Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Eur Heart J. 2015 Aug 1;36(29):1913-22. doi: 10.1093/eurheartj/ehv187. Epub 2015 Jun 1.
Non-contrast T1-weighted imaging (T1WI) has emerged as a novel non-invasive imaging for vulnerable coronary plaque showing a high-intensity plaque (HIP). However, the association between HIP and percutaneous coronary intervention (PCI) has not been evaluated. We investigated the association between the presence of HIP and the incidence of myocardial injury after PCI.
A total of 77 patients with stable angina were imaged with non-contrast T1WI by using a 1.5 T magnetic resonance system (HIP and non-HIP group, N = 31 and 46 patients, respectively). We defined HIP as a coronary plaque to myocardium signal intensity ratio (PMR) of ≥1.4. High-sensitive cardiac troponin-T (hs-cTnT) was measured at baseline and 24 h after PCI. Percutaneous coronary intervention-related myocardial injury (PMI) was defined as an elevation of hs-cTnT >5× 99th percentile upper reference limit. High-intensity plaque was associated with the characteristics of ultrasound attenuation and positive remodelling on intravascular ultrasound. Although baseline hs-cTnT was similar between the groups, increase in hs-cTnT was significantly greater in the HIP vs. non-HIP group (0.065 [0.023-0.304] vs. 0.017 [0.005-0.026], P < 0.001). Percutaneous coronary intervention-related myocardial injury occurred more frequently in the HIP than non-HIP group (58.1 vs. 10.9%, P < 0.001), and the cut-off value of PMR found to be 1.44 for predicting PMI (sensitivity 78.3% and specificity 81.5%). In multivariate analysis, a PMR of ≥1.4 was a significant predictor of PMI (odds ratio 5.63, 95% confidence interval 1.28-24.7, P = 0.022).
High-intensity plaque on non-contrast T1WI was characterized as vulnerable coronary plaque on IVUS and was associated with higher incidence of PMI.
非对比 T1 加权成像（T1WI）作为一种新型的无创成像方法，可用于显示高信号斑块（HIP）的易损性冠状动脉斑块。然而，HIP 与经皮冠状动脉介入治疗（PCI）之间的关系尚未得到评估。我们研究了 HIP 的存在与 PCI 后心肌损伤发生率之间的关系。
共对 77 例稳定型心绞痛患者进行了 1.5T 磁共振系统的非对比 T1WI 成像（HIP 组和非-HIP 组，N=31 例和 46 例）。我们将 HIP 定义为冠状动脉斑块与心肌信号强度比（PMR）≥1.4。在基线和 PCI 后 24 小时测量高敏心肌肌钙蛋白-T（hs-cTnT）。经皮冠状动脉介入相关心肌损伤（PMI）定义为 hs-cTnT 升高>5×99 百分位上参考限。HIP 与血管内超声上的超声衰减和正性重构特征相关。尽管两组间的基线 hs-cTnT 相似，但 HIP 组 hs-cTnT 的增加显著大于非-HIP 组（0.065[0.023-0.304] vs. 0.017[0.005-0.026]，P<0.001）。HIP 组发生经皮冠状动脉介入相关心肌损伤的频率明显高于非-HIP 组（58.1% vs. 10.9%，P<0.001），PMR 的截断值为 1.44 可预测 PMI（敏感性 78.3%，特异性 81.5%）。多变量分析显示，PMR≥1.4 是 PMI 的显著预测因子（比值比 5.63，95%置信区间 1.28-24.7，P=0.022）。
非对比 T1WI 上的高强度斑块在 IVUS 上表现为易损性冠状动脉斑块，与更高的 PMI 发生率相关。
