Hajhosseiny Reza, Hartley Adam, Cole Graham, Munoz Camilla, Sethi Amarjit, Al-Lamee Rasha, Khawaja Saud, Zaman Sameer, Howard James, Gopalan Deepa, Ariff Ben, Kaprielian Raffi, Neji Radhouene, Kunze Karl P, Kaura Amit, Prieto Claudia, Khamis Ramzi, Botnar René M
School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK; British Heart Foundation Centre of Research Excellence, King's College London, London, UK.
National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK.
J Cardiovasc Magn Reson. 2025;27(1):101898. doi: 10.1016/j.jocmr.2025.101898. Epub 2025 Apr 22.
Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection.
To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST.
The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01±0.14 vs. 0.67±0.18 vs. 0.35±0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P=0.05 and P=0.04, respectively).
iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.
检测易损冠状动脉斑块可预测未来心肌梗死。我们开发了一种新型的非对比心血管磁共振序列（iT2prep-BOOST），可实现同步、配准的冠状动脉造影和斑块检测。
在非ST段抬高型心肌梗死（NSTEMI）患者中验证iT2prep-BOOST。
招募了41例疑似NSTEMI患者。采用有创冠状动脉造影±血管内成像将冠状动脉节段分为以下类别：正常、非罪犯和罪犯节段；狭窄节段以及具有易损斑块特征（脂质、钙化、纤维粥样瘤、薄帽纤维粥样瘤（TCFA）、斑块破裂和血栓）的节段。在iT2prep-BOOST上分析每个冠状动脉节段的斑块/心肌信号强度比（PMR）。
罪犯节段的平均±标准差PMR显著高于非罪犯节段和正常节段（分别为1.01±0.14 vs. 0.67±0.18 vs. 0.35±0.24，P<0.001）。与正常冠状动脉节段相比，具有脂质、钙化和纤维粥样瘤的冠状动脉节段PMR显著更高（P<0.001），但显著低于具有斑块破裂和管腔内血栓的节段（P<0.05）。随着冠状动脉节段狭窄程度增加，PMR逐渐升高（P<0.001）。多变量分析显示，糖化血红蛋白以及冠状动脉疾病家族史与平均PMR之间存在显著关联（分别为P=0.05和P=0.04）。
iT2prep-BOOST有潜力同时无创且无需造影剂地可视化冠状动脉管腔和斑块，并区分正常节段与非罪犯和罪犯斑块节段。PMR的预后价值需要在前瞻性多中心研究中进行调查。
