Total Non-calcified Plaque Research Articles

Abstract 14729: Association of Iliac Artery Non-Calcified Plaque Volume and Acute Limb Ischemia: Insights From the VOYAGER PAD Angiographic Core Lab

Introduction/Background: Acute limb ischemia (ALI) is a severe complication of peripheral artery disease. Lipid lowering and antithrombotic therapies reduce ALI but pathologic studies have described thrombus in distal arteries without plaque, suggesting that artery to artery embolism from proximal (aortic-iliac) athero-thrombosis may be a key driver. Research Questions/Hypothesis: We hypothesized that the burden and character of atherosclerosis in the iliac arteries of patients with PAD would be associated with long term risk of ALI. Methods: VOYAGER PAD enrolled 6,554 patients with PAD and collected 2,200 baseline angiograms in 1,664 patients including 400 CT angiograms enabling plaque characterization. A case-control of 9 who had ALI during follow up and 9 controls were matched on anatomic and patient characteristics, type of index revascularization and disease pattern. Images were read by a blinded, independent imaging core lab. Results/Data: Of the 9 ALI cases, 45% had iliac artery occlusion and 55% had distal artery occlusion. Plaque characteristics were different in cases relative to controls including significantly greater non-calcified plaque volume (OR 2.36, 95% CI 1.05 - 9.38, p=0.03) as well as similar trends for low attenuation plaque (OR 1.65, 95% CI 0.89 - 4.72, p=0.05), and plaque burden (OR 1.16, 95% CI 1.00 - 1.25, p=0.03, Figure). In patients who experienced ALI, there was a trend for greater non-calcified plaque in the limb that experienced the ALI relative to the contra-lateral limb (index 7.2 vs contra-lateral 5.4, p=0.08). Conclusions: In a case-control series, total non-calcified plaque volume and overall plaque burden in the iliac arteries were associated with future ALI over 3 years. Based on the observations in this case-control, we are now analyzing plaque and outcomes in the full cohort. These data are hypothesis generating and suggest that plaque characteristics may be associated with ALI and may serve a surrogate marker of risk.

Are artificial intelligence derived coronary atherosclerotic characteristics associated with subsequent development of acute coronary syndrome (ACS)

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Scripps Health Krueger Wyeth Grant Background ACS results from unstable atherosclerotic plaques. Current measures to assess risk do not consider the patient’s coronary atherosclerotic composition. This was a case control study using a prospective single-center registry of patients undergoing CCTA (N=2,700) from 2017–2020 to assess the association between plaque characterization and the occurrence of ACS. Methods ACS cases were adjudicated independently by two cardiologists using data from the EMR. Patients with prior ACS prior to CCTA, were excluded. Controls were selected 1:1 by nearest neighbor propensity matching (R. v. 4.0.3.) based on age, sex, smoking, HTN, HLD, and DM. Plaque burden and stenosis features were calculated by a commercially available artificial intelligence (AI) coronary analysis (Figure 1). Results There were 21 cases and 21 controls. Mean age of 68, 43% women, 5% Hispanic, 29% smoking hx, 76% HTN, 81% HLD, 24% DM, CAD-RADS score 2.3, and CAC of 487. Median time from CT to ACS for cases was 329 days. Presence of total non-calcified plaque, calcified plaque, fibro-fatty plaque, maximum stenosis diameter percentage and total plaque were each associated with greater risk of ACS (Table 1). Conclusion AI assessment of CCTA plaque characteristics were associated with ACS. This study shows the association between AI derived coronary atherosclerotic features and development of ACS in patients undergoing CCTA and highlights the potential utility of using AI-driven plaque characterization to predict ACS.

Coronary Computed Tomography Angiography Evaluation of Plaque Morphology and Its Relationship to HDL and Total Cholesterol to HDL Ratio

