Coronary Plaque Composition Research Articles

Associations of High-Density Lipoprotein Functionality with Coronary Plaque Characteristics in Diabetic Patients with Coronary Artery Disease: Integrated Backscatter Intravascular Ultrasound Analysis.

High-density lipoprotein (HDL) functionality has been reported to be associated with coronary artery disease (CAD). However, little is known about the impact of HDL functionality on coronary atherosclerosis. Thirty-eight type 2 diabetic patients with CAD who underwent percutaneous coronary intervention were examined. Coronary atheroma burden and plaque composition of the culprit lesions were assessed using conventional gray-scale and integrated backscatter intravascular ultrasound. HDL-mediated cholesterol efflux capacity (HDL-CEC) and HDL antioxidant capacity, estimated as HDL inflammatory index (HII), were examined. The associations between HDL functionality and coronary plaques were analyzed using multivariate data analysis, including principal components analysis and orthogonal partial least squares (OPLS) models. Percent atheroma volume was correlated with HDL-CEC (r = 0.34, p = 0.04) but not with HII (p = 0.65). The OPLS model demonstrated that the percentage lipid volume was significantly associated with HDL functionality [coefficient (95% confidence interval); HDL-CEC: -0.26 (-0.49, -0.04); HII: 0.34 (0.08, 2.60), respectively]. HII exhibited the highest variable importance in projection score, indicating the greatest contribution. HDL functionality was associated with coronary plaque composition, a key component of plaque vulnerability. Our findings highlight the potential importance of HDL functionality for coronary plaque stabilization.

Association between Serum Oxysterols and Coronary Plaque Regression during Lipid-Lowering Therapy with Statin and Ezetimibe: Insights from the CuVIC Trial.

Several clinical trials using intravascular ultrasound (IVUS) evaluation have demonstrated that intensive lipid-lowering therapy by statin or a combination therapy with statin and ezetimibe results in significant regression of coronary plaque volume. However, it remains unclear whether adding ezetimibe to statin therapy affects coronary plaque composition and the molecular mechanisms of plaque regression. We conducted this prospective IVUS analysis in a subgroup from the CuVIC trial. The CuVIC trial was a prospective randomized, open, blinded-endpoint trial conducted among 11 cardiovascular centers, where 260 patients with coronary artery disease who received coronary stenting were randomly allocated into either the statin group (S) or the combined statin and ezetimibe group (S＋E). We enrolled 79 patients (S group, 39 patients; S＋E group, 40 patients) in this substudy, for whom serial IVUS images of nonculprit lesion were available at both baseline and after 6-8 months of follow-up. After the treatment period, the S＋E group had significantly lower level of low-density lipoprotein cholesterol (LDL-C; 80.9±3.7 vs. 67.7±3.8 mg/dL, p=0.0143). Campesterol, a marker of cholesterol absorption, and oxysterols (β-epoxycholesterol, 4β-hydroxycholesterol, and 27-hydroxycholesterol) were also lower in the S ＋E group. IVUS analyses revealed greater plaque regression in the S＋E group than in the S group (-6.14% vs. -1.18% for each group, p=0.042). It was noteworthy that the lowering of campesterol and 27-hydroxycholesterol, but not LDL-C, had a significant positive correlation with plaque regression. Compared with statin monotherapy, ezetimibe in combination with statin achieved significantly lower LDL-C, campesterol, and 27-hydroxycholesterol, which resulted in greater coronary plaque regression.

Effects of vitamins K2 and D3 supplementation in patients with severe coronary artery calcification: a study protocol for a randomised controlled trial

IntroductionCoronary artery calcification (CAC) and especially progression in CAC is a strong predictor of acute myocardial infarction and cardiovascular mortality. Supplementation with vitamin K2 and D3 has been suggested to...

The association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques assessed by near-infrared spectroscopy.

