Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease

Ingeborg Eskerud; Eva Gerdts; Terje H Larsen; Judit Simon; Pál Maurovich-Horvat; Mai Tone Lønnebakken

doi:10.1016/j.ijcha.2021.100831

Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease

Int J Cardiol Heart Vasc. 2021 Jun 30:35:100831. doi: 10.1016/j.ijcha.2021.100831. eCollection 2021 Aug.

Authors

Ingeborg Eskerud¹, Eva Gerdts¹, Terje H Larsen^{2

3}, Judit Simon⁴, Pál Maurovich-Horvat^{4

5}, Mai Tone Lønnebakken^{1

2}

Affiliations

¹ Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway.
² Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway.
³ Department of Biomedicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
⁴ MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, Hungary.
⁵ Medical Imaging Centre, Semmelweis University, 18 Hataror ut, 1122, Budapest, Hungary.

Abstract

Aim: Whether the total coronary atherosclerotic plaque burden is independently associated with myocardial ischemia in non-obstructive coronary artery disease (CAD) is not well established. We aimed to test the association of total plaque burden quantified by coronary computed tomography angiography (CCTA) with myocardial ischemia in patients with chronic coronary syndrome and non-obstructive CAD.

Methods: We included 125 patients (age 62 ± 9 years, 58% women) with chronic coronary syndrome and non-obstructive CAD (stenosis < 50%) by CCTA, who were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. Total plaque burden was quantified by CCTA as the total plaque volume in the main coronary arteries, and positive remodelling was defined as remodelling index > 1.10.

Results: Patients with myocardial ischemia (n = 66) had higher total plaque burden (847 ± 245 mm³ vs. 758 ± 251 mm³, p = 0.049) and higher left ventricular (LV) mass index (42.1 ± 9.9 g/m^2.7 vs. 37.3 ± 8.0 g/m^2.7, p = 0.004), while age, sex, prevalence of hypertension, diabetes, calcium score and positive remodelling did not differ between the groups (all p > 0.05). In multivariable regression analysis, total plaque burden remained associated with presence of myocardial ischemia (OR 1.02, 95% CI 1.00-1.04, p = 0.045) independent of age, sex, hypertension, diabetes, LV mass index, coronary calcium score and positive remodelling.

Conclusion: Total coronary artery plaque burden by CCTA was independently associated with myocardial ischemia in patients with non-obstructive CAD. Whether plaque quantification is useful for clinical management of patients with non-obstructive CAD should be tested in prospective studies.ClinicalTrials.gov: Identifier NCT01853527.

Keywords: Coronary computed tomography angiography; Coronary plaque burden; Coronary plaque volume; INOCA; Myocardial ischemia; Non-obstructive coronary artery disease.

Associated data

ClinicalTrials.gov/NCT01853527