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Traditionally non-high-density lipoprotein (non-HDL) indicators have been utilized to stratify cardiovascular risk. Population studies have demonstrated an inverse relationship between HDL cholesterol levels and cardiovascular risk, however, the mechanism by which HDL exhibits its protective effect on the cardiovascular system remains unclear. <h3>Objective/Purpose</h3> To investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with coronary artery plaque burden as determined by coronary computed tomography angiography (CCTA). <h3>Methods</h3> This is a cross-sectional study evaluating the association of HDL-C and TC/HDL ratio with coronary artery plaque volumes. We identified 190 subjects who had undergone quantitative plaque analysis and had lipoprotein values available at our institution. Plaque was analyzed quantitatively utilizing semi-automated plaque analysis software (QAngio version 2.0.5). The plaque volumes are presented as total atheroma volume normalized (TAVnorm). The HDL-C level and TC/HDL ratio were analyzed as continuous variables and categorized at clinically relevant levels. Multivariate regression models adjusted for cardiovascular risk factors were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. <h3>Results</h3> The mean (SD) age of the 190 subjects was 58.9 (+/-9.8) years, and 63% were male. After adjustment for cardiovascular risk factors, HDL- C (>40mg/dL) is inversely associated with fibrous (p=0.003), fibrous fatty (p=0.009), low attenuation plaque (LAP) (p=0.014), total non- calcified plaque (TNCP)(p=0.003), and total plaque (TP)(p=0.005) volume but not associated with dense calcified plaque (p=0.229). TC/HDL ratio (>4.0) is directly associated with LAP (p=0.024) and not associated with fibrous, fibrofatty, TNCP, dense calcified plaque and TP volume. Notably, when examined as continuous variables, increasing HDL- C level is inversely associated with fibrous plaque, TNCP and TP volume and increasing TC/HDL ratio is directly associated with increasing fibrous plaque, and fibrous fatty plaque, LAP, TNCP and TP volume, independent of other risk factors. <h3>Conclusions</h3> There is a strong association between low HDL-C and increasing TC/HDL ratio with increasing coronary plaque volumes, independent of traditional risk factors of atherosclerosis. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C in coronary artery disease. Additionally, TC/HDL ratio offers value as a secondary treatment target beyond LDL-C, which is especially beneficial in individuals with prevalent lipid discordance, such as those with diabetes and metabolic syndrome.

524 Association Of Plasma Lipid Metabolomics And Coronary Plaque Progression In The Evaporate Trial

Introduction: Despite the effects of statins on reduction of LDL-cholesterol (LDL-C) and coronary plaque progression, significant residual cardiovascular (CV) risk persists in patients with elevated triglycerides (TGL). Icosapent ethyl (IPE) as an adjunct to statins was shown to significantly reduce adverse CV events in patients with residual hypertriglyceridemia. The EVAPORATE trial showed that IPE significantly reduced progression of Total Plaque (TP) and Total Non Calcified plaque (TNCP), assessed by serial CCTA.

Coronary computed tomography angiography evaluation of plaque morphology and its relationship to HDL and total cholesterol to HDL ratio

BackgroundWhile population studies have demonstrated that high density lipoprotein cholesterol (HDL-C) and the ratio of total cholesterol to HDL (TC/HDL) improve cardiovascular risk prediction, the mechanism by which these parameters protect the cardiovascular system remains uncertain. ObjectiveTo investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with the morphology of coronary artery plaque as determined by coronary computed tomography angiography (CCTA). MethodsThis is a cross-sectional study involving 190 subjects with stable coronary artery disease. Semi-automated plaque analysis software was utilized to quantify plaque and plaque volumes are presented as total atheroma volume normalized (TAVnorm). Multivariate regression models were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. ResultsOf the 190 subjects the average (SD) age was 58.9 (9.8) years, with 63% being male. After adjustment for cardiovascular risk factors, HDL- C (>40 mg/dl) is inversely associated with fibrous (p = 0.003), fibrous fatty (p = 0.007), low attenuation plaque (LAP) (p = 0.007), total non-calcified plaque (TNCP) (p = 0.002) and total plaque (TP)(p = 0.004) volume. Furthermore, the TC/HDL ratio (> 4.0) is associated with fibrous (p = 0.047) and total non-calcified plaque (p = 0.039), but not with fibrofatty, LAP, dense calcified plaque, or TP volume. ConclusionThere is a strong association between low HDL-C levels and increasing TC/HDL ratio with certain types of coronary plaque characteristics, independent of traditional risk factors. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C and the TC/HDL ratio's clinical relevance in coronary artery disease management.

