Additional Effect of Coronary High-Intensity Plaque on T1-Weighted Magnetic Resonance Imaging With Circulating Malondialdehyde-Modified Low-Density Lipoprotein on Cardiac Events

Circ J. 2021 Oct 25;85(11):2032-2039. doi: 10.1253/circj.CJ-21-0220. Epub 2021 Jul 17.

Abstract

Background: Although elevated levels of oxidized low-density lipoprotein (LDL) could play a critical role in vulnerable plaque, there are no studies that have compared coronary high-intensity plaque (HIP) and circulating malondialdehyde-modified (MDA)-LDL levels for the prediction of cardiac events.Methods and Results:A total of 139 patients with coronary artery stenosis (>70%) were examined with non-contrast T1-weighted magnetic resonance imaging (MRI) (HIP: n=64, non-HIP: n=75). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) ≥1.4. We evaluated the subsequent major adverse cardiac events (MACE) during the follow-up period (5.6±1.3 years). MDA-LDL levels were independently associated with the presence of HIP (P<0.0001). The incidence of MACE was 15%, and it was significantly higher in patients with HIP (27%) than in those without HIP (5%; P=0.011). Cox proportional hazard analysis showed MDA-LDL levels (P=0.007) and PMR (P=0.016) were significantly associated with MACE. For MACE prediction, C-statistic values for MDA-LDL, PMR, and PMR+MDA-LDL were 0.724, 0.791, and 0.800, respectively. Compared with MDA-LDL alone, the addition of PMR to MDA-LDL increased net reclassification improvement by 0.78 (P=0.012).

Conclusions: MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease. Furthermore, adding PMR to MDA-LDL levels markedly improved prediction of subsequent MACE after PCI.

Keywords: Cardiac events; Coronary high-intensity plaque; Magnetic resonance imaging; Malondialdehyde-modified low-density lipoprotein.

MeSH terms

  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Humans
  • Lipoproteins, LDL
  • Magnetic Resonance Imaging
  • Malondialdehyde
  • Percutaneous Coronary Intervention*
  • Plaque, Atherosclerotic* / diagnostic imaging
  • Plaque, Atherosclerotic* / pathology

Substances

  • Lipoproteins, LDL
  • Malondialdehyde