Lipid content in coronary atheromatous plaques, measured by near-infrared spectroscopy (NIRS), can predict the risk of future coronary events. Biomarkers that reflect lipid content in coronary plaques may therefore improve coronary artery disease (CAD) risk assessment. We aimed to investigate the association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques in statin-treated patients with stable CAD undergoing percutaneous coronary intervention. 56 patients with stable CAD underwent three-vessel imaging with NIRS when feasible. The coronary artery segment with the highest lipid content, defined as themaximum lipid core burden index within any4mmlength across the entire lesion (maxLCBI4mm), was defined as target segment. Lipoprotein subfractions and Lipoprotein a (Lp(a)) were analyzed in fasting serum samples by nuclear magnetic resonance spectroscopy and by standard in-hospital procedures, respectively. Penalized linear regression analyses were used to identify the best predictors of maxLCBI4mm. The uncertainty of the lasso estimates was assessed as the percentage presence of a variable in resampled datasets by bootstrapping. Only modest evidence was found for an association between lipoprotein subfractions and maxLCBI4mm. The lipoprotein subfractions with strongest potential as predictors according to the percentage presence in resampled datasets were Lp(a) (78.1 % presence) and free cholesterol in the smallest high-density lipoprotein (HDL) subfractions (74.3 % presence). When including established cardiovascular disease (CVD) risk factors in the regression model, none of the lipoprotein subfractions were considered potential predictors of maxLCBI4mm. In this study, serum levels of Lp(a) and free cholesterol in the smallest HDL subfractions showed the strongest potential as predictors for lipid content in coronary atheromatous plaques. Although the evidence is modest, our study suggests that measurement of lipoprotein subfractions may provide additional information with respect to coronary plaque composition compared to traditional lipid measurements, but not in addition to established risk factors. Further and larger studies are needed to assess the potential of circulating lipoprotein subfractions as meaningful biomarkers both for lipid content in coronary atheromatous plaques and as CVD risk markers.

The association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques assessed by near-infrared spectroscopy

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association The Liaison Committee for education, research and innovation in Central Norway. Background Lipid content in coronary atheromatous plaques, measured by near-infrared spectroscopy (NIRS), can predict the risk of future coronary events. Biomarkers that reflect lipid content in coronary plaques may therefore improve coronary artery disease (CAD) risk assessment, and lipoprotein subfractions could potentially add value beyond traditional lipid measurements. Purpose We aimed to investigate the association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques in statin-treated patients with stable CAD undergoing percutaneous coronary intervention. Methods 56 patients with stable CAD underwent three vessel imaging with NIRS when feasible. The coronary artery segment with the highest lipid content, defined as the maximum lipid core burden index within any 4mm length across the entire lesion (maxLCBI4mm), was selected as target segment. Lipoprotein subfractions were analyzed in fasting serum samples by nuclear magnetic resonance spectroscopy. Penalized linear regression analyses (lasso) were used to identify the best predictors of maxLCBI4mm. The uncertainty of the lasso estimates was assessed as the percentage of the resampled datasets by bootstrapping. Results Only modest evidence was found for an association with lipoprotein subfractions and maxLCBI4mm. The lipoprotein subfractions with strongest potential as predictors according to the percentage presence in resampled datasets were lipoprotein a (Lp(a)) (reg.coeff = 57.0; 78.1 % presence) and free cholesterol in the smallest high-density lipoprotein (HDL) subfractions (reg.coeff = 36.5; 74.3 % presence). When including established cardiovascular risk factors in the regression model, none of the lipoprotein subfractions was considered potential predictors of maxLCBI4mm. Conclusion In this study, Lp(a) and free cholesterol in the smallest HDL subfractions in serum showed the strongest potential as predictors for lipid content in coronary atheromatous plaques. Although the evidence is modest, our study suggests that measurements lipoprotein subfractions may provide additional information with respect to coronary plaque composition compared to traditional lipid measurements, but not in addition to established risk factors. Future studies are needed to verify our findings, and to investigate the clinical implication of lipoprotein subfractions as meaningful biomarkers for lipid-rich plaques and enhanced risk prediction in CAD.

P62 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON–CULPRIT CORONARY PLAQUES

Abstract Background Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood. Purpose. Our study aims to analyse the characteristics of non–culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery. Methods We included 1848 non–culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient. Results Overall, median age was 66 years (56–74), with 24.6% of women and 53.4% of ACS. At patient–level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion–level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season). Conclusions Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.

Correlation between coronary artery plaque composition ratio and plaque stability evaluated by 124-layer CT.

Correlation between coronary artery plaque composition ratio and plaque stability evaluated by 124-layer CT.