Abstract 12493: Comparison of Coronary Plaque Progression by Coronary Computed Tomography Angiography in Systemic Lupus Erythematosus and Rheumatoid Arthritis

Introduction: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are autoimmune diseases associated with high incidence of cardiovascular disease (CVD), likely related to common underlying pathways of inflammation. Characterization of coronary atherosclerosis, particularly total plaque (TP) and total non-calcified plaque (TNCP), on Coronary Computed Tomography Angiography (CCTA) has been correlated with adverse CV events. We compared rates of coronary plaque progression by serial CCTA in SLE and RA patients. Methods: Semi-automated plaque software (Qangio, Medis) was used for quantitative coronary assessment. Analysis included 22 SLE [48.5 (13.0) years; 19 females; 64% White] and 22 age and sex- matched RA patients [49.1 (11.2) years; 19 females; 95% Hispanic]. Linear regression was used to compare log adjusted total atheroma volume ((TAV norm ) = (Plaque volume)/Vessel length * mean cohort vessel length)) for TP and TNCP between SLE and RA patients. Results: Baseline mean levels of TAV norm for TP and TNCP in RA patients vs SLE patients were 0 (0 - 7.3) mm 3 vs 21.2 (1.1 - 64.1) mm 3 (p &lt;.0001) and 0 (0 - 5.8) mm 3 vs 19.5 (1.1 - 62.2) mm 3 (p&lt;.0001), respectively. After adjustment for baseline plaque and CV risk factors, progression of TAV norm was higher in SLE than RA patients (log TAV TP volume (β: 2.271 (.530), p=.0001) and log TNCP volume (β: 2.384 (.502), p&lt;.0001) (Table 1). Patients with RA had 87% less TP and 89% less TNCP progression than those with SLE. Conclusions: These results suggest that coronary plaque progression is greater in young, adult SLE patients, compared to RA patients. These results improve the mechanistic understanding of increased CV risk in these patients. Further research to evaluate screening and targeted management strategies for CVD in this high risk cohort, especially SLE is warranted.

Abstract 11478: Epicardial Adipose Tissue Volume - Relationship with Coronary Artery Plaque Vulnerability and Myocardial Ischemia in Non-Obstructive Coronary Artery Disease

Introduction: Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability and myocardial ischemia in patients with non-obstructive CAD. Methods: We included 125 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA). EAT volume was quantified on non-contrast cardiac computed tomography images by a semiautomatic analysis software. CCTA images were analysed with respect to plaque volume and composition. Plaque vulnerability was assessed as total coronary non-calcified plaque volume and positive remodelling index &gt;1.10. Myocardial ischemia was detected by contrast dobutamine stress echocardiography. Patients were grouped in tertiles of EAT volume and high EAT volume was defined as volumes in the highest tertile (≥125 ml). Results: In the total study population (median age 63(58, 69) years and 58% women), the median EAT volume was 104 (77, 141) ml. High EAT volume was more common in men and associated with higher BMI, hypertension and positive remodelling (all p&lt;0.05). There was no difference in age, prevalence of diabetes, total non-calcified plaque volume or presence of myocardial ischemia between groups (all p≥0.34). This was confirmed in univariable logistic regression analyses (Table). After adjusting for covariables in a multivariable model, the association between positive remodelling and high EAT volume was attenuated (Table). Conclusion: High EAT volume was associated with positive remodelling, but not with total non-calcified plaque volume or myocardial ischemia, and the association was attenuated after multivariable adjustments.

Abstract 14060: Gender Difference in Atherosclerotic Plaque Characteristics and Vascular Morphology Features by Coronary CTA in Coronary Artery Disease With and Without Ischemia (CREDENCE Substudy)

Introduction: It is unknown whether gender differences exist in the atherosclerotic plaque characteristics (APCs) and vessel morphology of patients with and without ischemia. Hypothesis: There are no gender differences in the APCs or vessel morphology of patients with and without ischemia. Methods: The 303 patients in the CREDENCE (Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia) trial were enrolled following referral for non-emergent invasive coronary angiography with 3-vessel FFR and subsequently underwent CCTA per study protocol. Ischemic vessels were defined by FFR &lt; 0.8 or vessel diameter stenosis &gt; 90% on invasive investigation. A blinded quantitative analysis using artificial intelligence software was used to quantify APCs visualized on CCTA throughout the coronary tree (Cleerly Labs, Cleerly Inc., New York). APCs and vessel morphology data were stratified by gender for further analysis. Results: Among the 303 patients in the study cohort, 162 (53.4%) patients (22.8% females) had ischemic vessels and 141 (46.6%) patients (36.2% females) had non-ischemic vessels. While men were more likely to use tobacco ( p &lt;0.0001), there were no other gender differences in the age or comorbidity profile of the cohort. On imaging, men had more total plaque (non-ischemic group only) ( p =0.018), low-density non-calcified plaque and non-calcified plaque (NCP) volume, as well as greater lesion length, and lumen volume than females. There were no gender differences in calcified plaque, remodeling, high risk plaques, stenosis diameter, or APCs normalized for vessel volume (PAV). Conclusion: In patients with and without ischemia, men have a higher prevalence of low-density NCP and total NCP volume, with no significant differences in remodeling or other atherosclerotic features. These composition plaque differences may be useful to determine gender-specific risks of coronary ischemia as compared to invasive FFR.

