Layered plaque is associated with high levels of vascular inflammation and vulnerability in patients with stable angina pectoris

Takayuki Niida; Daisuke Kinoshita; Keishi Suzuki; Haruhito Yuki; Daichi Fujimoto; Damini Dey; Hang Lee; Iris McNulty; Maros Ferencik; Taishi Yonetsu; Tsunekazu Kakuta; Ik-Kyung Jang

doi:10.1007/s11239-024-02982-3

Layered plaque is associated with high levels of vascular inflammation and vulnerability in patients with stable angina pectoris

J Thromb Thrombolysis. 2024 Apr 22. doi: 10.1007/s11239-024-02982-3. Online ahead of print.

Authors

Affiliations

¹ Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
² Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
⁵ Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁶ Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
⁷ Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. ijang@mgh.harvard.edu.

PMID: 38649561
DOI: 10.1007/s11239-024-02982-3

Abstract

Layered plaque, a signature of previous plaque destabilization and healing, is a known predictor for rapid plaque progression; however, the mechanism of which is unknown. The aim of the current study was to compare the level of vascular inflammation and plaque vulnerability in layered plaques to investigate possible mechanisms of rapid plaque progression. This is a retrospective, observational, single-center cohort study. Patients who underwent both coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) for stable angina pectoris (SAP) were selected. Plaques were defined as any tissue (noncalcified, calcified, or mixed) within or adjacent to the lumen. Perivascular inflammation was measured by pericoronary adipose tissue (PCAT) attenuation at the plaque levels on CTA. Features of plaque vulnerability were assessed by OCT. Layered plaques were defined as plaques presenting one or more layers of different optical densities and a clear demarcation from underlying components on OCT. A total of 475 plaques from 195 patients who presented with SAP were included. Layered plaques (n = 241), compared with non-layered plaques (n = 234), had a higher level of vascular inflammation (-71.47 ± 10.74 HU vs. -73.69 ± 10.91 HU, P = 0.026) as well as a higher prevalence of the OCT features of plaque vulnerability, including lipid-rich plaque (83.8% vs. 66.7%, P < 0.001), thin-cap fibroatheroma (26.1% vs. 17.5%, P = 0.026), microvessels (61.8% vs. 34.6%, P < 0.001), and cholesterol crystals (38.6% vs. 25.6%, P = 0.003). Layered plaque was associated with a higher level of vascular inflammation and a higher prevalence of plaque vulnerability, which might play an important role in rapid plaque progression.Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT04523194 .

Keywords: Computed tomography angiography; Layered plaque; Optical coherence tomography; Plaque vulnerability; Vascular inflammation.

Associated data

ClinicalTrials.gov/NCT04523194