Abstract 4475: Coronary Stenting to Plaque with Necrotic Core Induces Microvascular Injury and Results in the Late Phase Left Ventricular Remodeling: A Virtual Histology Intravascular Ultrasound Study
Background: We already reported that plaque components defined as necrotic core (NC) by virtual histology intravascular ultrasound (VH-IVUS) were related to small embolic particles during coronary stenting. Here we hypothesized that stenting to lesions with NC would affect the left ventricular function.
Methods: Fifty-two consecutive patients undergoing elective coronary stenting were enrolled. Before stenting, NC was identified by VH-IVUS. Coronary flow velocity reserve (CFVR) was measured before and after stenting. After 6 months, follow up coronary angiography, left ventriculography, and CFVR measurement were performed.
Results: Baseline NC area was 1.1+/−1.0 mm2 (median 0.8). We divided study patients into 2 groups; (group L: NC area 0 – 0.8 mm2 (n=27), group H: NC area >0.8 mm 2 (n=25)). Although baseline CFVR did not differ between the groups (L: 1.6+/−0.7 vs. H: 1.4+/−0.5, NS), CFVR after stenting tended to be lower in group H (L: 2.4+/−0.9 vs. H: 2.0+/−0.8, p=0.06). CFVR improved after 6 months in both groups (L: 2.9+/−1.1 vs. H: 2.8+/−0.8, NS). As to left ventricular volume, left ventricular end-systolic volume (LVESV) and end-diastolic volume (LVEDV) were similar at baseline but they tended to be larger in group H than group L at 6 months (L vs. H; LVESV: 42+/−13 vs. 60+/−38 ml, p=0.06; LVEDV: 114+/−23 vs. 138+/−48 ml, p=0.06). Linear regression analysis revealed a weak but significant correlation between the baseline NC area and LVESV (r=0.54, p<0.001), LVEDV (r=0.49, p=0.003), and EF at 6 months (r=−0.38, p=0.03).
Conclusion: Coronary stenting to lesions with NC induces microvascular dysfunction and may be related to LV remodeling in the late phase.