Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/90814
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Type: Journal article
Title: Coronary atheroma composition and its association with segmental endothelial dysfunction in non-ST segment elevation myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography
Author: Puri, R.
Nicholls, S.
Brennan, D.
Andrews, J.
Liew, G.
Carbone, A.
Copus, B.
Nelson, A.
Kapadia, S.
Tuzcu, E.
Beltrame, J.
Worthley, S.
Worthley, M.
Citation: International Journal of Cardiovascular Imaging, 2015; 31(2):247-257
Publisher: Springer Netherlands
Issue Date: 2015
ISSN: 1569-5794
1573-0743
Statement of
Responsibility: 
Rishi Puri, Stephen J. Nicholls, Danielle M. Brennan, Jordan Andrews, Gary Y. Liew, Angelo Carbone, Barbara Copus, Adam J. Nelson, Samir R. Kapadia, E. Murat Tuzcu, John F. Beltrame, Stephen G. Worthley, Matthew I. Worthley
Abstract: Little is known of the relationship between coronary atheroma composition and corresponding endothelial dysfunction. We tested the hypothesis that segmental epicardial vasoreactivity relates to atheroma composition in patients with non-ST segment elevation myocardial infarction (NSTEMI) in vivo. In 23 NSTEMI patients referred for coronary angiography, a non-culprit vessel underwent intracoronary salbutamol (0.30 μg/min) provocation during automated IVUS pullback. A 40 MHz rotational IVUS catheter delivered radiofrequency signals at constant 67 μm intervals via a custom-built IVUS console (iMAP, iLAB, Boston Scientific). Macrovascular response [change in segmental lumen volume (SLV) at baseline and following salbutamol], percent atheroma volume (PAV) and tissue composition was evaluated in 187 contiguous non-overlapping 5 mm coronary segments. Compared with segments that dilated, constrictive segments showed similar SLV, but greater vessel volumes and PAV at baseline. The extent of necrotic and lipidic plaque was significantly greater in constrictive segments, whereas fibrotic plaque content was significantly greater in segments that dilated. Calcific plaque content did not relate to endothelium-dependent vasoreactivity. The change in SLV correlated inversely with the amount of lipidic and necrotic plaque (both r = −0.23, p = 0.002), and directly with fibrotic plaque content (r = 0.23, p = 0.002). In a multivariable model, the extent of both lipidic and necrotic plaque independently associated with segmental vasoconstriction (β = 1.2, p = 0.023; β = 0.66, p = 0.027). Following NSTEMI, both lipidic and necrotic plaque content each associate with segmental endothelial dysfunction. The link between plaque composition and vessel reactivity provides a mechanistic basis of the pathogenesis associated with vulnerable plaque in humans in vivo.
Keywords: Endothelial function; Atherosclerosis; Intravascular ultrasound; iMAP; Salbutamol
Rights: © Springer Science+Business Media Dordrecht 2014
RMID: 0030026151
DOI: 10.1007/s10554-014-0545-2
Grant ID: http://purl.org/au-research/grants/nhmrc/565579
Appears in Collections:Medicine publications

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