The Relationship Between Volumetric Plaque Components and Classical Cardiovascular Risk Factors and the Metabolic Syndrome

Abstract

Objectives: The aim of this study was to analyze volumetric plaque composition of the coronary arterial tree according to the classical cardiovascular risk factors and metabolic syndrome (MS) by using virtual histology-intravascular ultrasound (VH-IVUS).

Background: It remains unclear how the cardiovascular risk factors correlate with the histological components of coronary plaques.

Methods: “Whole vessel” VH-IVUS analysis was performed in 189 vessels of 63 patients. The components of atherosclerotic plaques were classified as fibrous, fibrofatty, necrotic core (NC), and dense calcium. Quantitative assessment of these plaque components and the presence of VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) in the coronary arterial trees were compared to cardiovascular risk factors.

Results: There was a significantly larger mean plaque+media (P+M) burden in patients with diabetes mellitus (DM) (47±5 vs. 39±7% in non-DM patients, p<0.001) and MS (47±4 vs. 39±7% in non-MS patients, p<0.001). DM patients had a significantly larger %NC (17.8±5.6 vs. 12.5±6.1, p=0.003) compared to non-DM patients; and MS patients had a significantly larger %NC (17.3±5.8 vs. 12.8±6.2, p=0.016) as compared to non-MS patients. Finally, VH-TCFAs were more frequent in DM patients (3.4±2.0 vs. 2.1±1.7 in non-DM patients, p=0.016) and in MS patients (4.1±2.1 vs. 1.9±1.4 in non-MS patients, p=0.001).

Conclusions: Three-vessel VH-IVUS analysis showed that DM and MS patients had a larger P+M burden, larger amount of NC, and more frequent VH-TCFAs in coronary arterial trees compared to patients without DM or MS implying greater plaque vulnerability in DM and MS patients.