Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease | springermedicine.com

Springer Medicine

Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2017 | Research

Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease

Authors: Allison G. Hays, Micaela Iantorno, Michael Schär, Monica Mukherjee, Matthias Stuber, Gary Gerstenblith, Robert G. Weiss

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Login to get access

Abstract

Background

Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronary endothelial dysfunction is associated with local coronary artery eccentricity.

Methods

We used 3 T coronary CMR to measure CEF as changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE), a known endothelial-dependent stressor, in 29 patients with known CAD and 16 healthy subjects. Black-blood MRI quantified mean coronary wall thickness (CWT) and coronary eccentricity index (EI) and CEF was determined in the same segments.

Results

IHE-induced changes in CSA and CBF in healthy subjects (10.6 ± 6.6% and 38.3 ± 29%, respectively) were greater than in CAD patients 1.3 ± 7.7% and 6.5 ± 19.6%, respectively, p < 0.001 vs. healthy for both measures), as expected. Mean CWT and EI in healthy subjects (1.1 ± 0.3 mm 1.9 ± 0.5, respectively) were less than those in CAD patients (1.6 ± 0.4 mm, p < 0.0001; and 2.6 ± 0.6, p = 0.006 vs. healthy). In CAD patients, we observed a significant inverse relationship between stress-induced %CSA change and both EI (r = -0.60, p = 0.0002), and CWT (r = -0.54, p = 0.001). Coronary EI was independently and significantly related to %CSA change with IHE even after controlling for mean CWT (adjusted r = -0.69, p = 0.0001). For every unit increase in EI, coronary CSA during IHE is expected to change by -6.7 ± 9.4% (95% confidence interval: -10.3 to -3.0, p = 0.001).

Conclusion

There is a significant inverse and independent relationship between coronary endothelial macrovascular function and the degree of local coronary wall eccentricity in CAD patients. Thus anatomic and physiologic indicators of high-risk coronary vascular pathology are closely related. The noninvasive identification of coronary eccentricity and its relationship with underlying coronary endothelial function, a marker of vascular health, may be useful in identifying high-risk patients and culprit lesions.

1.

Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation. 2007;115:1285–95.PubMed

2.

Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation. 2000;101:1899–906.CrossRefPubMed

3.

Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes Jr DR, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101:948–54.CrossRefPubMed

4.

Manginas A, Voudris V, Pavlides G, Karatasakis G, Athanassopoulos G, Cokkinos DV. Effect of plaque burden on coronary vasoreactivity in early atherosclerosis. Am J Cardiol. 1998;81:401–6.CrossRefPubMed

5.

Yamagishi M, Terashima M, Awano K, Kijima M, Nakatani S, Daikoku S, Ito K, Yasumura Y, Miyatake K. Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome. J Am Coll Cardiol. 2000;35:106–11.CrossRefPubMed

6.

Fuster V. 50th anniversary historical article. Acute coronary syndromes: the degree and morphology of coronary stenoses. J Am Coll Cardiol. 1999;34:1854–6.CrossRefPubMed

7.

Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47:C13–8.CrossRefPubMed

8.

Ganz P, Vita JA. Testing endothelial vasomotor function: nitric oxide, a multipotent molecule. Circulation. 2003;108:2049–53.CrossRefPubMed

9.

Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316:1371–5.CrossRefPubMed

10.

Hodgson JM, Reddy KG, Suneja R, Nair RN, Lesnefsky EJ, Sheehan HM. Intracoronary ultrasound imaging: correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty. J Am Coll Cardiol. 1993;21:35–44.CrossRefPubMed

11.

Fayad ZA, Fuster V, Fallon JT, Jayasundera T, Worthley SG, Helft G, Aguinaldo JG, Badimon JJ, Sharma SK. Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging. Circulation. 2000;102:506–10.CrossRefPubMed

12.

Kim WY, Stuber M, Bornert P, Kissinger KV, Manning WJ, Botnar RM. Three-dimensional black-blood cardiac magnetic resonance coronary vessel wall imaging detects positive arterial remodeling in patients with nonsignificant coronary artery disease. Circulation. 2002;106:296–9.CrossRefPubMed

13.

Desai MY, Lai S, Barmet C, Weiss RG, Stuber M. Reproducibility of 3D free-breathing magnetic resonance coronary vessel wall imaging. Eur Heart J. 2005;26:2320–4.CrossRefPubMed

14.