Association of plaque type with insulin resistance estimated by HOMA-IR (Homeostatic Model Assessment for Insulin Resistance).

BackgroundPrevious studies have reported that insulin resistance plays an important role in the burden of atherosclerosis. However, only limited studies have evaluated the association between the type of plaque and insulin resistance. HOMA-IR is the method used to assess β-cell function and insulin resistance using fasting glucose and fasting insulin levels. MethodsWe conducted a retrospective analysis using the data from EVAPORATE trial (Effect of Vascepa on Improving Coronary Atherosclerosis in People with High Triglycerides Taking Statin Therapy) . We evaluated 72 patients with known coronary atherosclerosis, aged 30–85 years, 54% were male, 67% had diabetes, 44% were smokers, mean BMI 32.8 kg/m2. Coronary computed tomography angiography (CTA) was performed using a multidetector CT scanner. Quantitative plaque assessment was performed using a semi-automated plaque analysis software (QAngio, Medis, Netherlands). ResultsIn a univariate regression analysis, densely calcified plaque (DC), Fibrous plaque (F), total non-calcified plaque (NCP), and total plaque (TP) were associated with their baseline HOMA-IR. After adjusting for age, gender, diabetes mellitus, Hypertension, and past smoking, we estimate a 1 unit increase of HOMA-IR is associated with 12% higher fibrous plaque volume, p=0.029, and 17% higher DC plaque volume, p=0.045. ConclusionHOMA-IR is independently associated with fibrous, and dense calcified plaque.

Effect of diabetes mellitus on coronary plaque characteristics and progression by serial Coronary Computed Tomography Angiography (CCTA)

Abstract Background Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) and associated poor outcomes. There is a higher incidence of major adverse cardiac events in patients with DM than those without DM. Coronary plaque characteristics measured by CCTA are correlated with adverse cardiovascular (CV) outcomes. Purpose We sought to evaluate coronary plaque characteristics as well as rates of progression of coronary plaque burden as measured by serial CCTA in patients with DM and those without DM. Methods The study population included a total of 403 participants (mean age 61.4±11.4 years, 53% men; median scan interval 1.5 years) who were prospectively enrolled in serial CCTA trials. We identified 212 participants with DM and 191 participants without DM, who had undergone serial CCTA. Coronary Plaque volumes were measured and characterized as low attenuation plaque (LAP), total non-calcified plaque (TNCP) and total plaque (TP) using semi-automated plaque analysis software (Qangio medis). Multivariate linear regression was used to examine the effect of DM on coronary plaque progression. Results Patients with DM had greater rates of progression of normalized TP volume (median change in annualized plaque (IQR): 39.1 (9.9–114.4) in DM vs 23.5 (4.1–63.8) mm3 in non-DM, p=0.001), TNCP volume (21.6 (3.3–60.8) in DM vs 8.7 (0.1–35.6) mm3 in non-DM, p=0.003) and LAP volumes (0.7 (−0.6 to 7.8) in DM vs 0.1 (−0.4 to 1.9) mm3 in non-DM, p=0.04). After adjusting for relevant risk factors and baseline plaque, the annualized rates of progression were higher in patients with DM by 28% for TP (p=0.004), 27% for TNCP (p=0.011), 23% for fibrous plaque (p=0.026) and by 42% LAP (p=0.050), compared to those without DM. Conclusion Patients with DM have significantly higher rates of coronary plaque progression, including vulnerable LAP, than those without DM. Our findings reveal differences in rates, burden and characteristics of coronary plaque progression in patients with DM vs those without DM. These results provide mechanistic understanding of natural history of coronary atherosclerosis in this vulnerable population, that could explain the increased risk of CV events among patients with DM. Coronary atherosclerotic phenotyping by CCTA could serve as a potential surrogate measure for risk stratification and evaluation in clinical trials to examine therapeutic strategies in this vulnerable population. Funding Acknowledgement Type of funding sources: None.

