Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study

J Am Coll Cardiol. 2015 Jul 21;66(3):245-256. doi: 10.1016/j.jacc.2015.05.056.

Abstract

Background: Coronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR).

Objectives: This pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR.

Methods: Prospective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed.

Results: In the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001).

Conclusions: Statin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition. (Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technique [AQUAMARINE]; UMIN000003567).

Keywords: atherosclerosis; cardiac magnetic resonance; coronary artery disease; vulnerable plaque.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiography / methods
  • C-Reactive Protein / analysis
  • Coronary Artery Disease* / drug therapy
  • Coronary Artery Disease* / pathology
  • Coronary Artery Disease* / physiopathology
  • Dose-Response Relationship, Drug
  • Drug Monitoring / methods
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Lipoproteins, LDL / blood
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Pilot Projects
  • Plaque, Atherosclerotic* / drug therapy
  • Plaque, Atherosclerotic* / pathology
  • Plaque, Atherosclerotic* / physiopathology
  • Prospective Studies
  • Quinolines* / administration & dosage
  • Quinolines* / adverse effects
  • Reproducibility of Results
  • Research Design
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoproteins, LDL
  • Quinolines
  • C-Reactive Protein
  • pitavastatin