Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels

Ki-Bum Won, Byoung Kwon Lee, Ran Heo, Hyung-Bok Park, Fay Y Lin, Martin Hadamitzky, Yong-Jin Kim, Ji Min Sung, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J Budoff, Ilan Gottlieb, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Jonathon A Leipsic, Sang-Eun Lee, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Kavitha Chinnaiyan, Daniel S Berman, Jagat Narula, Jeroen J Bax, James K Min, Hyuk-Jae Chang, Ki-Bum Won, Byoung Kwon Lee, Ran Heo, Hyung-Bok Park, Fay Y Lin, Martin Hadamitzky, Yong-Jin Kim, Ji Min Sung, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J Budoff, Ilan Gottlieb, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Jonathon A Leipsic, Sang-Eun Lee, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Kavitha Chinnaiyan, Daniel S Berman, Jagat Narula, Jeroen J Bax, James K Min, Hyuk-Jae Chang

Abstract

Background: Despite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited.

Objectives: The authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA).

Methods: A total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm3/year) was defined as total PVC divided by the interscan period.

Results: Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P = 0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β = -0.114) in overall participants (P < 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β = -2.401; P = 0.004).

Conclusions: Serial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).

Keywords: CCTA, coronary computed tomographic angiography; CV, cardiovascular; PVC, plaque volume changes; atherosclerosis; coronary computed tomography angiography; hemoglobin; Δ hemoglobin, hemoglobin level changes.

Conflict of interest statement

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711139017). Dr. Leipsic has served as a consultant for and has stock options in HeartFlow and Circle Cardiovascular Imaging; has received grant support from GE Healthcare; and has received speaker fees from Philips. Dr. Samady has equity interest in Covanos. Dr. Berman receives software royalties from Cedars-Sinai Medical Center. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min has served on scientific advisory boards for Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

© 2022 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Distribution of Hemoglobin at Baseline and Follow-Up The proportion of categorical hemoglobin levels at baseline and follow-up is presented.
Central Illustration
Central Illustration
Comparison of Annualized Total Plaque Volume Changes According to Low and High Hemoglobin Levels at Baseline and Follow-Up The median interscan period was 3.2 (2.5 to 4.4) years. Among subjects with a low hemoglobin level (defined as a hemoglobin level of 3/year; P = 0.027). By contrast, the annualized total PVC were not significantly different between low and high hemoglobin levels at follow-up in subjects with a high hemoglobin level at baseline (23.8 ± 33.0 vs 15.0 ± 24.0 mm3/year; P = 0.098). This finding might support the hypothesis that the association between Δ hemoglobin and coronary PVC is different according to baseline hemoglobin levels. PVC = plaque volume changes.

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