The impact of epicardial fat volume on coronary plaque vulnerability: insight from optical coherence tomography analysis

Abstract Background Detecting coronary vulnerable plaques in vivo and assessing their vulnerability have been great challenges for clinicians and the research community. Intravascular ultrasound (IVUS) is commonly used in clinical practice for diagnosis and treatment decisions. However, due to IVUS limited resolution (about 150–200 µm), it is not sufficient to detect vulnerable plaques with a threshold cap thickness of 65 µm. Optical Coherence Tomography (OCT) has a resolution of 15–20 µm and can measure fibrous cap thickness more accurately. The aim of this study was to use OCT as the benchmark to obtain patient-specific coronary plaque cap thickness and evaluate the differences between OCT and IVUS fibrous cap quantifications. A cap index with integer values 0–4 was also introduced as a quantitative measure of plaque vulnerability to study plaque vulnerability. Methods Data from 10 patients (mean age: 70.4; m: 6; f: 4) with coronary heart disease who underwent IVUS, OCT, and angiography were collected at Cardiovascular Research Foundation (CRF) using approved protocol with informed consent obtained. 348 slices with lipid core and fibrous caps were selected for study. Convolutional Neural Network (CNN)-based and expert-based data segmentation were performed using established methods previously published. Cap thickness data were extracted to quantify differences between IVUS and OCT measurements. Results For the 348 slices analyzed, the mean value difference between OCT and IVUS cap thickness measurements was 1.83% (p = 0.031). However, mean value of point-to-point differences was 35.76%. Comparing minimum cap thickness for each plaque, the mean value of the 20 plaque IVUS-OCT differences was 44.46%, ranging from 2.36% to 91.15%. For cap index values assigned to the 348 slices, the disagreement between OCT and IVUS assignments was 25%. However, for the OCT cap index = 2 and 3 groups, the disagreement rates were 91% and 80%, respectively. Furthermore, the observation of cap index changes from baseline to follow-up indicated that IVUS results differed from OCT by 80%. Conclusions These preliminary results demonstrated that there were significant differences between IVUS and OCT plaque cap thickness measurements. Large-scale patient studies are needed to confirm our findings.

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A score to quantify coronary plaque vulnerability in high-risk patients with type 2 diabetes: an optical coherence tomography study

Cardiovascular Diabetology ◽

10.1186/s12933-014-0117-8 ◽

2014 ◽

Vol 13 (1) ◽

Cited By ~ 17

Author(s):

Mathias Burgmaier ◽

Martin Hellmich ◽

Nikolaus Marx ◽

Sebastian Reith

Keyword(s):

Type 2 Diabetes ◽

Optical Coherence Tomography ◽

High Risk ◽

Coronary Plaque ◽

Optical Coherence ◽

Plaque Vulnerability ◽

High Risk Patients ◽

Risk Patients

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TCT-254 Epicardial fat volume and coronary plaque characteristics

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2012.08.278 ◽

2012 ◽

Vol 60 (17) ◽

pp. B72

Author(s):

kennosuke yamashita ◽

Masahiko Ochiai ◽

Seitarou Ebara ◽

Toshitaka Okabe ◽

Myong-Hwa Yamamoto ◽

...

Keyword(s):

Coronary Plaque ◽

Epicardial Fat ◽

Epicardial Fat Volume ◽

Fat Volume

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GW25-e1493 The Impact of Epicardial Fat Volume and Inflammatory Cytokines on Coronary Artery Disease and Atherosclerotic Plaque Stability

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.06.559 ◽

2014 ◽

Vol 64 (16) ◽

pp. C121

Author(s):

Dong Chen ◽

Jing Wang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Inflammatory Cytokines ◽

Atherosclerotic Plaque ◽

Epicardial Fat ◽

Plaque Stability ◽

Epicardial Fat Volume ◽

Artery Disease ◽

The Impact ◽

Fat Volume

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Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study

Cardiovascular Diabetology ◽

10.1186/s12933-019-0926-x ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Sebastian Reith ◽

Andrea Milzi ◽

Enrico Domenico Lemma ◽

Rosalia Dettori ◽

Kathrin Burgmaier ◽

...

Keyword(s):

Type 2 Diabetes ◽

Optical Coherence Tomography ◽

Finite Elements ◽

Coronary Plaque ◽

Optical Coherence ◽

Plaque Vulnerability ◽

Finite Elements Analysis ◽

Coronary Syndrome ◽

Fibrous Cap

Abstract Background Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Methods Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. Results Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797–0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92–0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41–3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68–0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47–25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13–0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion’s fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. Conclusion Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.

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New Insights into the Association between Fibrinogen and Coronary Atherosclerotic Plaque Vulnerability: An Intravascular Optical Coherence Tomography Study

Cardiovascular Therapeutics ◽

10.1155/2019/8563717 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Jun Wang ◽

Lu Jia ◽

Xing Li ◽

Siyu Jin ◽

Xiaomei Li ◽

...

Keyword(s):

Coronary Heart Disease ◽

Optical Coherence Tomography ◽

Heart Disease ◽

Plaque Rupture ◽

Experimental Studies ◽

High Body Mass Index ◽

Coronary Plaque ◽

Optical Coherence ◽

Plaque Vulnerability ◽

Coronary Syndrome

Background. Fibrinogen levels have been associated with coronary plaque vulnerability in experimental studies. However, it has yet to be determined if serum fibrinogen levels are independently associated with coronary plaque vulnerability as detected by optical coherence tomography (OCT) in patients with coronary heart disease. Methods. Patients with coronary heart disease (CHD) who underwent coronary angiography and OCT in our department from January 2015 to August 2018 were included in this study. Coronary lesions were categorized as ruptured plaque, nonruptured with thin-cap fibroatheroma (TCFA), and nonruptured and non-TCFA. Presence of ruptured plaque and nonruptured with TCFA was considered to be vulnerable lesions. Determinants of coronary vulnerability were evaluated by multivariable logistic regression analyses. Results. A total of 154 patients were included in this study; 17 patients had ruptured plaques, 15 had nonruptured plaques with TCFA, and 122 had nonruptured plaques with non-TCFA. Results of univariate analyses showed that being male, diabetes, current smoking, high body mass index (BMI), and clinical diagnosis of acute coronary syndrome (ACS) were associated with coronary vulnerability. No significant differences were detected in patient characteristics, coronary angiographic findings, and OCT results between patients with higher and normal fibrinogen. Results of multivariate logistic analyses showed that diabetes and ACS were associated with TCFA, while diabetes, higher BMI, and ACS were associated with plaque rupture. Conclusions. Diabetes, higher BMI, and ACS are independently associated with coronary vulnerability as detected by OCT. Serum fibrinogen was not associated with coronary vulnerability in our cohort.

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