Hazirolan T, Gupta SN, Mohamed MA, Bluemke DA. Reproducibility of black-blood coronary vessel wall MR imaging. J Cardiovasc Magn Reson. 2005;7:409–13.CrossRefPubMed

15.

Nitenberg A, Chemla D, Antony I. Epicardial coronary artery constriction to cold pressor test is predictive of cardiovascular events in hypertensive patients with angiographically normal coronary arteries and without other major coronary risk factor. Atherosclerosis. 2004;173:115–23.CrossRefPubMed

16.

Hays AG, Iantorno M, Soleimanifard S, Steinberg A, Schar M, Gerstenblith G, Stuber M, Weiss RG. Coronary vasomotor responses to isometric handgrip exercise are primarily mediated by nitric oxide: a noninvasive MRI test of coronary endothelial function. Am J Physiol Heart Circ Physiol. 2015;308:H1343–50.CrossRefPubMedPubMedCentral

17.

Hays AG, Hirsch GA, Kelle S, Gerstenblith G, Weiss RG, Stuber M. Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease. J Am Coll Cardiol. 2010;56:1657–65.CrossRefPubMed

18.

Hays AG, Stuber M, Hirsch GA, Yu J, Schar M, Weiss RG, Gerstenblith G, Kelle S. Non-invasive detection of coronary endothelial response to sequential handgrip exercise in coronary artery disease patients and healthy adults. PLoS ONE. 2013;8:e58047.CrossRefPubMedPubMedCentral

19.

Choi BJ, Prasad A, Gulati R, Best PJ, Lennon RJ, Barsness GW, Lerman LO, Lerman A. Coronary endothelial dysfunction in patients with early coronary artery disease is associated with the increase in intravascular lipid core plaque. Eur Heart J. 2013;34:2047–54.CrossRefPubMedPubMedCentral

20.

Higuma T, Soeda T, Abe N, Yamada M, Yokoyama H, Shibutani S, Vergallo R, Minami Y, Ong DS, Lee H, et al. A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction: Incidence, Morphologic Characteristics, and Outcomes After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2015;8:1166–76.CrossRefPubMed

21.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.CrossRefPubMed

22.

Hays AG, Kelle S, Hirsch GA, Soleimanifard S, Yu J, Agarwal HK, Gerstenblith G, Schar M, Stuber M, Weiss RG. Regional coronary endothelial function is closely related to local early coronary atherosclerosis in patients with mild coronary artery disease: pilot study. Circ Cardiovasc Imaging. 2012;5:341–8.CrossRefPubMedPubMedCentral

23.

Weiss RG, Bottomley PA, Hardy CJ, Gerstenblith G. Regional myocardial metabolism of high-energy phosphates during isometric exercise in patients with coronary artery disease. N Engl J Med. 1990;323:1593–600.CrossRefPubMed

24.

Meyer CH, Hu BS, Nishimura DG, Macovski A. Fast spiral coronary artery imaging. Magn Reson Med. 1992;28:202–13.CrossRefPubMed

25.

Keegan J, Gatehouse PD, Yang GZ, Firmin DN. Spiral phase velocity mapping of left and right coronary artery blood flow: correction for through-plane motion using selective fat-only excitation. J Magn Reson Imaging. 2004;20:953–60.CrossRefPubMed

26.

Terashima M, Meyer CH, Keeffe BG, Putz EJ, de la Pena-Almaguer E, Yang PC, Hu BS, Nishimura DG, McConnell MV. Noninvasive assessment of coronary vasodilation using magnetic resonance angiography. J Am Coll Cardiol. 2005;45:104–10.CrossRefPubMed

27.

Fleckenstein JL, Archer BT, Barker BA, Vaughan JT, Parkey RW, Peshock RM. Fast short-tau inversion-recovery MR imaging. Radiology. 1991;179:499–504.CrossRefPubMed

28.

Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Chuang YC, DeFalco RA, Leon MB. Limitations of angiography in the assessment of plaque distribution in coronary artery disease: a systematic study of target lesion eccentricity in 1446 lesions. Circulation. 1996;93:924–31.CrossRefPubMed

29.

