The Relationship Between Volumetric Plaque Components and Classical Cardiovascular Risk Factors and the Metabolic Syndrome A 3-Vessel Coronary Artery Virtual Histology-Intravascular Ultrasound Analysis

Objectives The aim of this study was to analyze volumetric plaque composition of the coronary arterial tree according to the classical cardiovascular risk factors and metabolic syndrome (MS) using virtual histology-intravascular ultrasound (VH-IVUS). Background It remains unclear how the cardiovascular risk factors correlate with the histological components of coronary plaques. Methods "Whole vessel" VH-IVUS analysis was performed in 189 vessels of 63 patients. The components of atherosclerotic plaques were classified as fibrous, fibrofatty, necrotic core (NC), and dense calcium. Quantitative assessment of these plaque components and the presence of VH-IVUS-derived thin-cap fibroatheroma in the coronary arterial trees were compared with cardiovascular risk factors. Results There was a significantly larger mean plaque-plus-media burden in patients with diabetes mellitus (DM) (47 +/- 5% vs. 39 +/- 7% in non-DM patients, p < 0.001) and MS (47 +/- 4% vs. 39 +/- 7% in non-MS patients, p < 0.001). DM patients had a significantly larger %NC (17.8 +/- 5.6% vs. 12.5 +/- 6.1%, p = 0.003) compared with non-DM patients; and MS patients had a significantly larger %NC (17.3 +/- 5.8% vs. 12.8 +/- 6.2%, p = 0.016) as compared to non-MS patients. Finally, VH-IVUS-derived thin-cap fibroatheromas were more frequent in DM patients (3.4 +/- 2.0 vs. 2.1 +/- 1.7 in non-DM patients, p = 0.016) and in MS patients (4.1 +/- 2.1 vs. 1.9 +/- 1.4 in non-MS patients, p = 0.001). Conclusions Three-vessel VH-IVUS analysis showed that DM and MS patients, compared to patients without DM or MS, had a larger plaque-plus-media burden, larger amount of NC, and more frequent VH-IVUS-derived thin-cap fibroatheromas in coronary arterial trees, implying greater plaque vulnerability in DM and MS patients. (J Am Coll Cardiol Intv 2011;4:503-10) (C) 2011 by the American College of Cardiology Foundation