Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study.

Abstract

BACKGROUND:

Coronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR).

OBJECTIVES:

This pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR.

METHODS:

Prospective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed.

RESULTS:

In the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001).

CONCLUSIONS:

Statin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition. (Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technique [AQUAMARINE]; UMIN000003567).

• Authors: Teruo Noguchi, Atsushi Tanaka, Tomohiro Kawasaki, Yoichi Goto, Yoshiaki Morita, Yasuhide Asaumi, Kazuhiro Nakao, Reiko Fujiwara, Kunihiro Nishimura, Yoshihiro Miyamoto, Masaharu Ishihara, Hisao Ogawa, Nobuhiko Koga, Jagat Narula, Satoshi Yasuda
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 66 Issue 3 Pg. 245-256 (Jul 21 2015) ISSN: 1558-3597 [Electronic] United States
• PMID: 26184618 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Lipoproteins, LDL
• Quinolines
• C-Reactive Protein
• pitavastatin

Topics

• Angiography (methods)
• C-Reactive Protein (analysis)
• Coronary Artery Disease (drug therapy, pathology, physiopathology)
• Dose-Response Relationship, Drug
• Drug Monitoring (methods)
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage, adverse effects)
• Lipoproteins, LDL (blood)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Pilot Projects
• Plaque, Atherosclerotic (drug therapy, pathology, physiopathology)
• Prospective Studies
• Quinolines (administration & dosage, adverse effects)
• Reproducibility of Results
• Research Design
• Tomography, X-Ray Computed (methods)
• Treatment Outcome