Abstract
BackgroundEarly identification of vulnerable plaques by remodeling index prior to rupture and development of acute event is of considerable importance especially by a reliable non-invasive method as CT coronary angiography (CTA), so we aim to evaluate coronary artery remodeling index in patients with low- to intermediate-risk stable angina by CTA.ResultsThis single-center, cross-sectional, observational study included 150 patients with stable angina with normal resting ECG, negative markers, normal systolic function by 2D echocardiography (EF > 50%), and without regional wall motion abnormality at rest who were referred to MSCT evaluation of the coronary artery tree; the mean age was 56.8 ± 6.4 years, 83.3% had one-vessel disease, and 16.7% had two-vessel diseases. The mean remodeling index (RI) was 1.04 ± 0.28, 38% had significant positive remodeling, LAD was the most affected vessel (55.3), and proximal lesions were predominant in 48.5%; there was a statistically significant positive correlation between RI and cholesterol, triglyceride, LDL, duration of DM, HBA1c, and plaque burden (P < 0.001) and a statistically significant negative correlation with HDL (P < 0.001). Predictors of higher RI were positive family history, diabetes mellitus, low HDL, HBA1c, and plaque burden% (P < 0.001). Patients with remodeling index > 1.1 were diabetic, hypertensive, smoker, with longer duration of diabetes mellitus, higher HBA1c, cholesterol, triglyceride, LDL, plaque burden, wall lumen ratio, stenosis area, and lower HDL.ConclusionCTA was able to detect the presence and extent of early, non-obstructive but significant coronary artery-positive remodeling in patients with low- to intermediate-risk stable angina patients.Trial registrationNCT03963609, 22 May 2019
Highlights
Identification of vulnerable plaques by remodeling index prior to rupture and development of acute event is of considerable importance especially by a reliable non-invasive method as CT coronary angiography (CTA), so we aim to evaluate coronary artery remodeling index in patients with low- to intermediate-risk stable angina by CTA
The response of coronary arteries to atherosclerosis and plaque growth manifested as either compensatory enlargement or shrinkage which is known as coronary artery remodeling
Invasive coronary angiography is considered the gold standard for the diagnosis of coronary artery disease since it provides an excellent visualization of coronary lumen change, coronary angiography can only provide a two-dimensional outline of the coronary lumen and cannot demonstrate the complex nature of
Summary
Identification of vulnerable plaques by remodeling index prior to rupture and development of acute event is of considerable importance especially by a reliable non-invasive method as CT coronary angiography (CTA), so we aim to evaluate coronary artery remodeling index in patients with low- to intermediate-risk stable angina by CTA. The assessment of positive remodeling of coronary arteries has attracted a lot of attention due to the Remodeling index is defined as the ratio of the maximum vessel area (or diameter) to a normal reference vessel area (or diameter), and plaques are classified as having significant positive remodeling when the RI is > 1.1 [3]. Invasive coronary angiography is considered the gold standard for the diagnosis of coronary artery disease since it provides an excellent visualization of coronary lumen change, coronary angiography can only provide a two-dimensional outline of the coronary lumen and cannot demonstrate the complex nature of (2019) 71:7 atherosclerotic plaques which are responsible for the association between the angiographic findings and clinical outcome [4]. IVUS is the standard reference for the assessment of coronary plaque composition and progression in clinical studies, it is an invasive procedure which is not commonly performed in routine clinical practice [4].
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