IMPACT OF LIPID-LOWERING THERAPY ON CORONARY PLAQUE COMPOSITION IN PATIENTS WITH STABLE AND UNSTABLE ANGINA EVALUATED BY INTRAVASCULAR ULTRASOUND WITH VIRTUAL HISTOLOGY; FINDINGS FROM THE SUBANALYSES OF THE TRUTH STUDY

Previous trials using intravascular ultrasound(IVUS) have demonstrated that the lipid lowering therapy with statin decrease plaque volume and increase plaque echogenecity in patients with coronary artery disease. The aim of this study was to demonstrate the early effect of statin on plaque composition by IVUS-Virtual Histology(VH) during half a year after coronary event. Thirty six patients with ACS were prospectively enrolled. One target segment was determined in a non-PCI site (>5 mm proximal or distal to the PCI site) with a reproducible index side branch or from the ostium of target vessel. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=10); and non TCFA(n=26) In 6 months after statin therapy, no change was demonstrated in mean percentage of the lipid core(16.9 ± 8.5% to 16.2 ± 10.1%, p=0.67), whereas plaque volume and LDL-cholesterol level were significantly reduced. There was a significant reduction of lipid core percentage in the TCFA type (21.1 ± 7.6 % to 10.9 ± 5.8 %, p= 0.001), but not in the non-TCFA type. The percentage change in lipid core showed a significant relation with the change in high-sensitivity C-reactive protein(r=0.4, p=0.03). Changes in LDL cholesterol and lipid core demonstrated no significant associations. A clear reduction of lipid core was observed only in the TCFA type which suggest that the changes of plaque composition following statin therapy might occur earlier in vulnerable plaque than stable plaque and appears related to their anti-inflammatory effects.

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Abstract 2542: Effect of Lipid Lowering Therapy on Progression of Coronary Fibroatheroma Evaluated by Virtual Histology Intravascular Ultrasound

Circulation ◽

10.1161/circ.118.suppl_18.s_742-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Kenya Nasu ◽

Etsuo Tsuchikane ◽

Osamu Katoh ◽

Masashi Kimura ◽

Mariko Ehara ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Laboratory Data ◽

Density Lipoprotein ◽

Necrotic Core ◽

Lipid Lowering ◽

Control Group ◽

Lipid Lowering Therapy ◽

Cross Sectional ◽

Virtual Histology ◽

Lowering Therapy

Background: The aim of this study is to asses the effect of 12 month treatment with Fluvastatin (60 mg daily) on progression of fibroatheroma in a non-culprit vessel. Methods: This prospective study was performed at 2 centers and designed to enroll 80 patients. Patients were randomized to receive lipid-lowering therapy by Fluvastatin or a lipid lowering diet. All patients with high low-density lipoprotein-cholesterol level (> 140 mg/dl) were included in the Fluvastatin group. Non-culprit vessels were imaged with a 20 MHz phased-array intravascular ultrasound (IVUS) catheter with motorized pull-back system at 0.5 mm/s. Virtual Histology-derived fibroatheroma (VHD-FA) was defined as 1) percent necrotic core area >20%; 2) percent plaque plus media cross-sectional area >40%. For each image, the area of vessel and each plaque component were calculated. At 12-month followup repeat IVUS measurements were performed. Results: A total of 44 VHD-FAs in the Fluvastatin group and 47 VHD-FAs in the control group were detected at baseline. In the Fluvastatin group, fibrous and fibro-fatty areas are significantly decreased, necrotic core did not increase, and there was a significant reduction in atherogenic lipoproteins. In the control group, fibrous, necrotic core and dense calcium areas significantly increased (table ). Conclusion: Lipid-lowering therapy with Fluvastatin prevented progression of coronary fibroatheroma. Laboratory data and IVUS measurements

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