Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Department of Radiological Technology, Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
J Cardiovasc Magn Reson. 2023 Jan 30;25(1):4. doi: 10.1186/s12968-023-00916-1.
This study aimed to compare the coronary plaque characterization by cardiovascular magnetic resonance (CMR) and near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) (NIRS-IVUS), and to determine whether pre-percutaneous coronary intervention (PCI) evaluation using CMR identifies high-intensity plaques (HIPs) at risk of peri-procedural myocardial infarction (pMI). Although there is little evidence in comparison with NIRS-IVUS findings, which have recently been shown to identify vulnerable plaques, we inferred that CMR-derived HIPs would be associated with vulnerable plaque features identified on NIRS-IVUS.
52 patients with stable coronary artery disease who underwent CMR with non-contrast T1-weighted imaging and PCI using NIRS-IVUS were studied. HIP was defined as a signal intensity of the coronary plaque-to-myocardial signal intensity ratio (PMR) ≥ 1.4, which was measured from the data of CMR images. We evaluated whether HIPs were associated with the NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI) and plaque morphology on IVUS, and assessed the incidence and predictor of pMI defined by the current Universal Definition using high-sensitive cardiac troponin-T.
Of 62 lesions, HIPs were observed in 30 lesions (48%). The HIP group had a significantly higher remodeling index, plaque burden, and proportion of echo-lucent plaque and maxLCBI ≥ 400 (known as large lipid-rich plaque [LRP]) than the non-HIP group. The correlation between the maxLCBI and PMR was significantly positive (r = 0.51). In multivariable logistic regression analysis for prediction of HIP, NIRS-derived large LRP (odds ratio [OR] = 5.41; 95% confidence intervals [CIs] 1.65-17.8, p = 0.005) and IVUS-derived echo-lucent plaque (OR = 5.12; 95% CIs 1.11-23.6, p = 0.036) were strong independent predictors. Furthermore, pMI occurred in 14 of 30 lesions (47%) with HIP, compared to only 5 of 32 lesions (16%) without HIP (p = 0.005). In multivariable logistic regression analysis for prediction of incidence of pMI, CMR-derived HIP (OR = 5.68; 95% CIs 1.53-21.1, p = 0.009) was a strong independent predictor, but not NIRS-derived large LRP and IVUS-derived echo-lucent plaque.
There is an important relationship between CMR-derived HIP and NIRS-derived large LRP. We also confirmed that non-contrast T1-weighted CMR imaging is useful for characterization of vulnerable plaque features as well as for pre-PCI risk stratification. Trial registration The ethics committee of Juntendo Clinical Research and Trial Center approved this study on January 26, 2021 (Reference Number 20-313).
本研究旨在比较心血管磁共振（CMR）和近红外光谱（NIRS）-血管内超声（IVUS）（NIRS-IVUS）对冠状动脉斑块的特征描述，并确定经皮冠状动脉介入治疗（PCI）前使用 CMR 是否可以识别易发生围手术期心肌梗死（pMI）的高信号斑块（HIPs）。尽管与最近显示能够识别易损斑块的 NIRS-IVUS 发现相比，证据很少，但我们推测 CMR 衍生的 HIPs 与 NIRS-IVUS 上识别的易损斑块特征相关。
对 52 例接受 CMR 检查的稳定型冠状动脉疾病患者进行了研究，检查包括非对比 T1 加权成像和使用 NIRS-IVUS 的 PCI。HIP 定义为冠状动脉斑块与心肌信号强度比（PMR）≥1.4 的信号强度，通过 CMR 图像数据测量。我们评估了 HIP 是否与 NIRS 衍生的最大 4mm 脂质核心负荷指数（maxLCBI）和 IVUS 上的斑块形态有关，并使用高敏心肌肌钙蛋白 T 评估当前通用定义中 pMI 的发生率和预测因子。
在 62 个病变中，30 个病变（48%）存在 HIP。与非 HIP 组相比，HIP 组的重构指数、斑块负荷、回声不透明斑块比例和 maxLCBI≥400（称为大脂质丰富斑块 [LRP]）更高。maxLCBI 与 PMR 之间存在显著的正相关（r=0.51）。多变量逻辑回归分析预测 HIP 的结果显示，NIRS 衍生的大 LRP（比值比 [OR] = 5.41；95%置信区间 [CI] 1.65-17.8，p=0.005）和 IVUS 衍生的回声不透明斑块（OR=5.12；95%CI 1.11-23.6，p=0.036）是独立的强预测因子。此外，在 30 个存在 HIP 的病变中有 14 个（47%）发生了 pMI，而在 32 个没有 HIP 的病变中只有 5 个（16%）发生了 pMI（p=0.005）。多变量逻辑回归分析预测 pMI 的发生率的结果显示，CMR 衍生的 HIP（OR=5.68；95%CI 1.53-21.1，p=0.009）是独立的强预测因子，而 NIRS 衍生的大 LRP 和 IVUS 衍生的回声不透明斑块则不是。
CMR 衍生的 HIP 与 NIRS 衍生的大 LRP 之间存在重要关系。我们还证实，非对比 T1 加权 CMR 成像不仅可用于易损斑块特征的描述，还可用于 PCI 前的风险分层。
日本顺天堂大学临床研究与试验中心伦理委员会于 2021 年 1 月 26 日批准了本研究（编号 20-313）。
