Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

Tomas Kovarnik, Zhi Chen, Gary S Mintz, Andreas Wahle, Kristyna Bayerova, Ales Kral, Martin Chval, Karel Kopriva, John Lopez, Milan Sonka, Ales Linhart, Tomas Kovarnik, Zhi Chen, Gary S Mintz, Andreas Wahle, Kristyna Bayerova, Ales Kral, Martin Chval, Karel Kopriva, John Lopez, Milan Sonka, Ales Linhart

Abstract

Background: Coronary atherosclerosis progresses faster in patients with diabetes mellitus (DM) and causes higher morbidity and mortality in such patients compared to non-diabetics ones (non-DM). We quantify changes in plaque volume and plaque phenotype during lipid-lowering therapy in DM versus non-DM patients using advanced intracoronary imaging.

Methods: We analyzed data from 61 patients with stable angina pectoris included to the PREDICT trial searching for prediction of plaque changes during intensive lipid-lowering therapy (40 mg rosuvastatin daily). Geometrically correct, fully 3-D representation of the vascular wall surfaces and intravascular ultrasound virtual histology (IVUS-VH) defined tissue characterization was obtained via fusion of two-plane angiography and IVUS-VH. Frame-based indices of plaque morphology and virtual histology analyses were computed and averaged in 5 mm long baseline/follow-up registered vessel segments covering the entire length of the two sequential pullbacks (baseline, 1-year). We analyzed 698 5-mm-long segments and calculated the Liverpool active plaque score (LAPS).

Results: Despite reaching similar levels of LDL cholesterol (DM 2.12 ± 0.91 mmol/l, non-DM 1.8 ± 0.66 mmol/l, p = 0.21), DM patients experienced, compared to non-DM ones, higher progression of mean plaque area (0.47 ± 1.15 mm2 vs. 0.21 ± 0.97, p = 0.001), percent atheroma volume (0.7 ± 2.8% vs. - 1.4 ± 2.5%, p = 0.007), increase of LAPS (0.23 ± 1.66 vs. 0.13 ± 1.79, p = 0.018), and exhibited more locations with TCFA (Thin-Cap Fibro-Atheroma) plaque phenotype in 5 mm vessel segments (20.3% vs. 12.5%, p = 0.01). However, only non-DM patients reached significant decrease of LDL cholesterol. Plaque changes were more pronounced in PIT (pathologic intimal thickening) compared to TCFA with increased plaque area in both phenotypes in DM patients.

Conclusion: Based on detailed 3D analysis, we found advanced plaque phenotype and further atherosclerosis progression in DM patients despite the same reached levels of LDLc as in non-DM patients. Trial registration ClinicalTrials.gov identifier: NCT01773512.

Keywords: Atherosclerosis; Diabetes mellitus; Intravascular ultrasound; Statins.

Figures

Fig. 1
Fig. 1
3D model of coronary artery done by fusion of CAG and IVUS and marked 5 mm vessel segment
Fig. 2
Fig. 2
Determination of plaque phenotype in frame-based analysis
Fig. 3
Fig. 3
Distribution of LDLc changes in DM and non-DM patients
Fig. 4
Fig. 4
Plaque compositions responsible for either the plaque increase or the plaque decrease. F fibrous tissue, FF fibro-fatty tissue, NC necrotic tissue, DC calcified tissue
Fig. 5
Fig. 5
Plaque phenotype transition in DM patients. The “y” axis represents relative occurrence of a plaque phenotype in 5 mm vessel segments during baseline. Changes into follow-up plaque phenotypes are expressed in colors within each baseline column
Fig. 6
Fig. 6
Plaque phenotype transition in non-DM patients. The “y” axis represents relative occurrence of a plaque phenotype in 5 mm vessel segments during baseline. Changes into follow-up plaque phenotype are expressed in colors within each baseline column
Fig. 7
Fig. 7
Longitudinal and cross section views of one baseline and follow-up pullbacks showing development of new TCFA in DM patients. Orange line shows location of cross sectional frames. It can been seen significant progression of plaque together with increase of necrotic core
Fig. 8
Fig. 8
Changes of mean lumen, vessel and plaque area per 5 mm vessel segments in PIT and TCFA phenotypes in DM vs. non-DM patients
Fig. 9
Fig. 9
Changes of plaque composition in PIT and TCFA plaque phenotype in DM vs. non-DM patients. Values in “y” axis are expressed as relative amount
Fig. 10
Fig. 10
3D analysis of typical DM and non-DM patients differences in plaque area changes and plaque composition changes are clearly visible

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