The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study.

Feiyu Li,Zhaoyang Fan,Chun Yuan,Christopher M Kramer,Xihai Zhao,Mary Mcgrae Mcdermott,Jinnan Wang,Timothy J Carroll,Thomas S Hatsukami,Daniel S Hippe,Debiao Li,Baocheng Chu

doi:10.1186/1532-429x-12-37

Abstract

BackgroundAtherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. However, associations of plaque eccentricity with plaque morphology and plaque composition are unclear. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR).MethodsTwenty-eight subjects with an ankle-brachial index less than 1.00 were examined with 1.5T high-spatial-resolution, multi-contrast weighted CMR. One hundred and eighty diseased locations of the proximal superficial femoral artery (about 40 mm) were analyzed. The eccentric lesion was defined as [(Maximum wall thickness- Minimum wall thickness)/Maximum wall thickness] ≥ 0.5. The arterial morphology and plaque components were measured using semi-automatic image analysis software.ResultsOne hundred and fifteen locations were identified as eccentric lesions and sixty-five as concentric lesions. The eccentric lesions had larger wall but similar lumen areas, larger mean and maximum wall thicknesses, and more calcification and lipid rich necrotic core, compared to concentric lesions. For lesions with the same lumen area, the degree of eccentricity was associated with an increased wall area. Eccentricity (dichotomous as eccentric or concentric) was independently correlated with the prevalence of calcification (odds ratio 3.78, 95% CI 1.47-9.70) after adjustment for atherosclerotic risk factors and wall area.ConclusionsPlaque eccentricity is associated with preserved lumen size and advanced plaque features such as larger plaque burden, more lipid content, and increased calcification in the superficial femoral artery.

Highlights

Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events
Walking and Leg Circulation Study (WALCS) III participants were identified from consecutive patients with Peripheral arterial disease (PAD) in the non-invasive vascular laboratories at Northwestern Memorial Hospital (Chicago, IL) or from consecutive patients with a diagnosis of PAD who were seen in the vascular surgery, general internal medicine, geriatric, cardiology, or endocrinology clinics at the Northwestern Medical Faculty Foundation (Chicago, IL)
According to the eccentricity index (EI), 115 locations were identified as eccentric lesions and 65 were concentric lesions

Summary

Introduction

Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR). The risk of death for PAD patients with claudication, especially from coronary and cerebrovascular events, is approximately 2 times greater than the risk for controls without PAD [2,4]. Despite their increased risk of cardiovascular events, patients with. Previous studies in various arterial beds have demonstrated that plaque compositions are strongly associated with plaque progression, vulnerability and subsequent symptoms [5,6,7]. The lower extremity arterial calcification content, measured by computed tomography, has been demonstrated as a potential marker for PAD severity and high risk of amputation in PAD patients [7]

Methods

Results

Discussion

Conclusion