Cardio-ankle vascular index is associated with coronary plaque composition assessed with iMAP-intravascular ultrasound in patients with coronary artery disease

      Highlights

      • Cardio-ankle vascular index (CAVI) is a parameter of aortic stiffness.
      • Patients with high CAVI have greater necrotic tissue in coronary culprit plaque.
      • CAVI is a useful surrogate marker for the prediction of coronary plaque vulnerability.

      Abstract

      Background

      The cardio-ankle vascular index (CAVI) is an indicator of arterial stiffness and has been reported to be associated with the severity of coronary artery disease and cardiovascular events. However, whether CAVI can predict the composition of coronary plaques remains unclear.

      Methods

      We enrolled 208 patients who underwent percutaneous coronary intervention (PCI) for culprit lesions evaluated with iMAP-intravascular ultrasound (IVUS), a radiofrequency imaging system for characterizing tissues. iMAP-IVUS classified the culprit plaque composition as fibrotic, lipidic, necrotic, or calcified, and the respective absolute volumes [fibrotic volume (FV), lipidic volume (LV), necrotic volume NV, and calcified volume] and their ratios (%) within the total plaque volume were calculated. A plaque with a median %NV of ≥ 33.2% was defined as a larger NV (LNV) plaque. We measured CAVI and divided the patients into two groups according to CAVI ≥8 (high CAVI, n = 164) or <8 (low CAVI, n = 44).

      Results

      Culprit plaques had significantly greater absolute NV (p = 0.016), %NV (p = 0.01), and smaller %FV (p = 0.02) in patients with high CAVI than in those with low CAVI. Patients with high CAVI had a higher prevalence of LNV plaques in culprit lesions than those with low CAVI (54% vs. 34%, p = 0.026). CAVI correlated significantly and positively with absolute NV, LV, and negatively with %FV. In logistic regression analysis after adjustment for the classic coronary risk factors and possible variables associated with vulnerable plaques, high CAVI had an independent and significant association with the presence of LNV plaques (OR, 3.37; 95% CI, 1.45–7.79; p = 0.0032).

      Conclusions

      A high CAVI is associated with the composition of coronary culprit plaques, particularly increased amount of necrotic tissue, in patients with coronary artery disease undergoing PCI .

