Results: Preintervention IVUS-VH was performed prospectively in 75 culprit lesions with coronary stenosis ≥ 90% in consecutive 75 patients with stable angina pectoris. Patients with MetS had plaque morphological and coronary angiographic differences compared with those without MetS (Table⇓). Stepwise regression analyses revealed that MetS was an independent predictor of impaired coronary microcirculation and myocardial perfusion evaluated by corrected Thrombolysis In Myocardial Infarction (TIMI) frame count, myocardial blush grade and no reflow/slow flow phenomenon. The external elastic membrane (EEM)-area (p=0.024), plaque area (p=0.024) and fibro-fatty area (FFA) (p=0.032) were independent coronary plaque characterization of MetS. Based on a receiver operating characteristic curve, the best cutoff levels of EEM area, plaque area and FFA were 14.7 mm2, 11.1 mm2 and 0.8 mm2, respectively. The hazard ratio of patients who had more than the best cutoff levels of all plaque characterization was 9.5 compared with those who had less than the levels, after adjusting for clinical parameters, which were associated with MetS. (p=0.011).
Conclusions: IVUS-VH may help to predict characteristic coronary plaques in MetS patients. Large coronary plaques with fibro-fatty lesions have a potential for the development of impaired microcirculation and myocardial perfusion caused by coronary intervention.