Abstract 14687: Achieved Eicosapentaenoic Acid (EPA) Levels Predicts Regression of Coronary Plaque Volumes by Coronary Computed Tomography Angiography (CCTA) in the EVAPORATE Trial

Background: Despite the beneficial effects of statins on progression of coronary atherosclerosis and cardiovascular (CV) events, significant CV risk persists in patients with hypertriglyceridemia. In REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), icosapent ethyl (IPE) added to statins reduced initial and total CV events by 25% and 30%, but the mechanisms of benefit are unclear. In a follow-up analysis, degree of CV benefit from IPE was predominantly related to achieved serum EPA levels. Methods: EVAPORATE is a randomized, placebo-controlled trial, using CCTA to evaluate the effects of IPE as an adjunct to statins on coronary plaque volumes in a cohort with elevated triglycerides. Here, we present the 18-month, pre-specified secondary end-point analysis on association of achieved serum EPA levels, and change in coronary plaque volumes in the pooled cohort. Results: 80 patients were enrolled, and 68 completed the 18-month visit. Median (IQR) level of serum EPA for the pooled cohort was 20.6 (13.8) ug/ml at baseline and 25.3 (55.5) ug/ml at follow up. At 18 months, EPA levels &gt; 26 ug/ml predicted regression of fibro-fatty plaque (logβ: - 0.75± 0.36), total non-calcified plaque (TNCP) (logβ: - 0.77± 0.33), and total plaque (TP) (logβ: - 0.63± 0.28) volumes (mm3), after adjustment for age, sex, diabetes, hypertension, and baseline TGL levels (p &lt; 0.05 for all). Conclusions: Higher serum EPA levels predict regression of prognostically relevant coronary plaque volumes, TNCP, and TP on CCTA. This provides important mechanistic correlation to the CV benefits of IPE.

Abstract 15473: Effect of Statins on Coronary Plaque Progression Assessed by Serial Coronary Computed Tomography Angiography

Introduction: Statins stabilize coronary plaques and reduce clinical events. However, it is unclear how statins change the total plaque burden and plaque morphology. Hypothesis: We aimed at investigating whether statin users have less coronary plaque progression compared to non-statins users. Methods: We identified 243 subjects undergoing serial computed tomography angiography, 163 taking statins and 80 who are not. Coronary plaque (total, calcified, non-calcified including fibrous, fibrous-fatty and low-attenuation plaque (LAP)) volume was measured using semi-automated plaque software (Qangio, Medis) and its change overtime between statins users and non-statins users was evaluated using Analysis of Covariance (ANCOVA) modeling adjusted for age, gender, diabetic status, presence of hypertension, past smoking use, and baseline plaque levels. Results: Subjects on statin therapy had higher body mass index, were more likely to be diabetic, had hyperlipidemia, and were past smokers. Median coronary artery calcium score was significantly lower in the statin group; p&lt;0.034. Driven primarily by changes in fibrous plaque, those on statin therapy showed 25% less total plaque (P=0.013) and 31% less total non-calcified plaque (P=0.006) at follow-up than non-statin users. Conclusions: The current study indicates that statin use is associated with less progression of total plaque and total non-calcified plaque burden.

Abstract 16281: Non-calcified Coronary Plaque Burden is Related to Epicardial Adipose Tissue and Peri-coronary Adipose Tissue Attenuation in Heart Failure With Preserved Ejection Fraction

Introduction: Coronary inflammation may be a factor in developing heart failure with preserved ejection fraction (HFpEF). Epicardial fat volume (EFV) measured using non-contrast computed tomography (CT) and pericoronary adipose tissue (PCAT) attenuation on coronary CT angiography (CCTA) are considered to be inflammatory mediators, which play an important role in the development of coronary plaque. Hypothesis: We hypothesize that there is an interrelationship between these measures in HFpEF and no obstructive coronary artery disease (CAD). Methods: 28 subjects with HFpEF (European Society of Cardiology criteria), with coronary CCTA-documented absence of obstructive CAD. Non-calcified plaque (NCP), low-density non-calcified plaque (LDNCP), PCAT attenuation were quantified using semi-automated software and EFV was quantified using QFAT software. PCAT attenuation in Hounsfield Units (HU) was measured in a standardized 40 mm segment around the proximal right coronary artery. Statistical analysis was performed using Spearman correlation and multivariable regression models adjusted for age, BMI, EFV, and PCAT tested relations to NCP burden. Results: Overall, the mean age of 64.8±12 years, 74% women, BMI 29.3±4, total cholesterol 162±41mg/dl, LDL 85±29 mg/dl, HDL 55±14 mg/dl, systolic BP 132±22mmHg, diastolic BP 77±12mmHg, EFV 139±73 cm 3 and, PCAT attenuation -78±8 HU. Mean total NCP burden 34±13%, total LDNCP burden 3±1.8 %, and coronary calcium score (CCS) 414±920. EFV and PCAT attenuation correlated with the coronary risk markers including CCS and NCP burden variables (Table). In multivariable analysis, age and PCAT (β±SE=0.43±0.2, p=0.04, 0.64±0.3, p=0.03 per 1%-change in NCP burden respectively) were related to NCP burden. Conclusions: EFV and PCAT attenuation are associated with non-calcified plaque burden and may play an important role in the pathophysiological process of HFpEF. Further studies are needed to further understand these findings.

