PT  - JOURNAL ARTICLE
AU  - Samuel L Sidharta
AU  - Timothy J Baillie
AU  - Stuart Howell
AU  - Stephen J Nicholls
AU  - Natalie Montarello
AU  - Satoshi Honda
AU  - Daisuke Shishikura
AU  - Sinny Delacroix
AU  - Susan Kim
AU  - John F Beltrame
AU  - Peter J Psaltis
AU  - Stephen G Worthley
AU  - Matthew I Worthley
TI  - Evaluation of human coronary vasodilator function predicts future coronary atheroma progression
AID  - 10.1136/heartjnl-2017-312579
DP  - 2018 Sep 01
TA  - Heart
PG  - 1439--1446
VI  - 104
IP  - 17
4099  - http://heart.bmj.com/content/104/17/1439.short
4100  - http://heart.bmj.com/content/104/17/1439.full
SO  - Heart2018 Sep 01; 104
AB  - Objective Coronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.Methods 33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12–18 months (n=520 segments).Results Lipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (−0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: −3.03, 95% CI (−5.81 to −0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).Conclusions Epicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.Trial registration number ACTRN12612000594820, Post-results.