Three-dimensional morphological response of lipid-rich coronary plaques to statin therapy: a serial optical coherence tomography study.
OBJECTIVE
Previous studies have suggested that intensive statin therapy, compared with moderate statin therapy, provided greater reduction of LDL and better protection against major cardiovascular events. However, the exact dose-dependent mechanism of plaque stabilization remains unclear. The aim of this study is to investigate the three-dimensional (3D) response of fibrous caps overlying lipid plaques to statin therapy.


METHODS
We applied a novel computer algorithm to investigate the fibrous cap 3D morphological change over time in patients with coronary artery disease. Patients were treated with either atorvastatin 20 mg/day (moderate intensity) or atorvastatin 60 mg/day (high intensity). Optical coherence tomography was performed at baseline, 6, and 12 months. A total of 31 lipid plaques from 21 patients were analyzed.


RESULTS
Conventional metrics such as the minimum fibrous cap thickness change between the two treatment groups were not significantly different between the baseline and the 12-month follow-up. In contrast, the 3D metric thin cap (<80 μm) surface area change between the baseline and the 12-month follow-up showed dose-dependent, significant differences between the statin treatment groups (P<0.001). 3D reconstructions of fibrous caps further indicated that fibrous caps showed diverse (scattered vs. confluent) patterns and could evolve in a complex manner.


CONCLUSIONS
High-intensity statin therapy more effectively stabilized fibrous caps at follow-up. The new 3D algorithm provided more comprehensive and detailed information on the changes in plaque phenotype in response to statin therapy.
aResearch Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge bCardiology Division cMGH Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA dDepartment of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China eDivision of Cardiology, Kyung Hee University, Seoul, South Korea.
Zhao
Z
Wang
Young-Seok
YS
Cho
Tsunenari
T
Soeda
Yoshiyasu
Y
Minami
Lei
L
Xing
Haibo
H
Jia
Aaron
A
Aguirre
Rocco
R
Vergallo
Hang
H
Lee
James G
JG
Fujimoto
Bo
B
Yu
Ik-Kyung
IK
Jang
D000368:Aged; D000465:Algorithms; D000069059:Atorvastatin / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000187:drug effects* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005260:Female; D005355:Fibrosis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069059:Atorvastatin