The effect of omega-3 fatty acids on coronary atherosclerosis quantified by coronary computed tomography angiography

Data on the effects omega-3 fatty acids on coronary artery disease (CAD) are contradictory. While a recent metanalysis could not show improved cardiovascular outcomes, anti-atherogenic mechanisms are well known. Aim was to assess the influence of Omega-3 polyunsaturated long-chain fatty acids (PUFA) supplementation on coronary atherosclerosis quantified by coronary computed tomography angiography (CTA). 106 patients (59.4y±10.7; 50% females) with low-to-intermediate risk referred to CTA were included. 53 patients under omega 3-PUFA (docosahexaenoic acid, DHA and eicosapentaenoic acid, EPA) supplementation were retrospectively matched with 53 controls (CR) for age, gender and coronary risk profile (smoking, arterial hypertension, family history, dyslipidemia, c-LDL, Cholesterol, TG, diabetes) (1:1, propensity score) and lifestyle habits (exercise, alcohol consumption and nutrition). CTA analysis included 1) stenosis severity score >70%severe, 50-70% moderate, 25-50%mild, <25% minimal), 2) total plaque burden (segment involvement score (SIS) and mixed non-calcified plaque burden (G-score) and 3) high-risk-plaque features (Napkin-Ring-Sign, low attenuation plaque (LAP), spotty calcification<3mm, RI>1.1). CT-Density (Hounsfield Units, HU) of plaque was quantified by CTA. Prevalence of coronary atherosclerosis (any plaque: 83% vs. 90.6%, p=0.252), >50% stenosis and stenosis severity score (p=0.134) were not different between groups. Total and non-calcified plaque burden scores were lower in the omega-3 group (2.7 vs. 3.5, p=0.08 and 4.5 vs. 7.4, p=0.027 for SIS and G-score, resp.). Coronary artery calcium score (CACS) was similar (84.7 vs. 87.1AU). High-risk-plaque prevalence was lower in the Omega-3 group (3.8% vs. 32%, p<0.001); the number of high-risk-plaques (p<0.001) and Napkin-Ring-Sign prevalence was lower (3.8% vs. 20.9%) (p<0.001), resp. CT-density (HU) of plaque was higher in the Omega-3 group (131.6±2 vs. 62.1±27, p=0.02) indicating more fibrous-dense plaque component rather than lipid-rich atheroma. Mean duration of Omega-3 intake was 38.6±52months (range, 2-240). Omega-3-PUFA supplementation is associated with less coronary atherosclerotic "high-risk" plaque (lipid-rich) and lower total non-calcified plaque burden independent on cardiovascular risk factors. Our study supports direct anti-atherogenic effects of Omega-3-PUFA.

Association Of Thoracic And Pericardial Fat Volumes With Burden Of Baseline Coronary Plaque Components: Evaporate Trial

Introduction: Pericardial fat/Thoracic fat is an important factor in pathogenesis of coronary atherosclerosis due to association with metabolic and inflammatory activity and underlying anatomic proximity to coronary arteries. Total Plaque (TP) and total non-calcified plaque (TNCP) are associated with adverse cardiac outcomes. Association of thoracic/pericardial fat volumes and burden of different components of coronary plaques by CCTA is not known.

Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results.

