Document Detail

Quantitative relationship between the extent and morphology of coronary atherosclerotic plaque and downstream myocardial perfusion.
MedLine Citation:
PMID:  21996395     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to quantify the effects of coronary atherosclerosis morphology and extent on myocardial flow reserve (MFR).
BACKGROUND: Although the relationship between coronary stenosis and myocardial perfusion is well established, little is known about the contribution of other anatomic descriptors of atherosclerosis burden to this relationship.
METHODS: We evaluated the relationship between atherosclerosis plaque burden, morphology, and composition and regional MFR (MFR(regional)) in 73 consecutive patients undergoing Rubidium-82 positron emission tomography and coronary computed tomography angiography for the evaluation of known or suspected coronary artery disease.
RESULTS: Atherosclerosis was seen in 51 of 73 patients and in 107 of 209 assessable coronary arteries. On a per-vessel basis, the percentage diameter stenosis (p = 0.02) or summed stenosis score (p = 0.002), integrating stenoses in series, was the best predictor of MFR(regional). Importantly, MFR(regional) varied widely within each coronary stenosis category, even in vessels with nonobstructive plaques (n = 169), 38% of which had abnormal MFR(regional) (<2.0). Total plaque length, composition, and remodeling index were not associated with lower MFR. On a per-patient basis, the modified Duke CAD (coronary artery disease) index (p = 0.04) and the number of segments with mixed plaque (p = 0.01) were the best predictors of low MFR(global).
CONCLUSIONS: Computed tomography angiography descriptors of atherosclerosis had only a modest effect on downstream MFR. On a per-patient basis, the extent and severity of atherosclerosis as assessed by the modified Duke CAD index and the number of coronary segments with mixed plaque were associated with decreased MFR.
Masanao Naya; Venkatesh L Murthy; Ron Blankstein; Arkadiusz Sitek; Jon Hainer; Courtney Foster; Mariya Gaber; Jolene M Fantony; Sharmila Dorbala; Marcelo F Di Carli
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-14     Completed Date:  2011-12-07     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1807-16     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Coronary Angiography
Coronary Artery Disease / physiopathology,  radiography*,  radionuclide imaging
Coronary Circulation*
Middle Aged
Plaque, Atherosclerotic / physiopathology,  radiography*,  radionuclide imaging
Positron-Emission Tomography
Tomography, X-Ray Computed
Grant Support
Comment In:
J Am Coll Cardiol. 2012 Apr 10;59(15):1407-8; author reply 1408   [PMID:  22480481 ]
J Am Coll Cardiol. 2011 Oct 18;58(17):1817-8   [PMID:  21996396 ]

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