Relationship between coronary hyper-intensive plaques identified by cardiovascular magnetic resonance and clinical severity of acute coronary syndrome

Figures

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  Fig. 1. Flowchart of the study design for patient recruitment and inclusion. a A total of 67 patients with coronary artery disease (CAD) in the Department of Cardiology were prospectively enrolled. Overall, 50 patients with acute coronary syndrome (ACS) and 12 patients with stable angina were included in the final analysis. Proven ACS was classified into 3 subgroups, including unstable angina (n = 27), non-ST elevation myocardial infarction (NSTEMI) (n = 8), and ST elevation myocardial infarction (STEMI) (n = 15). CHIPs were observed in 1 (8%) stable angina, 7 (26%) unstable angina, and 3 (38%) NSTEMI, and 10 (67%) STEMI patients, respectively. b Of the 50 ACS patients, 24 patients (including 30 lesions; 8 lesions with CHIPs and 22 lesions with non-CHIPs) were included in the final analysis

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  Fig. 2. A comparison of plaque hyper-intensity (in plaque to myocardium signal intensity ratio (PMR)) between different severities of coronary artery disease. Results are expressed as a box and whisker diagram with minimum, first quartile, median, third quartile, maximum and all individual data points. A progressive increase in PMR was observed among patients with stable angina, unstable angina, non-STEMI, and STEMI (p = 0.004, ANOVA). Post hoc tests showed PMR values of STEMI group was significantly higher than stable angina group (P = 0.007) (*) and unstable angina groups (P = 0.006) (**). However, it has not reached statistic differences between other groups

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  Fig. 3. A representative ACS case with a CHIP on CATCH compared with invasive coronary imaging. A 58-year-old male subject with unstable angina pectoris. Coronary plaque images acquired with CATCH are shown (a, bright blood image; b, dark blood image; c, fusion image). CATCH dark blood image (b) and fusion image (c) showed high signal intensity in the proximal left anterior descending coronary artery with a PMR of 1.5 (arrows). Invasive coronary angiography (d) showed high-grade stenosis in the segment corresponding to the hyper-intensive plaque on the CATCH images (circle). OCT examination (e and f) showed intraluminal thrombus (red star) and microvessel in the corresponding lesion (circle)

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  Fig. 4. Relationship between high-risk plaque features and plaque to myocardium ratio (PMR) in ACS. High-risk plaque features such as plaque rupture (P = 0.003), thrombus (P = 0.037) and intimal vasculature (P = 0.031) were associated with significantly higher PMR; no significant differences were found in other plaque features including the presence of TCFA (P = 0.625), lipid-rich plaques (P = 0.771), absence of calcification (P = 0.706) and macrophage infiltration (P = 0.498)