Though statin therapy is known to slow coronary atherosclerosis progression and reduce cardiovascular (CV) events, significant CV risk still remains. In the REDUCE-IT study, icosapent ethyl (IPE) added to statin therapy reduced initial CV events by 25% and total CV events by 30%, but its effects on coronary atherosclerosis progression have not yet been fully investigated. Therefore, this study is to determine whether IPE 4 g/day will result in a greater change from baseline in plaque volume measured by serial multidetector computed tomography than placebo in statin-treated patients. EVAPORATE is a randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis by coronary computed tomographic angiography (CCTA) (≥1 angiographic stenoses with ≥20% narrowing), on stable statin therapy with low-density lipoprotein cholesterol levels 40-115 mg/dL, and persistently high triglyceride levels (135-499 mg/dL). Patients underwent an interim scan at 9 months and were followed for an additional 9 months with CCTA at 0, 9, and 18 months. Here, we present the protocol-specified interim efficacy results. A total of 80 patients were enrolled, with 67 completing the 9-month visit and having interpretable CCTA at baseline and at 9 months (age = 57 ± 6 years, male = 36, 63%). At the 9-month interim analysis, there was no significant change in low attenuation plaque (LAP) between active and placebo groups (74% vs. 94%, P = 0.469). However, there was slowing of total non-calcified plaque (sum of LAP, fibrofatty, and fibrous plaque) (35% vs. 43%, P = 0.010), total plaque (non-calcified + calcified plaque) (15% vs. 26%, P = 0.0004), fibrous plaque (17% vs. 40%, P = 0.011), and calcified plaque (-1% vs. 9%, P = 0.001), after adjustment by baseline plaque, age, sex, diabetes, baseline triglyceride levels, and statin use. EVAPORATE is the first study using CCTA to evaluate the effects of IPE as an adjunct to statin therapy on atherosclerotic plaque characteristics in a high-risk CV population with persistently high triglyceride levels. It provides important mechanistic data in regards to the reduction in CV events in the REDUCE-IT clinical trial. NCT029226027.

Association of high-density lipoprotein levels with baseline coronary plaque volumes by coronary CTA in the EVAPORATE trial

Background and aimsDyslipidemia with elevated triglycerides (TGL) and low high-density lipoprotein cholesterol (HDL-C) predicts residual cardiovascular risk, despite goal LDL-C levels and optimal statin therapy. Coronary plaque characterization by CCTA can provide mechanistic understanding of coronary artery disease and associated prognosis. The role of HDL-C in the pathogenesis of atherosclerosis is not well understood in statin-treated patients with elevated TGL. We sought to examine the association of HDL-C levels with baseline coronary plaque volumes, namely total plaque (TP) and total non-calcified plaque (TNCP) volumes by CCTA in participants enrolled in the EVAPORATE trial. MethodsWe analyzed 80 participants who were enrolled in the trial. Linear regression analysis as a univariate and multivariate model adjusted for significant cardiovascular risk factors was performed to evaluate independent association of HDL-C and baseline coronary plaque volumes. In an exploratory analysis, stratified by sex, we compared the association of serum HDL-C levels with baseline coronary plaque volumes in males and females. ResultsMean (SD) age of participants (n = 80) was 57.1 (8.6) years and 43% were male. Median (Inter Quartile Range/IQR) log-TNCP volume was 83.0 (0.1–7.3) mm3 and median (IQR) log-TP volume was 144.8 (0.1–7.1) mm3. After adjustment for relevant clinical covariates including age, gender, BMI, hypertension, diabetes, past smoking and baseline TGL levels, increasing levels of HDL-C remain independently associated with lower baseline log-TNCP volumes (β: 0.043 ± 0.021, p = 0.042) and baseline log-TP volumes (β: 0.046 ± 0.022, p = 0.035) on CCTA. On stratifying by sex in a multivariable regression analysis, HDL-C levels were inversely associated with baseline log-TNCP volumes (β: 0.066 ± 0.026, p = 0.018) and log-TP volumes (β: 0.077 ± 0.025, p = 0.004) in females, but not in males (log-TNCP volumes β: 0.038 ± 0.034, p = 0.282) and log-TP volumes (β: −0.033 ± 0.036, p = 0.364). ConclusionsIn a cohort of statin treated patients with known atherosclerosis and residually elevated TGL, there was a significant inverse relationship between HDL-C levels and baseline coronary plaque, TP and TNCP volumes on CCTA. Our findings provide more detailed mechanistic evidence regarding the protective role of HDL-C in coronary atherosclerosis in a high-risk cohort. Further investigation to evaluate the interaction of HDL-C levels and coronary plaque volumes on differential CVD risk in statin-treated patients with elevated TGL levels is warranted.

