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Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2019 Sep 24; Vol. 18 (1), pp. 122. Date of Electronic Publication: 2019 Sep 24. - Publication Year :
- 2019
-
Abstract
- Background: Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes.<br />Methods: Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA.<br />Results: Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797-0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92-0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41-3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68-0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47-25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13-0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion's fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications.<br />Conclusion: Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.
- Subjects :
- Acute Coronary Syndrome complications
Acute Coronary Syndrome pathology
Aged
Coronary Artery Disease complications
Coronary Artery Disease pathology
Coronary Vessels pathology
Diabetes Mellitus, Type 2 diagnosis
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Risk Factors
Rupture, Spontaneous
Vascular Calcification complications
Vascular Calcification pathology
Acute Coronary Syndrome diagnostic imaging
Coronary Artery Disease diagnostic imaging
Coronary Vessels diagnostic imaging
Diabetes Mellitus, Type 2 complications
Plaque, Atherosclerotic
Tomography, Optical Coherence
Vascular Calcification diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 31551093
- Full Text :
- https://doi.org/10.1186/s12933-019-0926-x