The impact of baseline calcified plaque volume on coronary rapid plaque progression by serial coronary computed tomography angiography in patients with type 2 diabetes

Objectives Patients with type 2 diabetes mellitus (T2DM) are susceptible to coronary artery disease (CAD), and coronary outcomes in these patients are heterogeneous. However, the impact of coronary plaque compositions on rapid plaque progression (RPP) in patients with T2DM has rarely been reported. This study aimed to investigate the association of coronary plaque compositions with rapid lesion volume progression in patients with T2DM. Materials and Methods A total of 159 subjects (aged 62.51 ± 10.3 years, 68.6% were male) who underwent serial coronary computed tomography angiography (CCTA) with type 2 diabetic status were enrolled. Annual change of plaque volume (PV) (mm3/year) was defined as PV change divided by inter-scan period. RPP was defined as the progression of plaque burden (PV divided by vessel volume multiplied by 100) ≥0.59%/year. Plaque components were compared between RPP and no RPP groups. Then all patients were divided into 3 groups according to the baseline calcified plaque volume tertiles. The outcome was whether RPP occurred. Results The median inter-scan period was 2.09 (range 1.41–3.33) years. The overall incidence of RPP was 61.0%. The calcified plaque volume decreased significantly in the RPP group as compared to the no RPP group. The risk of RPP (odds ratio [OR] 0.39; 95% confidence interval [CI]: 0.17-0.88; p = 0.024) was reduced in tertiles III as compared to that in tertiles I even after adjustment for baseline variables (OR 0.21; 95% CI: 0.07–0.63; p = 0.005). Moreover, adding the calcified plaque volume significantly raised the predictive value for the RPP (0.370, p = 0.030, and 0.059, p = 0.025, NRI, and IDI respectively) as compared to traditional factors. Conclusion The baseline calcified plaque volume is an independent protective factor for the rapid progression of coronary atherosclerosis in patients with T2DM.

Meta-analysis and trial sequential analysis of ezetimibe for coronary atherosclerotic plaque compositions.

Background: Lipid aggregation, inflammatory cell infiltration, fibrous cap formation, and disruption are the major causes of atherosclerotic cardiovascular disease (ASCVD) and the pathologic features of atherosclerotic plaques. Although ezetimibe's role in decreasing blood lipids is widely known, there are insufficient data to determine which part of the drug has an effect on atherosclerotic plaque compositions. Objective: The study aimed to systematically evaluate the efficacy of ezetimibe for coronary atherosclerotic plaque compositions. Methods: Two researchers independently searched the PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) on the efficacy of ezetimibe for coronary atherosclerotic plaques from inception until 22 January 2023. The meta-analysis and trial sequential analysis (TSA) were performed using Stata 14.0 and TSA 0.9.5.10 Beta software, respectively. Results: Four RCTs were finally included this study, which comprised 349 coronary artery disease patients. Meta-analysis findings showed that, compared with the control group, intervention measures could effectively reduce the fibro-fatty plaque (FFP) volume [WMD = -2.90, 95% CI (-4.79 and -1.00), and p = 0.003 < 0.05]; there were no significant difference in the reduction of fibrous plaque (FP) volume [WMD = -4.92, 95% CI (-11.57 and 1.74), and p = 0.15 > 0.05], necrotic core (NC) volume [WMD = -2.26, 95% CI (-6.99 and 2.46), and p = 0.35 > 0.05], and change dense calcification (change DC) volume [WMD = -0.07, 95% CI (-0.34 and 0.20), and p = 0.62 > 0.05] between the treatment group and the control group. TSA findings showed more studies are still required to confirm the efficacy of ezetimibe for FP and NC in the future. Conclusion: Compared to the control group, ezetimibe significantly decreased FFP, but it had no statistically significant difference on FP, NC, or change DC. According to TSA, further research will be required to confirm the efficacy of ezetimibe for FP and NC in the future.

Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia.

Chronic coronary syndrome (CCS) is a progressive disease, which often first manifests as acute coronary syndrome (ACS). Imaging modalities are clinically useful in making decisions about the management of patients with CCS. Accumulating evidence has demonstrated that myocardial ischemia is a surrogate marker for CCS management; however, its ability to predict cardiovascular death or nonfatal myocardial infarction is limited. Herein, we present a review that highlights the latest knowledge available on coronary syndromes and discuss the role and limitations of imaging modalities in the diagnosis and management of patients with coronary artery disease. This review covers the essential aspects of the role of imaging in assessing myocardial ischemia and coronary plaque burden and composition. Furthermore, recent clinical trials on lipid-lowering and anti-inflammatory therapies have been discussed. Additionally, it provides a comprehensive overview of intracoronary and noninvasive cardiovascular imaging modalities and an understanding of ACS and CCS, with a focus on histopathology and pathophysiology.

Coronary Artery Plaque Composition and Severity Relate to the Inflammasome in People With Treated Human Immunodeficiency Virus.

