Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Hong, Young Joon; Jeong, Myung Ho; Choi, Yun Ha; Hye, Eun; Ko, Jum Suk; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Youn, Heejung; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

doi:10.1016/j.ijcard.2009.04.042

Cited by 30 publications

(7 citation statements)

References 35 publications

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“…This report is the first to show significant stenosis with negative arterial remodeling but no definite plaque is a characteristic finding of VA on MDCTA. A prior study using virtual histology-intravascular ultrasound analysis reported that VA patients have less plaque and more negative arterial remodeling compared with unstable angina patients (4); this finding supports our characteristic MDCTA finding. Recently, using intravascular optical coherence tomography, Morikawa et al (17) also found that coronary artery segments involved in VA are characterized by diffuse intimal thickening without lipid or calcium content.…”

Section: Discussionsupporting

confidence: 88%

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Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

et al. 2012

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ObjectiveWe aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test).Materials and MethodsFifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test.ResultsAmong the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively.ConclusionSignificant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.

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Section: Discussionsupporting

confidence: 88%

“…Vasospasm is confirmed by conventional coronary angiography with provocation using acetylcholine or ergonovine (2). Several intravascular ultrasound (IVUS) studies have shown that early atherosclerosis with high incidence of negative arterial remodeling at the site of the focal spasm is a characteristic finding of VA (3, 4). …”

Section: Introductionmentioning

confidence: 99%

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

et al. 2012

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“…Previous intravascular ultrasound (IVUS) studies have reported that the morphological features of vasospastic lesions are diffuse intimal thickening (12), negative remodeling (13), and increased area of sonolucent zone (14). Previous IVUS studies, however, could not precisely explain what happens to the vascular structure of the spasm lesion at baseline.…”

Section: Discussionmentioning

confidence: 99%

Conformational Change in Coronary Artery Structure Assessed by Optical Coherence Tomography in Patients With Vasospastic Angina

Tanaka

Shimada

Tearney

et al. 2011

Journal of the American College of Cardiology

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Objectives The aim of this study was to investigate the conformational change of arterial structure in the vasospastic lesion with optical coherence tomography. Background Coronary artery spasm plays an important role in the pathogenesis of ischemic heart diseases. The conformational change of each arterial layer during vasospasm has not been studied in detail. Methods We assessed 19 coronary arteries (10 spasm and 9 nonspasm lesions) with optical coherence tomography during the provocation test for coronary spasm. An intimal bump was defined as 1 or more intimal projections into the lumen that disappeared after the administration of nitroglycerine (NTG). Intimal gathering was defined as a folding/gathering of the intima, resulting in multiple kinks in the luminal contour that resolved after the administration of NTG. Results The spasm lesion more frequently showed an intimal bump at baseline and intimal gathering during spasm compared with the nonspasm lesion (spasm 80% vs. nonspasm 0%, p < 0.01, spasm 100% vs. nonspasm 0%, p < 0.01, respectively). The spasm lesion demonstrated a thicker maximum media thickness (spasm 0.24 ± 0.04 mm vs. nonspasm 0.12 ± 0.03 mm, p < 0.01) at baseline, whereas no differences were observed after the administration of NTG (spasm 0.13 ± 0.03 mm vs. nonspasm 0.13 ± 0.02 mm, p = 0.65). Conclusions Our results suggest that medial contraction occurs even in an asymptomatic state and facilitates the formation of an intimal bump in patients with vasospastic angina. Luminal narrowing during spasm is associated with intimal gathering without alteration of intimal area.

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“…To date, CAG with spasm provocation is the standard detection technique, while further noninvasive advancement of intracoronary imaging technologies such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) also provide information about coronary spastic lesions [18,19,20]. Data from virtual histology IVUS has provided quantitative information on plaque composition at coronary spastic sites, and suggest that VSA patients experience diffuse thickened fibrous-dominant plaque, in contrast to less calcification, a necrotic core, and thicker-cap fibroatheroma, potentially contributing to less plaque vulnerability than the culprit lesions in non-VSA patients [18,19]. OCT assessment has confirmed diffuse thickened fibrous proliferation of intima without lipid and calcium accumulation in coronary plaques [20], thus indirectly supporting the IVUS data.…”

Section: Discussionmentioning

confidence: 99%

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Jin

Kim²,

Kang

et al. 2017

Cardiology

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Background: Diminished vascular tone is an established biomarker of heart damage. Little is known about the extent of coronary vessel tone (CVT) with spasm as assessed by dual-acquisition multidetector computed tomography angiography (MCTA) in patients with vasospastic angina (VSA). Objective: We evaluated the CVT modulated by intravenous nitrate injection (INI) using MCTA imaging in VSA patients. Methods: Twenty-one VSA patients (60 ± 9 years; 76% males) who underwent initial MCTA (without morning vasodilation), followed by an intracoronary ergonovine provocation test were included. Within 3 days after the initial MCTA patients received INI followed by 28-vessel segment spasm analyzed by MCTA 3D software, applying the following formula as the definition of CVT index (CVTI): (CSA_{IV nitrate} - CSA_initial/CSA_{IV nitrate}) ×100 %, where CSA is the cross-sectional area. Results: Compared to the initial MCTA measures, the INI provocation resulted in the significant increase of average diameter and CSA at the spasm site (2.60 mm [2.11-3.16] vs. 1.42 mm [1.13-2.13]; 5.37 mm² [3.67-7.54] vs. 1.62 mm² [1.02-3.02]; p < 0.001). The CVTI at the spastic segments was higher than at the proximal reference segments (41.0% [21.8-52.3] vs. 18.8% [5.9-26.6] for CVTI diameter; 65.1% [38.6-77.0] vs. 33.9% [5.2-48.1] for CVTI CSA, respectively). To predict VSA, the cut-off value for CVTI diameter was 38.6% (AUC 0.777; 95% CI 0.653-0.901) and 62.5% (AUC 0.779; 95% CI 0.657-0.902) for CVTI CSA in a receiver-operating characteristic curve analysis, with 57.1% sensitivity and 92.9% specificity. Conclusions: This novel imaging technique for assessing CVT by dual-acquisition MCTA after applying INI provocation is suitable for the detection of coronary artery spasm in patients with VSA.

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Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Cited by 30 publications

References 35 publications

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

Conformational Change in Coronary Artery Structure Assessed by Optical Coherence Tomography in Patients With Vasospastic Angina

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

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