Abstract 19352: Features of Plaque Disruption by Coronary CT Angiography Are Associated with Lipid Core Plaque by Intra-coronary Near-infrared Spectroscopy
Background: Features of plaque rupture and thrombus formation by invasive imaging correlate with lipid-rich necrotic core at pathological examination. Using intra-coronary near-infrared spectroscopy (NIRS) as a reference standard, we sought to delineate an association between CT angiography (CTA) features of plaque disruption and lipid core plaque (LCP):
Methods: We analyzed patients with chest pain undergoing CTA followed by invasive angiography and target-vessel NIRS. Plaques were quantitatively analyzed by CTA (SUREPlaque, Vital Images, Minnetonka, MN) for percent stenosis and proportionate volume of low attenuation plaque (LAP, <50 Hounsfield Units). Plaques >25% stenosis were further scrutinized by two independent observers for CTA features of disruption, including ulceration and intra-plaque dye penetration (IDP). Target-vessel plaques with and without features of disruption by CTA were compared for frequency of LCP by NIRS. LCP was defined as a high probability signal within a 2 mm segment on the NIRS block chemogram:
Results: We compared CTA and target-vessel NIRS in 21 patients with chest pain (age 58 ± 13; 67% male). Among 48 target-vessel plaques, 16 (33%) had features of disruption by CTA, including ulceration in 3 (6%) and IDP in 16 (33%). Compared to other lesions, plaques with features of disruption by CTA more frequently contained LAP by quantitative CTA analysis (26 ± 13% vs. 15 ± 9%, p=0.01). NIRS detected LCP at the site of 12 (75%) plaques with features of disruption by CTA compared to only 8 (25%) lesions without CTA evidence of disruption (p<0.001, Figure):
Conclusions: Features of plaque disruption by CTA, including ulceration and IDP, are associated with LCP by NIRS. To understand the clinical implication of this, further studies are needed:
- © 2010 by American Heart Association, Inc.