Inflammasome activation is increased in people with human immunodeficiency virus (PWH), but its relationship with coronary plaque is poorly understood in this setting. In a large human immunodeficiency virus cardiovascular prevention cohort, relationships between caspase-1, interleukin (IL)-1β, and IL-18 and coronary plaque indices were assessed by multivariate logistic regression. Higher IL-18 and IL-1β were associated with Leaman score, an integrative measure of plaque burden and composition. As Leaman score >5 is associated with cardiovascular events in the general population, future work is needed to determine how the inflammasome relates to events and whether strategies to reduce its activation affect events or plaque progression among PWH.

Assessment of Systemic Immune-Inflammation Index and Systemic Inflammation-Response Index in Different Coronary Artery Plaque Types.

Coronary computed tomography angiography can evaluate coronary arterial plaque composition with high resolution. We aimed to determine and compare the values of systemic immune-inflammation index (SII) and systemic inflammation-response index (SIRI) in different plaque types. Highest values of SIRI and SII were found in mixed plaque type followed by non-calcified plaque type. SII value of 463.07 predicted one-year major adverse cardiac events (MACE) with a sensitivity of 72.7% and specificity of 64.3% and SIRI value of 1.14 predicted one-year MACE with a sensitivity of 93% and specificity of 62%. Paired analysis of area under the curve (AUC) of the receiver operating characteristic curves showed that SIRI had higher AUC than coronary calcium score and SII. Univariate logistic regression results showed that age, creatinine level, coronary calcium score, SII, and SIRI were the independent predictors of one-year MACE. According to the results of multivariate regression analysis, after adjusting other factors, age, creatinine level, and SIRI were the independent predictors of one-year MACE. SIRI seemed to improve the risk prediction in coronary artery disease. Therefore, special attention may need to be paid to patients who have a high SIRI.

Coronary low-attenuation plaque and high-sensitivity cardiac troponin

ObjectiveIn patients with acute chest pain who have had myocardial infarction excluded, plasma cardiac troponin I concentrations ≥5 ng/L are associated with risk of future adverse cardiovascular events. We aim...

Relationship Between Sclerostin Levels and Coronary Artery Calcification and Plaque Composition.

The primary function of sclerostin is the regulation of bone metabolism. Research investigating the cardiovascular effects of sclerostin had conflicting results. We aimed to study serum sclerostin levels in coronary artery plaque types. Coronary calcium scores of 175 patients were evaluated. Patients with normal coronary arteries and calcium score of greater than zero constituted control (n = 47) and study groups (n = 83), respectively. Patients' plaques were further categorized as non-calcified plaque, calcified plaque, or mixed plaque (n = 45, n = 40, and n = 43, respectively). The study group had increased serum sclerostin levels than that of controls. Moreover, sclerostin levels were significantly higher in patients with calcified or mixed plaques compared to those without plaque or non-calcified plaque (median 248.5, 60.7-790.4) pg/mL and 1085.8 (185.8-3902.2) pg/mL versus 68.7 (34.0-141.3) pg/mL, and 67.7 (48.6-94.9) pg/mL, P < 0.001, respectively). Sclerostin showed a high correlation with coronary calcium scores (r = 0.95, P < 0.001). Serum sclerostin concentration of 106.27 pg/mL had 97.5% sensitivity and 67.4% specificity for the prediction of calcific plaque, whereas the level of 308.55 pg/mL had 95.3% sensitivity and 90.9% specificity for the prediction of mixed plaque. Coronary calcium scores, serum sclerostin, and C-reactive protein levels were significant predictors of 1-year major adverse cardiac events. Increased serum sclerostin level is a marker of coronary atherosclerosis burden and has a value for the prediction of 1-year major adverse cardiac events.

42 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON-CULPRIT CORONARY PLQUES

Abstract Background Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood. Purpose Our study aims to analyse the characteristics of non-culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery. Methods We included 1848 non-culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient. Results Overall, median age was 66 years (56-74), with 24.6% of women and 53.4% of ACS. At patient-level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion-level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season). Table 1 Conclusions Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.

Daytime sleepiness is associated with increased coronary plaque burden among patients with obstructive sleep apnea.

