Segmental coronary endothelial dysfunction in patients with minimal atherosclerosis is associated with necrotic core plaques

Abstract

Background/objective: Endothelial dysfunction and atherosclerosis are systemic disorders, but are often characterised by segmental involvement and complications. A potential mechanism for local involvement early in the disease process may be related to plaque composition. This study was designed to test the hypothesis that in patients with minimal coronary atherosclerosis, coronary artery segments with abnormal endothelial function have specific plaque characteristics.

Methods: Intravascular ultrasound (IVUS) images were obtained from 30 patients who underwent coronary endothelial function assessment. Spectral analysis of the IVUS radiofrequency data was used for assessment of plaque composition. IVUS findings of the coronary sections were compared according to the corresponding endothelial response to acetylcholine.

Results: Sections with a decrease epicardial coronary arterial diameter in response to acetylcholine had smaller baseline lumen (7.5 (2.4) mm(2) vs 8.8 (3.3) mm(2), p = 0.006) but larger plaque burden (37.1% (9.4%) vs 31% (7%), p = 0.003) than sections with normal endothelial response. Sections with endothelial dysfunction had larger necrotic core plaques: 0.13 (0.03-0.33) mm(2) vs 0.0 (0.0-0.07), p<0.001 and more dense calcium: 0.03 (IQR 0.0-0.13) mm(2) vs 0.0 (0.0-0.10) mm(2), p<0.01), than those with normal endothelial response. Only necrotic core area was associated with endothelial dysfunction (p<0.001) after adjusting for other measures.

Conclusions: This study suggests that local coronary endothelial dysfunction in patients with minimal coronary atherosclerosis is associated with plaque characteristics that are typical of vulnerable plaques.

Conflict of interest statement

Competing interests: None.

Figures

Figure 1

Examples of intravascular ultrasound (IVUS) findings. Grey scale IVUS and tissue characterisation of plaques by use of radiofrequency intravascular ultrasound analysis are shown for five of the patients. For each patient, two images are shown on the left from a segment in the left anterior descending (LAD) coronary artery with endothelial dysfunction. Two images on the right are from a segment with normal endothelial function. Virtual histology colour code: Grey, arterial wall; dark green, fibrous; light green, fibrofatty; red, necrotic core; white, dense calcified area.

Figure 2

Coronary artery diameter response to acetylcholine and nitroglycerin. Segmental response to intracoronary acetylcholine (Ach) and nitroglycerin (NTG) as determined by percentage change in coronary artery diameter.

Figure 3

Plaque composition and endothelial function. Plaque composition according to spectral analysis of intravascular ultrasound radiofrequency data (mean (SEM)).