      Graphical abstract

      Keywords

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      References

        • Virmani R
        • Kolodgie FD
        • Burke AP
        • Farb A
        • Schwartz SM.
        Lessons from sudden coronary death.
        Arterioscler Thromb Vasc Biol. 2000; 20: 1262-1275
        • Mattace-Raso FUS
        • Van Der Cammen TJM
        • Hofman A
        • Van Popele NM
        • Bos ML
        • Schalekamp MADH
        • et al.
        Arterial stiffness and risk of coronary heart disease and stroke: The Rotterdam Study.
        Circulation. 2006; 113: 657-663
        • Laurent S
        • Cockcroft J
        • Van Bortel L
        • Boutouyrie P
        • Giannattasio C
        • Hayoz D
        • et al.
        Expert consensus document on arterial stiffness: methodological issues and clinical applications.
        Eur Heart J. 2006; 27: 2588-2605
        • Nye ER.
        The effect of blood pressure alteration on the pulse wave velocity.
        Br Heart J. 1964; 26: 261-265
        • Shirai K
        • Utino J
        • Otsuka K
        • Takata M.
        A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI).
        J Atheroscler Thromb. 2006; 13: 101-107
        • Shirai K
        • Song M
        • Suzuki J
        • Kurosu T
        • Oyama T
        • Nagayama D
        • et al.
        Contradictory effects of β1- and α1- aderenergic receptor blockers on cardio-ankle vascular stiffness index (CAVI): CAVI is independent of blood pressure.
        J Atheroscler Thromb. 2011; 18: 49-55
        • Nakamura K
        • Tomaru T
        • Yamamura S
        • Miyashita Y
        • Shirai K
        • Noike H.
        Cardio-ankle vascular index is a candidate predictor of coronary atherosclerosis.
        Circ J. 2008; 72: 598-604
        • Miyoshi T
        • Doi M
        • Hirohata S
        • Sakane K
        • Kamikawa S
        • Kitawaki T
        • et al.
        Cardio-ankle vascular index is independently associated with the severity of coronary atherosclerosis and left ventricular function in patients with ischemic heart disease.
        J Atheroscler Thromb. 2010; 17: 249-258
        • Sato Y
        • Nagayama D
        • Saiki A
        • Watanabe R
        • Watanabe Y
        • Imamura H
        • et al.
        Cardio-ankle vascular index is independently associated with future cardiovascular events in outpatients with metabolic disorders.
        J Atheroscler Thromb. 2016; 23: 596-605
        • Saito Y
        • Kobayashi Y
        • Fujii K
        • Sonoda S
        • Tsujita K
        • Hibi K
        • et al.
        Clinical expert consensus document on standards for measurements and assessment of intravascular ultrasound from the Japanese association of cardiovascular intervention and therapeutics.
        Cardiovasc Interv Ther. 2020; 35: 1-12
        • Koga S
        • Ikeda S
        • Miura M
        • Yoshida T
        • Nakata T
        • Koide Y
        • et al.
        iMAP-intravascular ultrasound radiofrequency signal analysis reflects plaque components of optical coherence tomography-derived thin-cap fibroatheroma.
        Circ J. 2015; 79: 2231-2237
        • Thygesen K
        • Alpert JS
        • Jaffe AS
        • Chaitman BR
        • Bax JJ
        • Morrow DA
        • et al.
        Fourth universal definition of myocardial infarction (2018).
        J Am Coll Cardiol. 2018; 72: 2231-2264
        • Kamon T
        • Kaneko H
        • Itoh H
        • Kiriyama H
        • Mizuno Y
        • Morita H
        • et al.
        Gender-specific association between the blood pressure category according to the updated ACC/AHA guidelines for hypertension and cardio-ankle vascular index: a community-based cohort study.
        J Cardiol. 2020; 75: 578-582
        • Tanaka A
        • Tomiyama H
        • Maruhashi T
        • Matsuzawa Y
        • Miyoshi T
        • Kabutoya T
        • et al.
        Physiological diagnostic criteria for vascular failure.
        Hypertension. 2018; 72: 1060-1071
        • Ellis SG
        • Vandormael MG
        • Cowley MJ
        • DiSciascio G
        • Deligonul U
        • Topol EJ
        • et al.
        Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease: Implications for patient selection.
        Circulation. 1990; 82: 1193-1202
        • Sathyanarayana S
        • Carlier S
        • Li W
        • Thomas L.
        Characterisation of atherosclerotic plaque by spectral similarity of radiofrequency intravascular ultrasound signals.
        EuroIntervention. 2009; 5: 133-139
        • Matsuo S
        • Imai E
        • Horio M
        • Yasuda Y
        • Tomita K
        • Nitta K
        • et al.
        Revised equations for estimated GFR from serum creatinine in Japan.
        Am J Kidney Dis. 2009; 53: 982-992
        • Cecelja M
        • Chowienczyk P.
        Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review.
        Hypertension. 2009; 54: 1328-1336
