Three-dimensional assessment of coronary high-intensity plaques with T1-weighted cardiovascular magnetic resonance imaging to predict periprocedural myocardial injury after elective percutaneous coronary intervention

Abstract

Background: Periprocedural myocardial injury (pMI) is a common complication of elective percutaneous coronary intervention (PCI) that reduces some of the beneficial effects of coronary revascularization and impacts the risk of cardiovascular events. We developed a 3-dimensional volumetric cardiovascular magnetic resonance (CMR) method to evaluate coronary high intensity plaques and investigated their association with pMI after elective PCI. Methods: Between October 2012 and October 2016, 141 patients with stable coronary artery disease underwent T1-weighted CMR imaging before PCI. A conventional 2-dimensional CMR plaque-to-myocardial signal intensity ratio (2D-PMR) and the newly developed 3-dimensional integral of PMR (3Di-PMR) were measured. 3Di-PMR was determined as the sum of PMRs above a threshold of > 1.0 for voxels in a target plaque. pMI was defined as highsensitivity cardiac troponin T > 0.07 ng/mL.Results: pMI following PCI was observed in 46 patients (33%). 3Di-PMR was significantly higher in patients with pMI than those without pMI. The optimal 3Di-PMR cutoff value for predicting pMI was 51 PMR*mm 3 and the area under the receiver operating characteristic curve (0.753) was significantly greater than that for 2D-PMR (0.683, P = 0.015). 3Di-PMR was positively correlated with lipid volume (r = 0.449, P < 0.001) based on intravascular ultrasound.Stepwise multivariable analysis showed that 3Di-PMR ≥ 51 PMR*mm 3 and the presence of a side branch at the PCI target lesion site were significant predictors of pMI (odds ratio [OR], 11.9; 95% confidence interval [CI], 4.6-30.4, P < 0.001; and OR, 4.14; 95% CI, 1.6-11.1, P = 0.005, respectively). Conclusions: 3Di-PMR coronary assessment facilitates risk stratification for pMI after elective PCI.Trial registration: retrospectively registered.

Clinical impact of cardiac magnetic resonance in patients with suspected coronary artery disease associated with chronic kidney disease (AQUAMARINE-CKD study): study protocol for a randomized controlled trial

“…We assumed that CTCA in the SCOT-HEART study [ 1 , 15 , 16 ] did not assess plaque instability and that CMR with analysis of HIPs could assess plaque instability better than CTCA alone. In a previous study [ 14 ], 77% of all cardiovascular events occurred within 2 years, and the event rate for HIP with signal intensity > 1.4 was approximately 30%; thus, an annual event rate of 11.6% was expected. Based on additional assumptions about an enrollment period of 3 years and a follow-up period of 3 years, power of 0.8, and two-sided p value of 0.05, a total of 524 patients would be needed with the dropout rate set at 5%.…”

“…The location of a coronary plaque is determined by careful comparison using fiduciary points on CMRA images. Once a coronary plaque has been confirmed with CMRA, the corresponding areas on T1W images were carefully matched using the surrounding cardiac and chest wall structures [ 6 , 12 , 14 ]. Regarding PMR quantification of coronary plaques that are not HIPs, when CMRA shows coronary stenosis in segments 1–3, 5–7, or 11–13, the PMR of the target lesion will be measured using the co-registration method described above.…”

“…Based on the results of previous studies [ 6 , 12 , 14 ], we hypothesized that the 10-year probability of developing CAD would be ≥ 22% and that the effect of optimal drug therapy, such as a strong statin to reach the low-density lipoprotein (LDL) cholesterol control target and medications to reach the blood pressure control target, and the effect of screening with CMRA and non-contrast T1WI on patients with HIPs or coronary stenosis would result in 48–50% lower relative risk. The effect of early detection of coronary artery lesions (significant stenosis and unstable plaque) was estimated to result in a relative risk reduction of 48–50%.…”

Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): a pilot study

“…However, global MPRI or full quantification of myocardial blood flow on stress CMR [27] could represent a promising biomarker for targeting higher risk DM patients rather than identifying only obstructive CAD via the current clinical practice of identifying stress induced perfusion defects. This study adds to the growing literature of potential magnetic resonance imaging markers such as aortic stiffness [28], abdominal adiposity [29] and high signal coronary artery plaque characterisation [30] in patients with type 2 diabetes that have shown promise in identifying patients with increased cardiovascular risk or adverse cardiac remodelling.…”

Coronary Magnetic Resonance Angiography in Chronic Coronary Syndromes

“…Identification of high-risk coronary plaques by CMR has been shown to be an independent and prognostically significant marker of CAD in patients with CCS, in addition to or indeed regardless of coronary luminal stenosis (89). It has also recently been shown to predict periprocedural myocardial injury (Figure 12) (90). CMR has the capability to detect vulnerable coronary plaques by taking advantage of the intrinsic T1 shortening of plaque components (e.g., intraplaque haemorrhage, thrombus, and lipid core), both with and without the need for contrast agents (91)(92)(93)(94)(95).…”