PT  - JOURNAL ARTICLE
AU  - J E van Velzen
AU  - J D Schuijf
AU  - F R de Graaf
AU  - G Nucifora
AU  - G Pundziute
AU  - J W Jukema
AU  - M J Schalij
AU  - L J Kroft
AU  - A de Roos
AU  - J H C Reiber
AU  - E E van der Wall
AU  - J J Bax
TI  - Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis
AID  - 10.1136/hrt.2009.176933
DP  - 2009 Dec 15
TA  - Heart
PG  - 1990--1996
VI  - 95
IP  - 24
4099  - http://heart.bmj.com/content/95/24/1990.short
4100  - http://heart.bmj.com/content/95/24/1990.full
SO  - Heart2009 Dec 15; 95
AB  - 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 three 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, percentage 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 analysed, 70 were non-calcified plaques (31%), 96 mixed (42%) and 61 calcified (27%) on MSCT. 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) mm2 vs 7.3 (5.4–10.5) mm2, p<0.05). Interestingly, no differences were observed in percentage fibrotic, fibro-fatty, necrotic core and dense calcium. 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 association exists between the degree of stenosis and plaque composition or vulnerability, as evaluated non-invasively by MSCT and invasively by VH IVUS.