        • Horinaka S
        • Yabe A
        • Yagi H
        • Ishimura K
        • Hara H
        • Iemura T
        • et al.
        Cardio-ankle vascular index could reflect plaque burden in the coronary artery.
        Angiology. 2011; 62: 401-408
        • Selwaness M
        • Van Den Bouwhuijsen QJA
        • Verwoert GC
        • Dehghan A
        • Mattace-Raso FUS
        • Vernooij M
        • et al.
        Blood pressure parameters and carotid intraplaque hemorrhage as measured by magnetic resonance imaging: the Rotterdam study.
        Hypertension. 2013; 61: 76-81
        • Dart AM
        • Kingwell BA.
        Pulse pressure–a review of mechanisms and clinical relevance.
        J Am Coll Cardiol. 2001; 37: 975-984
        • Kopeć G
        • Podolec P.
        Central pulse pressure: is it really an independent predictor of cardiovascular risk?.
        Hypertension. 2008; 52115121
        • Gould KL
        • Johnson NP
        • Bateman TM
        • Beanlands RS
        • Bengel FM
        • Bober R
        • et al.
        Anatomic versus physiologic assessment of coronary artery disease: role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making.
        J Am Coll Cardiol. 2013; 62: 1639-1653
        • Ohtsuka S
        • Kakihana M
        • Watanabe H
        • Sugishita Y.
        Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction.
        J Am Coll Cardiol. 1994; 24: 1406-1414
        • Fukuda D
        • Yoshiyama M
        • Shimada K
        • Yamashita H
        • Ehara S
        • Nakamura Y
        • et al.
        Relation between aortic stiffness and coronary flow reserve in patients with coronary artery disease.
        Heart. 2006; 92: 759-762
        • Baumgart D
        • Haude M
        • Liu F
        • Ge J
        • Goerge G
        • Erbel R.
        Current concepts of coronary flow reserve for clinical decision making during cardiac catheterization.
        Am Heart J. 1998; 136: 136-149
        • Setoguchi S
        • Mohri M
        • Shimokawa H
        • Takeshita A.
        Tetrahydrobiopterin improves endothelial dysfunction in coronary microcirculation in patients without epicardial coronary artery disease.
        J Am Coll Cardiol. 2001; 38: 493-498
        • Puri R
        • Nicholls SJ
        • Brennan DM
        • Andrews J
        • Liew GY
        • Carbone A
        • et al.
        Coronary atheroma composition and its association with segmental endothelial dysfunction in non-ST segment elevation myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography.
        Int J Cardiovasc Imaging. 2015; 31: 247-257
        • Heo JH
        • Brugaletta S
        • Garcia-Garcia HM
        • Gomez-Lara J
        • Ligthart JMR
        • Witberg K
        • et al.
        Reproducibility of intravascular ultrasound iMAP for radiofrequency data analysis: Implications for design of longitudinal studies.
        Catheter Cardiovasc Interv. 2014; 83: E233-E242
        • Trusinskis K
        • Juhnevica D
        • Strenge K
        • Erglis A.
        IMap intravascular ultrasound evaluation of culprit and non-culprit lesions in patients with ST-elevation myocardial infarction.
        Cardiovasc Revascularization Med. 2013; 14: 71-75
        • Kozuki A
        • Shinke T
        • Otake H
        • Shite J
        • Matsumoto D
        • Kawamori H
        • et al.
        Feasibility of a novel radiofrequency signal analysis for in-vivo plaque characterization in humans: Comparison of plaque components between patients with and without acute coronary syndrome.
        Int J Cardiol. 2013; 167: 1591-1596
        • Hougaard M
        • Hansen HS
        • Thayssen P
        • Antonsen L
        • Jensen LO.
        Uncovered culprit plaque ruptures in patients with ST-segment elevation myocardial infarction assessed by optical coherence tomography and intravascular ultrasound with iMap.
        JACC Cardiovasc Imaging. 2018; 11: 859-867
        • Sudo M
        • Hiro T
        • Takayama T
        • Iida K
        • Nishida T
        • Fukamachi D
        • et al.
        Tissue characteristics of non-culprit plaque in patients with acute coronary syndrome vs. stable angina: a color-coded intravascular ultrasound study.
        Cardiovasc Interv Ther. 2016; 31: 42-50
        • Yang G
        • Wang W
        • Sheng X
        • Yang F
        • Kong L
        • He J
        • et al.
        Tissue characteristics of culprit lesion and myocardial tissue-level perfusion in non-ST-segment elevation acute coronary syndromes: the EARLY-MYO-ACS study.
        Int J Cardiol. 2019; 287: 32-38
        • Okamoto H
        • Kume T
        • Yamada R
        • Koyama T
        • Tamada T
        • Imai K
        • et al.
        Prevalence and clinical significance of layered plaque in patients with stable angina pectoris ― Evaluation with histopathology and optical coherence tomography ―.
        Circ J. 2019; 83: 2452-2459