European Heart Journal Advance Access originally published online on January 13, 2006
European Heart Journal 2006 27(6):655-663; doi:10.1093/eurheartj/ehi716
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Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans
Erasmus Medical Center, Thoraxcenter Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands
Received 15 June 2005; revised 3 November 2005; accepted 15 December 2005; online publish-ahead-of-print 13 January 2006.
* Corresponding author. Tel: +31 10 4635260; fax: +31 10 4369154. E-mail address: p.w.j.c.serruys{at}erasmusmc.nl
Aims Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes.
Methods and results In 51 consecutive patients (45 men), aged 38–76 years (mean age: 58±10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data (IVUS-Virtual HistologyTM). The study vessel was the left anterior descending artery in 23 (45%) patients; the circumflex artery in nine (18%), and right coronary artery in 19 (37%). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5±13 mm long (range: 30.2–78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first (median: 8.75%; IQR: 5.7–18) vs. the third (median: 6.1%; IQR: 3.2–12) (P=0.036) and fourth (median: 4.5%; IQR: 2.4–7.9) (P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [ß=–0.28 (95%CI: –0.15, –0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus.
Conclusion Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.
Key Words: Plaque • Lipid core • Imaging • Vulnerable plaque • Virtual histology
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