Structural changes of atherosclerotic plaques according to multislice computer tomography during dynamic follow

Abstract

The aim of our study was analyze coronary atherosclerosis progression and changes in plaque composition and morphology, including unstability signs, in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) using 64-slice multidetector computed tomography (MDCT).

Materials and methods. We enrolled in the study 19 patients with NSTE-ACS, who underwent 64-MDCT in 1–3 days after ACS onset and 13.4±3.2 months later. We analyzed changes in coronary lesions average density, length, lumen stenosis and MDCT-signs of plaque’s vulnerability, such as presence of uneven contour, spotty calcium, “ring-like sign” and positive remodeling.
Results. The average plaque’s MDCT-density was the most dynamic index, which have essentially changed in 35 (77.8%) cases. In the majority of them, that consisted 48,9% of all plaques, average density significantly decreased (p=0,03). Other quantitative MDCT-characteristics have changed more rarely: the degree of stenosis in 24.4% cases and the plaque’s length in 15.5%. The appearance or disappearance of plaque’s qualitative unstability MDCT-signs were always combined with changes in the quantitative plaque’s characteristics and reflected the basic trend of its changes (stabilization or destabilization). Moreover, our data revealed a significant correlation between the target low density lipid level achievement and decrease in the number of plaques with an uneven contour (r = 0.57, p<0,05). A more intensive lipid-lowering therapy resulted in a greater reduction in the length of plaques (r = 0.46, p<0,05).
Conclusions. Thus, the MDCT is a relatively safe and effective method to evaluate changes in coronary plaques, that allows to expand its application for the study of the plaques and stenosis dynamics. Personal changes of plaques may be important in cases, where they lead to its stabilization, for example, under the effective statin therapy or destabilization, that could contribute to adverse cardiovascular events.