OBJECTIVES The purpose of this study was to assess coronary arterial remodeling as a marker of subclinical atherosclerosis using coronary wall MRI in an asymptomatic population-based cohort. BACKGROUND In early atherosclerosis, compensatory enlargement of both the outer wall of the vessel as well as the lumen, termed compensatory enlargement or positive remodeling, occurs before luminal narrowing. METHODS 179 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated using black-blood coronary wall MRI. Coronary cross-sectional area (vessel size), lumen area, and mean wall thickness of the proximal coronary arteries were measured. RESULTS Men had a greater vessel size, lumen area, and mean wall thickness than women (38.3±11.3 versus 32.6±9.4 mm2, 6.7±3.2 versus 5.3±2.4 mm2, and 2.0±0.3 versus 1.9±0.3 mm, respectively, p<0.05). No significant coronary artery narrowing was present by magnetic resonance angiography. Overall, coronary vessel size increased 25.9 mm2 per millimeter increase in coronary wall thickness, while lumen area increased only slightly at 3.1 mm2 for every millimeter increase in wall thickness (difference in slopes, p<0.0001). Adjusting for age and gender, participants with Agatston score greater than zero were more likely to have wall thickness greater than 2.0 mm (odds ratio 2.0, 95% CI 1.01–3.84). CONCLUSIONS Coronary wall MRI detected positive arterial remodeling, in asymptomatic men and women with subclinical atherosclerosis.

Background The key objectives of this study were to examine whether HIV infection itself is associated with subclinical coronary atherosclerosis and the potential contributions of cocaine use and antiretroviral therapies ( ART s) to subclinical coronary artery disease ( CAD ) in HIV ‐infected persons. Methods and Results Between June 2004 and February 2015, 1429 African American ( AA ) adults with/without HIV infection in Baltimore, Maryland, were enrolled in an observational study of the effects of HIV infection, exposure to ART , and cocaine use on subclinical CAD . The prevalence of subclinical coronary atherosclerosis was 30.0% in HIV ‐uninfected and 33.7% in HIV ‐infected ( P =0.17). Stratified analyses revealed that compared to HIV ‐uninfected, HIV ‐infected ART naïve were at significantly lower risk for subclinical coronary atherosclerosis, whereas HIV ‐infected long‐term ART users (≥36 months) were at significantly higher risk. Thus, an overall nonsignificant association between subclinical coronary atherosclerosis and HIV was found. Furthermore, compared to those who were ART naïve, long‐term ART users (≥36 months) were at significantly higher risk for subclinical coronary atherosclerosis in chronic cocaine users, but not in those who never used cocaine. Cocaine use was independently associated with subclinical coronary atherosclerosis. Conclusions Overall, HIV infection, per se, was not associated with subclinical coronary atherosclerosis in this population. Cocaine use was prevalent in both HIV ‐infected and ‐uninfected individuals and itself was associated with subclinical disease. In addition, cocaine significantly elevated the risk for ART ‐associated subclinical coronary atherosclerosis. Treating cocaine addiction must be a high priority for managing HIV disease and preventing HIV / ART ‐associated subclinical and clinical CAD in individuals with HIV infection.

Purpose:To determine the relationship of pericardial fat, which secretes proinfl ammatory markers that have been implicated in coronary atherosclerosis, with atherosclerotic plaque in an asymptomatic population-based cohort. Materials and Methods:In this institutional review board-approved study, all participants supplied written informed consent. One hundred eighty-three participants (89 women, 94 men; mean age, 61 years 6 9 [standard deviation]) from the communitybased Multi-Ethnic Study of Atherosclerosis (MESA) were included. The coronary artery eccentricity (ratio of maximal to minimal coronary artery wall thickness) was determined by using magnetic resonance (MR) imaging and served as an index of plaque burden. The pericardial fat volume was determined by using computed tomography. Linear regression coeffi cient analysis was used to correlate pericardial fat volume with coronary artery wall thickness and plaque eccentricity. Results:Pericardial fat volume correlated signifi cantly with degree of plaque eccentricity ( P , .05) in both men and women. After adjustments for body mass index (BMI) and waist circumference, traditional risk factors, C-reactive protein level, and coronary artery calcium content, the relationship between pericardial fat and plaque eccentricity remained signifi cant in men ( P , .01) but not in women. BMI and waist circumference correlated with degree of plaque eccentricity in the univariate model ( P , .05) but not after adjustment for pericardial fat volume or traditional risk factors. Conclusion:Pericardial fat volume, rather than BMI and waist circumference, was more strongly related to plaque eccentricity as a measure of coronary atherosclerotic plaque burden. The results support the proposed role of pericardial fat in association with atherosclerosis.q RSNA, 2011

Purpose:To evaluate the use of coronary wall MRI as a measure of atherosclerotic disease burden in an asymptomatic population free of clinical cardiovascular disease. Coronary wall magnetic resonance imaging (MRI) is a noninvasive method for evaluation of arterial wall remodeling associated with atherosclerosis. Materials and Methods:Asymptomatic participants of the Multi-Ethnic Study of Atherosclerosis (MESA) study were studied using black blood MRI. MRI-assessed coronary wall thickness was compared with computed tomography calcium score, carotid intimal-medial thickness, and risk factors for coronary artery disease.Results: Eighty-eight arterial segments were evaluated in 38 MESA participants (mean age, 61.3 Ϯ 8.7 years). The maximum coronary wall thickness was greater for participants with two or more cardiovascular risk factors than for those with one or no risk factors (2.59 Ϯ 0.33 mm vs. 2.36 Ϯ 0.30 mm, respectively, P ϭ 0.05.) For participants with zero calcium score, the mean and maximum coronary wall thickness for subjects with two or more risk factors for coronary artery disease were greater than the wall thickness for subjects with one or no risk factors (mean thickness: 1.95 Ϯ 0.17 mm vs. 1.7 Ϯ 0.19 mm; maximum thickness: 2.67 Ϯ 0.24 mm vs. 2.32 Ϯ 0.27 mm, respectively, P Ͻ 0.05). Subjects with increased carotid intimal-medial thickness also had increased coronary artery wall thickness (P Ͻ 0.05). Conclusion:Coronary artery wall MRI detects increased coronary wall thickness in asymptomatic individuals with subclinical markers of atherosclerotic disease and in individuals with zero calcium score.