To investigate the cross-sectional associations of daytime sleepiness with coronary plaque volume and composition in patients with obstructive sleep apnea (OSA), and whether or not these associations are modified by age, gender, and obesity. Patients who were confirmed with OSA through respiratory polygraphy and also underwent coronary CTA at a tertiary hospital were consecutively enrolled. The interval between the sleep monitoring and coronary CTA scan was < 3months. Every patient completed the Epworth sleepiness scale (ESS) to assess daytime sleepiness, and an ESS score of ≥ 11 was recognized as excessive daytime sleepiness (EDS). Coronary plaque volume and composition were measured using semi-automatic software. Of the 394 patients with OSA (median [IQR] age, 56.0 [49.0-64.0] years; median [IQR] body mass index, 27.9 [25.5-30.2] kg/m2; median [IQR] apnea-hypopnea index, 21.3 [11.7, 36.3] events/h), a total of 200 patients had EDS. In the overall participants, a significant dose-response relationship between ESS scores and low-attenuation plaque volume was found in the fully adjusted model (P = 0.019). Further analysis demonstrated that there was a significant interactive effect of ESS levels and obesity on coronary plaque volume (all P values for interaction analysis < 0.05). Specifically, ESS levels were associated with total plaque volume, volumes of noncalcified, low-attenuation, and calcified plaque (P = 0.008, 0.006, 0.005, and 0.043 respectively) in obese patients with OSA. Daytime sleepiness is significantly correlated with increased coronary plaque burden among patients with OSA. Thus, clinicians should recognize that patients with OSA reporting high ESS scores, especially those with obesity, are more prone to experience adverse coronary events.

Abstract 12310: Comparison of Coronary Artery Calcium Quantification Methods in Statin Users and Non-Users

Background: Coronary artery calcium (CAC) can be quantified using various methods. The Agatston score (AS) computes the weighted sum of lesions with the maximum plaque attenuation factor. Calcium Volume measures the total volume of CAC, whereas Calcium Density has been shown to provide superior prognostication compared to the AS. Since statin use is associated with change in coronary plaque composition and thus CAC, we evaluated the difference CAC quantification methods among patients with suspected CAD receiving and not receiving statin therapy. Methods: Patients with suspected CAD and underwent cardiac computed tomography were recruited from a tertiary hospital in Singapore. Patient demographics and risk factors were obtained from electronic medical records. AS, Calcium Volume, Number of Lesions and Calcium Density were individually analysed with patient demographics and risk factors using multivariate models. Results were compared between patients on statins and not on statins to assess differences in CAC quantification methods. Results: Of the 528 patients, 43.0% were female, 40.9% had hypertension, 14.8% had diabetes, 44.3% had family history of CAD and 23.5% were smokers. While 58.5% of patients had hyperlipidemia, only 48.9% were on statin therapy. The mean age was 53.9±10.9 years, and the mean BMI was 26.1±5.69. Diabetes, hypertension, family history of CAD, and older age was more likely present in statin users (P &lt; 0.05 for all). In multivariate analysis, these variables and higher BMI were significantly associated with statin use in all four models (Table 1). For CAC quantification, Calcium Volume, AS, and Number of Lesions did not differ significantly between statin users and non-users, whereas Calcium Density was higher in statin users (OR = 1.19, CI = (1.02, 1.39), P = 0.025). Conclusions: Statin use is associated with higher Calcium Density but is not associated with differences in other CAC quantification methods in patients with suspected CAD.

Abstract 13889: Effect of Eicosapentaenoic and Docosahexaenoic Acid Supplementation on Noncalcified Coronary Plaque and Coronary Artery Calcium Score in Subjects With Coronary Artery Disease According to Hypertension Status

Introduction: Higher amounts of noncalcified plaque and higher coronary artery calcium (CAC) scores are associated with increased cardiovascular events and mortality. The effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on noncalcified coronary plaque and more advanced calcified plaque as measured by the CAC score according to hypertensive (HTN) status is unknown. Methods: A total of 242 subjects with coronary artery disease (CAD) on statin were randomized to 3.36 g of EPA+DHA or none (control) for 30 months. Coronary plaque composition and CAC scores were measured with computed tomographic coronary angiography at baseline and 30-month follow-up. Results: Mean (SD) age was 63.1 years (7.7); mean (SD) LDL-C: 77.8 mg/dL (27.3) and median [IQR] triglyceride (TG): 117.5 mg/dL [81.3,166.8]. Despite a significantly higher CAC score at baseline in HTN subjects, both HTN and normotensive (NTN) subjects had similar CAC progression over 30 months with no difference between EPA+DHA and control groups (Figure B). NTN subjects on EPA+DHA had a 20.7% reduction in TG level and 36.6% lower neutrophil count, a marker of inflammation, and lack of progression of noncalcified plaque compared to control who had progression (median % change: -7.6 vs 13.2 mm 3 /mm, P=0.008) (Figure A). In contrast, HTN subjects on EPA+DHA and control had progression of noncalcified coronary plaque with no significant difference between the two groups (Figure A) Conclusions: EPA+DHA prevented progression of noncalcified plaque in NTN subjects but not HTN subjects with no effect on more advanced plaque which has calcified in the setting of low LDL-C and TG levels. The benefit of EPA+DHA in CAD patients on statin therapy appears limited to noncalcified coronary plaque in NTN subjects. Whether this benefit is related to more favorable effects on inflammation based on blood pressure status should be examined further.