0721 Coronary Atherosclerotic Plaque Burden and Composition in Patients with Obstructive Sleep Apnea by Coronary CT Angiography

Abstract Introduction OSA is closely associated with increased risk of coronary artery disease. Although previous small studies have investigated coronary plaque in OSA patients, limited data are available regarding the association of OSA with plaque morphology and composition. Therefore, we aimed to quantitatively characterize and compare coronary plaque burden and composition between patients with no or mild obstructive sleep apnea (OSA) and moderate-severe OSA using coronary computed tomography angiography (CTA) in a large-scale study. Methods We retrospectively analyzed consecutive patients who underwent sleep monitoring and coronary CTA. Metrics reflecting coronary plaque characteristics were compared between patients with no or mild OSA with apnea hypoxic index (AHI) ≤15 and moderate-severe OSA (AHI&amp;gt;15). The associations of OSA with coronary plaque components were determined by logistic and linear regression analysis. Results A total of 854 patients were enrolled in the study. Of these, 162 did not meet the inclusion criteria and of the remaining 692 patients 400 (57.8%) had moderate-severe OSA and 292 had no or mild OSA. Patients with moderate-severe OSA had a significantly higher total plaque volume, total non-calcified plaque (NCP) volume and total low density non-calcified plaque (LD-NCP) volume, and corresponding burden than those with no or mild OSA (all with p&amp;lt;0.05). Multivariate logistic regression analysis revealed that moderate-severe OSA patients are more likely to have any plaque, NCP and LD-NCP than those without no or mild OSA (p&amp;lt;0.05). In addition, stepwise multivariate linear regression analysis further revealed an independent relationship between moderate OSA (15&amp;lt;AHI≤30) and more so between severe OSA (AHI&amp;gt;30) and, NCP volume, LD-NCP volume, NCP composition, and LD-NCP composition, following adjustment for traditional cardiovascular risk factors, compared to no or mild OSA (AHI&amp;lt;15) (all with a p&amp;lt;0.05). Moderate-severe OSA conferred a similar odds ratio for LD-NCPs (a high-risk plaque) as the usual cardiovascular risk factors. Conclusion In this large cross-sectional study, OSA severity was associated with high-risk plaque features independent of traditional cardiovascular risk factors, suggesting an increased risk for cardiovascular events. Support This study was supported by NSFC (Project 81870335), International Science &amp; Technology Cooperation Program of China (No.2015DFA30160), Beijing Municipal Science &amp; Technology Commission (No. Z141100006014057)

ASSOCIATION OF HDL SUBCLASSES WITH BASELINE CORONARY PLAQUE BURDEN BY CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) FROM EVAPORATE (EFFECT OF VASCEPA ON IMPROVING CORONARY ATHEROSCLEROSIS IN PEOPLE WITH HIGH TRIGLYCERIDES TAKING STATIN THERAPY) TRIAL

Inflammation plays a key role in pathogenesis of atherosclerosis. Inflammatory markers have been studied as predictors for cardiovascular disease (CVD). Total Non-Calcified Plaque (TNCP) and Total Plaque (TP) volumes are correlated with adverse cardiovascular outcomes. We sought to examine

Coronary computed tomography-angiography quantitative plaque analysis improves detection of early cardiac allograft vasculopathy: A pilot study.

Cardiac allograft vasculopathy (CAV) is an increasingly important complication after cardiac transplant. We assessed the additive diagnostic benefit of quantitative plaque analysis in patients undergoing coronary computed tomography-angiography (CCTA). Consecutive patients undergoing CCTA for CAV surveillance were identified. Scans were visually interpreted for coronary stenosis. Semiautomated software was used to quantify noncalcified plaque (NCP), as well as its components. Optimal diagnostic cut-offs for CAV, with coronary angiography as gold standard, were defined using receiver operating characteristic curves. In total, 36 scans were identified in 17 patients. CAV was present in 17 (46.0%) reference coronary angiograms, at a median of 1.9years before CCTA. Median NCP (147 vs 58, P<.001), low-density NCP (median 4.5 vs 0.9, P=.003), fibrous plaque (median 76.1 vs 31.1, P=.003), and fibrofatty plaque (median 63.6 vs 27.6, P<.001) volumes were higher in patients with CAV, whereas calcified plaque was not (median 0.0 vs 0.0, P=.510). Visual assessment of CCTA alone was 70.6% sensitive and 100% specific for CAV. The addition of total NCP volume increased sensitivity to 82.4% while maintaining 100% specificity. NCP volume is significantly higher in patients with CAV. The addition of quantitative analysis to visual interpretation improves the sensitivity for detecting CAV without reducing specificity.