Plaque Vulnerability as Assessed by Radiofrequency Intravascular Ultrasound in Patients with Valvular Calcification.
BACKGROUND
Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability.


METHODS
Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score-matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive.


RESULTS
Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification.


CONCLUSIONS
There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA).
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Nagendra Boopathy
NB
Senguttuvan
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Sharath
S
Kumar
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Wang-Soo
http://orcid.org/0000-0002-8264-0866
WS
Lee
All India Institute of Medical Sciences, New Delhi, 110029, India.
Sundeep
S
Mishra
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Jun Hwan
JH
Cho
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Jee Eun
JE
Kwon
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Seong Hyeop
SH
Hyeon
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Yun Sang
YS
Jeong
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Hoyoun
H
Won
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Seung Yong
SY
Shin
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Kwang Je
KJ
Lee
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Tae Ho
TH
Kim
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Chee Jeong
CJ
Kim
Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea.
Sang-Wook
SW
Kim
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D057216:Propensity Score; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*