Abstract 11941: Accuracy of OCT Core Labs in Determining Coronary Artery Plaque Composition

Introduction: Intravascular optical coherence tomography (OCT) provides a high-resolution representation of coronary atherosclerosis. However, the accuracy of OCT image interpretation is unknown. We present a blinded study of histologically identified OCT human plaque composition by leading international OCT core labs. Hypothesis: Human readers are unable to accurately identify all plaque compositions. Methods: Seven recognized OCT core labs (Japan, Netherlands, Switzerland, USA) participated. Each laboratory was provided 51 OCT image clips recorded from ex vivo human coronary arteries within 24 hours of death and had regions of interest processed for H&amp;E stain. Nine plaque components were identified and are listed in Results. Each OCT core lab was asked to blindly read OCT images and complete a questionnaire indicating one of nine possible plaque types. Kappa coefficient ( k ) was used ( k &lt; 0.5 poor agreement, k &gt; 0.5 high agreement) to measure intra-reader agreement; the median k is reported for each plaque component. Results: High agreement was demonstrated in identifying stable plaque including fibrous (0.93), calcium (0.83), layered plaque (1.0), and ThCFA (0.63), in contrast to unstable plaque including calcified nodule (0.50), lipid pool (0.35), macrophages/foam cells (0.35), TCFA (0.39), and necrotic core (0.22). When categories were restricted to Fibrous, Calcium, and Lipids, with Lipids expanded to include lipid pool, TCFA, and necrotic core, similar to an OCT core lab definition, k for Lipids increased to 0.61. Conclusions: Results suggest that participating OCT core labs can accurately identify combined lipid categories (lipid pool, TCFA, and necrotic core), fibrous tissue and calcium. However, accuracy is reduced when reading more sophisticated unstable plaque components. Study results emphasize the need for the development of OCT plaque composition analysis with artificial intelligence.

Abstract 12520: Pathophysiologic Basis of Angina Symptoms in Women With Nonobstructive Atherosclerosis Using Artificial Intelligence-Enabled Coronary Plaque Analysis

Background: Coronary CT angiography (CCTA) artery plaque characteristics including low attenuation and positive remodeling are associated with future myocardial infarction. Associations between angina symptoms and plaque characteristics are unknown. Objective: To examine relationships between quantitative plaque characteristics and angina in women with nonobstructive plaque using artificial intelligence (AI)-enabled plaque analysis. Methods: A sample of women with angina and CCTA nonobstructive plaque (&lt;50% luminal stenosis) enrolled in the WARRIOR trial (NCT 03417388) was studied with validated AI software (Autoplaque 3.0, Cedars Sinai). Complete coronary plaque composition was expressed as noncalcified (NCP), low attenuation noncalcified plaque (LAP, as NCP&lt;30 Hounsfield Units) and calcified plaque (CP) (Figure). Plaque burden was defined as plaque volume x 100%/vessel volume. Angina was quantified by the Seattle Angina Questionnaire angina frequency domain. Relationships between plaque characteristics and angina frequency at enrollment were evaluated using linear and logistic regression in women with total plaque volume &gt;200mm 3 . Results: Among 72 women (age 61.8±10.1 yrs, BMI 30.3±7.2 kg/m2, LDL-C 86.5±27.9, HDL 55.8±17.3, total cholesterol 164.2±37.7 mg/dl, respectively), total plaque volume was 460.1±192.8mm 3 and NCP burden was 50.3± 7.1%. By linear regression, worsening angina frequency was related to increasing NCP burden (β=-0.76, p=0.011). In a logistic regression model, every unit increase in NCP burden was related to ~11% excess risk (1.108, 1.023-1.2, p=0.012) of monthly angina (angina frequency score ≤99). Conclusion: In women with nonobstructive coronary plaque and angina in the WARRIOR trial, higher CCTA NCP burden is associated with more frequent angina. Further work with quantitative AI analysis of CCTA from the WARRIOR trial will validate these preliminary findings.