Differences in Plaque Characteristics and Myocardial Mass: Implications for Physiological Significance

Chee Hae Kim; Seokhun Yang; Jinlong Zhang; Joo Myung Lee; Masahiro Hoshino; Tadashi Murai; Doyeon Hwang; Eun-Seok Shin; Joon-Hyung Doh; Chang-Wook Nam; Jianan Wang; Shao-Liang Chen; Nobuhiro Tanaka; Hitoshi Matsuo; Takashi Akasaka; Tsunekazu Kakuta; Bon-Kwon Koo

doi:10.1016/j.jacasi.2021.11.011

Differences in Plaque Characteristics and Myocardial Mass: Implications for Physiological Significance

JACC Asia. 2022 Mar 29;2(2):157-167. doi: 10.1016/j.jacasi.2021.11.011. eCollection 2022 Apr.

Authors

Chee Hae Kim¹, Seokhun Yang², Jinlong Zhang³, Joo Myung Lee⁴, Masahiro Hoshino⁵, Tadashi Murai⁵, Doyeon Hwang², Eun-Seok Shin⁶, Joon-Hyung Doh⁷, Chang-Wook Nam⁸, Jianan Wang⁹, Shao-Liang Chen¹⁰, Nobuhiro Tanaka¹¹, Hitoshi Matsuo¹², Takashi Akasaka¹³, Tsunekazu Kakuta⁵, Bon-Kwon Koo^{2

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Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea.
² Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea.
³ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁴ Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁵ Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
⁶ Division of Cardiology, Ulsan Hospital, Ulsan, South Korea.
⁷ Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
⁸ Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.
⁹ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China.
¹⁰ Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
¹¹ Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
¹² Department of Cardiology, Gifu Heart Center, Gifu, Japan.
¹³ Wakayama Medical University, Wakayama, Japan.
¹⁴ Institute on Aging, Seoul National University, Seoul, South Korea.

Abstract

Background: The mechanism of the fractional flow reserve (FFR) difference according to sex has not been clearly understood.

Objectives: This study sought to evaluate sex differences in coronary stenosis, plaque characteristics, and left ventricular (LV) mass and their implications for physiological significance.

Methods: This was a post hoc analysis of a pooled population of multicenter, international prospective cohorts. Patients (166 women and 489 men) underwent coronary computed tomography angiography (CCTA) within 90 days before invasive FFR measurements were included. The minimal lumen area, percent of plaque burden, whole vessel plaque volume by composition, high-risk plaque characteristics, and LV mass were analyzed from CCTA images.

Results: Among 1,188 vessels analyzed, the FFR value was higher in women than that in men (0.85 ± 0.13 vs 0.82 ± 0.14; P = 0.001) despite a similar percentage of diameter stenosis between the sexes (45.9% ± 18.9% vs 46.1% ± 17.7%; P = 0.920). The composition of fibrofatty plaque + necrotic core (13.1% ± 16.9% vs 21.2% ± 19.9%; P < 0.001) and frequencies of low attenuation plaque (12.7% vs 24.5%; P < 0.001) and positive remodeling (33.8% vs 45.5%; P = 0.001) were lower in women than in men. Vessel, plaque, and lumen volumes were significantly smaller in women than that in men (all P < 0.001); however, no sex difference was observed in any of these parameters after adjustment for LV mass (all P > 0.10). Sex was not an independent predictor of the FFR value after adjustment for stenosis severity, plaque characteristics, and LV mass.

Conclusions: Higher FFR values for the same stenosis severity in women can be explained by fewer high-risk plaque characteristics and smaller myocardial mass in women than that in men. (CCTA-FFR Registry for Risk Prediction; NCT04037163).

Keywords: CAD, coronary artery disease; CCTA, coronary computed tomography angiography; FFNC, fibrofatty + necrotic core; FFR, fractional flow reserve; LV, left ventricle; MLA, minimal lumen area; coronary artery disease; fractional flow reserve; myocardial mass; plaque; sex.

Associated data

ClinicalTrials.gov/NCT04037163