Abstract
BackgroundCoronary wall cardiovascular magnetic resonance (CMR) is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort.ResultsCross-sectional images of the proximal right coronary artery (RCA) were acquired using spiral black-blood coronary CMR (0.7 mm resolution) in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female). Coronary measurements (total vessel area, lumen area, wall area, and wall thickness) had small intra- and inter-observer variabilities (r = 0.93~0.99, all p < 0.0001), though one-third of these older subjects had suboptimal image quality. Increased coronary wall thickness correlated with increased coronary vessel area (p < 0.0001), consistent with positive remodeling. On multivariate analysis, type 2 diabetes was the only risk factor associated with increased coronary wall area and thickness (p = 0.03 and p = 0.007, respectively). Coronary wall CMR measures were also associated with coronary calcification (p = 0.01-0.03).ConclusionsRight coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.
Highlights
Noninvasive imaging techniques to assess subclinical coronary atherosclerosis have the potential to identify patients at higher risk for future coronary events and guide lifestyle modifications and pharmacological therapy to maximize cardiovascular risk reduction
By univariate analysis, increased coronary wall area (WA) and wall thickness (WT) were associated with male gender (WA: 23.6 ± 5.9 vs. 21.7 ± 6.0 mm2, p = 0.045; WT: 1.51 ± 0.24 vs. 1.43 ± 0.26 mm, p = 0.046), diabetes (WA: 25.5 ± 6.2 vs. 22.4 ± 5.8 mm2, p = 0.04; WT: 1.61 ± 0.25 vs. 1.46 ± 0.24 mm, p = 0.008), and body mass index (BMI) (WA: r = 0.16, p = 0.046; WT: r = 0.2, p = 0.01)
There were no significant associations between these risk factors and either vessel area (VA) or lumen area (LA)
Summary
Noninvasive imaging techniques to assess subclinical coronary atherosclerosis have the potential to identify patients at higher risk for future coronary events and guide lifestyle modifications and pharmacological therapy to maximize cardiovascular risk reduction. While coronary wall imaging by cardiovascular magnetic resonance (CMR) is challenging due to the small size of coronary arteries and cardiac/respiratory motion, it has been successfully applied in patients using breathhold[7,8,9] or respiratory gating (i.e., free-breathing) techniques[10,11,12,13,14]. Using these techniques, significant increases in coronary wall area and wall thickness have been found in patients with documented coronary artery disease[10,12] and in those with type 1 diabetes mellitus plus nephropathy [13]. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort
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