First Department of Medicine-Cardiology, University Medical Centre Mannheim, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim.
Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology).
J Thorac Imaging. 2022 Sep 1;37(5):285-291. doi: 10.1097/RTI.0000000000000666. Epub 2022 Jul 8.
Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors.
In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters.
We analyzed 74 coronary plaques in 23 patients (60±9 y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66 mg/dL ( P <0.0001). Significant changes were found for VV (196 to 215 mm 3 , P =0.0340), MLA (3.1 to 2.6 mm 2 , P =0.0413), and MLD (1.7 to 1.4 mm, P =0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly ( P >0.05).
Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.
先前的研究表明，采用侵入性血管内超声技术，强化降低低密度脂蛋白（LDL）治疗对动脉粥样斑块体积具有积极影响。本研究描述了接受前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂治疗的患者，其冠状动脉斑块成分在冠状动脉计算机断层扫描血管造影（CCTA）上的变化。
在这项前瞻性研究中，在接受 PCSK9 抑制剂治疗 1 年后，使用第三代双源 CT 对冠状动脉斑块进行了分析。斑块标志物包括总斑块体积（TPV）、钙化斑块体积（CPV）、非钙化斑块体积（NCPV）、管腔体积和血管体积（VV）、最小管腔面积（MLA）、最小管腔直径（MLD）、校正冠状动脉密度、偏心度、重塑指数和功能性斑块参数。主要终点定义为 TPV 的变化；次要终点是 TPV 或 CPV 消退或斑块参数的名义变化。
我们分析了 23 例患者（60±9 岁，65%为男性）的 74 个冠状动脉斑块。在接受 PCSK9 抑制剂治疗 1 年后，LDL 从 148 降至 66mg/dL（P<0.0001）。VV（从 196 降至 215mm³，P=0.0340）、MLA（从 3.1 降至 2.6mm²，P=0.0413）和 MLD（从 1.7 降至 1.4mm，P=0.0048）均有显著变化。TPV、CPV、NCPV、管腔体积和功能性斑块参数无明显变化（P>0.05）。
冠状动脉 CT 血管造影分析表明，降低 LDL 治疗可影响斑块成分。主要终点 TPV 变化未达到，但 VV、MLA 和 MLD 有显著变化。