Miao C, Chen S, Macedo R, Lai S, Liu K, Li D, Wasserman BA, Vogel-Claussen J, Lima JA, Bluemke DA. Positive remodeling of the coronary arteries detected by magnetic resonance imaging in an asymptomatic population: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2009;53:1708–15.CrossRefPubMedPubMedCentral

30.

Doucette JW, Corl PD, Payne HM, Flynn AE, Goto M, Nassi M, Segal J. Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation. 1992;85:1899–911.CrossRefPubMed

31.

Botnar RM, Stuber M, Kissinger KV, Kim WY, Spuentrup E, Manning WJ. Noninvasive coronary vessel wall and plaque imaging with magnetic resonance imaging. Circulation. 2000;102:2582–7.CrossRefPubMed

32.

von Birgelen C, Klinkhart W, Mintz GS, Papatheodorou A, Herrmann J, Baumgart D, Haude M, Wieneke H, Ge J, Erbel R. Plaque distribution and vascular remodeling of ruptured and nonruptured coronary plaques in the same vessel: an intravascular ultrasound study in vivo. J Am Coll Cardiol. 2001;37:1864–70.CrossRef

33.

Ludmer PL, Selwyn AP, Shook TL, Wayne RR, Mudge GH, Alexander RW, Ganz P. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med. 1986;315:1046–51.CrossRefPubMed

34.

Li F, McDermott MM, Li D, Carroll TJ, Hippe DS, Kramer CM, Fan Z, Zhao X, Hatsukami TS, Chu B, et al. The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study. J Cardiovasc Magn Reson. 2010;12:37.CrossRefPubMedPubMedCentral

35.

Ohara T, Toyoda K, Otsubo R, Nagatsuka K, Kubota Y, Yasaka M, Naritomi H, Minematsu K. Eccentric stenosis of the carotid artery associated with ipsilateral cerebrovascular events. AJNR Am J Neuroradiol. 2008;29:1200–3.CrossRefPubMed

36.

Puri R, Nicholls SJ, Brennan DM, Andrews J, Liew GY, Carbone A, Copus B, Nelson AJ, Kapadia SR, Tuzcu EM, et al. Coronary atheroma composition and its association with segmental endothelial dysfunction in non-ST segment elevation myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography. Int J Cardiovasc Imaging. 2015;31:247–57.CrossRefPubMed

37.

Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364:226–35.CrossRefPubMed

38.

Ito H, Motoyama S, Sarai M, Kawai H, Harigaya H, Kan S, Kato S, Anno H, Takahashi H, Naruse H, et al. Characteristics of plaque progression detected by serial coronary computed tomography angiography. Heart Vessels. 2014;29:743–9.CrossRefPubMed

39.

Kaul S, Narula J. In search of the vulnerable plaque: is there any light at the end of the catheter? J Am Coll Cardiol. 2014;64:2519–24.CrossRefPubMed

40.

Papafaklis MI, Takahashi S, Antoniadis AP, Coskun AU, Tsuda M, Mizuno S, Andreou I, Nakamura S, Makita Y, Hirohata A, et al. Effect of the local hemodynamic environment on the de novo development and progression of eccentric coronary atherosclerosis in humans: insights from PREDICTION. Atherosclerosis. 2015;240:205–11.CrossRefPubMed

41.

Wentzel JJ, Chatzizisis YS, Gijsen FJ, Giannoglou GD, Feldman CL, Stone PH. Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions. Cardiovasc Res. 2012;96:234–43.CrossRefPubMed

42.

Puri R, Leong DP, Nicholls SJ, Liew GY, Nelson AJ, Carbone A, Copus B, Wong DT, Beltrame JF, Worthley SG, Worthley MI. Coronary artery wall shear stress is associated with endothelial dysfunction and expansive arterial remodelling in patients with coronary artery disease. EuroIntervention. 2015;10:1440–8.CrossRefPubMed

43.

Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, Brady TJ, Pomerantsev E, Ludwig J, Flachskampf FA, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842–7.CrossRefPubMed

Title: Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease
Authors: Allison G. Hays
Micaela Iantorno
Michael Schär
Monica Mukherjee
Matthias Stuber
Gary Gerstenblith
Robert G. Weiss
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0358-2

Home
Congress Coverage
Clinical Collections
- Advances in Alzheimer’s
About Springer Medicine
Key Specialties