Original Article

Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis

Joëlla E van Velzen, Joanne D Schuijf, Fleur R de Graaf, Gaetano Nucifora, Gabija Pundziute, J Wouter Jukema, Martin J Schalij, Lucia J Kroft, Albert de Roos, Johannes R C Reiber, Ernst E van der Wall, Jeroen J Bax^*

Leiden University Medical Centre, Netherlands

Correspondence to: , ; j.j.bax{at}lumc.nl

Accepted 8 September 2009

Background: Imaging of coronary plaques has traditionally focused on evaluating degree of stenosis, as the risk for adverse cardiac events increases with stenosis severity. However, the relation between plaque composition and severity of stenosis remains largely unknown.

Objective: To assess plaque composition (non-invasively by multislice computed tomography (MSCT) angiography and invasively by virtual histology intravascular ultrasound (VH IVUS)) in relation to degree of stenosis.

Methods: 78 patients underwent MSCT (identifying 3 plaque types; non-calcified, calcified, mixed) followed by invasive coronary angiography and VH IVUS. VH IVUS evaluated plaque burden, minimal lumen area and plaque composition (fibrotic, fibro-fatty, necrotic core, dense calcium) and plaques were classified as fibrocalcific, fibroatheroma, thin capped fibroatheroma (TCFA), pathological intimal thickening. For each plaque, percent stenosis was evaluated by quantitative coronary angiography. Significant stenosis was defined > 50% stenosis.

Results: Overall, 43 plaques (19%) corresponded to significant stenosis. Of the 227 plaques analyzed, 70 were non-calcified plaques (31%), 96 mixed (42%) and 61 calcified (27%) on MSCT. Various plaque types on MSCT were equally distributed among significant and non-significant stenoses. VH IVUS identified that plaques with significant stenosis had higher plaque burden (67±11 vs. 53±12%, p<0.05) and smaller minimal lumen area (4.6(3.8-6.8) vs. 7.3(5.4-10.5)mm², p<0.05). Interestingly, no differences were observed in fibrotic, fibro-fatty, dense calcium and necrotic core. Non-significant stenoses were more frequently classified as pathological intimal thickening (46(25%) vs. 3(7%), p<0.05), although TCFA (more vulnerable plaque) was distributed equally (p=0.18).

Conclusion: No evident relation exists between the degree of stenosis and plaque composition or vulnerability, as evaluated non-invasively by MSCT and invasively by VH IVUS.

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