Relation between N-terminal pro-B-type natriuretic peptide and coronary plaque components in patients with acute coronary syndrome: virtual histology-intravascular ultrasound analysis.
BACKGROUND
The N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a sensitive indicator of hemodynamic stress and its increased level is associated with higher mortality in acute coronary syndrome (ACS) patients. Virtual histology-intravascular ultrasound (VH-IVUS) can provide quantitative information on plaque components.


METHODS
We measured preprocedural serum NT-pro-BNP levels in 156 ACS patients with preserved left ventricular systolic function and normal serum creatinine. VH-IVUS classified the color-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (>or=10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden of at least 40%. We divided the patients into two groups according to the NT-pro-BNP levels [group I: >or=200 pg/ml (n = 58) vs. group II: <200 pg/ml (n = 98)].


RESULTS
The percent areas of NC at the minimum lumen site (19.8+/-13.1% vs. 15.2+/-11.1%, P = 0.027) and at the largest NC site (24.7+/-10.3% vs. 19.2+/-11.4%, P = 0.015) were significantly greater in group I than in group II. Percent NC volume was significantly greater in group I than in group II (15.8+/-8.1% vs. 10.1+/-9.1%, P = 0.008). The total number of TCFAs was 38 in group I and 56 in group II. The presence of at least one TCFA (58 vs. 38%, P = 0.009) and multiple TCFAs (25 vs. 10%, P = 0.005) within culprit lesions were observed more frequently in group I than in group II. The TCFAs were located more in proximal in group I than in group II [the length from coronary ostium to TCFA: 10.8+/-7.6 mm in group I vs. 25.7+/-16.3 mm in group II (P<0.001)]: 85% of TCFAs was located within 20 mm from coronary ostium in group I; conversely only 36% of TCFAs was located within 20 mm from coronary ostium in group II (P<0.001).


CONCLUSIONS
VH-IVUS analysis shows that ACS patients with high NT-pro-BNP levels had more vulnerable plaque component (more NC-containing lesions and higher frequency of culprit lesion TCFAs) and had more proximally located TCFAs.
Hong
Young Joon
YJ
The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Dong-gu, Gwangju, Korea.
Ahn
Youngkeun
Y
Sim
Doo Sun
DS
Yoon
Nam Sik
NS
Yoon
Hyun Ju
HJ
Kim
Kye Hun
KH
Park
Hyung Wook
HW
Kim
Ju Han
JH
Jeong
Myung Ho
MH
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000097:blood; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009336:Necrosis; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D015854:Up-Regulation; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003404:Creatinine