Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures

Leif Christopher Engel; Ulf Landmesser; Youssef S. Abdelwahed; Milosz Jaguszewski; Kevin Gigengack; Thomas Heinrich Wurster; Carsten Skurk; Costantina Manes; Andreas Schuster; Michel Noutsias; Bernd Hamm; Rene M. Botnar; Marcus R. Makowski; Boris Bigalke

doi:10.1371/journal.pone.0228292

Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures

Leif Christopher Engel, Ulf Landmesser, Youssef S. Abdelwahed, Milosz Jaguszewski, Kevin Gigengack, Thomas Heinrich Wurster, Carsten Skurk, Costantina Manes, Andreas Schuster, Michel Noutsias, Bernd Hamm, Rene M. Botnar, Marcus R. Makowski, Boris Bigalke

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3 Scopus citations

Abstract

Background There is limited knowledge about morphological molecular-imaging-derived parameters to further characterize hemodynamically relevant coronary lesions. Objective The aim of this study was to describe and differentiate specific parameters between hemodynamically significant and non-significant coronary lesions using various invasive and noninvasive measures. Methods This clinical study analyzed patients with symptoms suggestive of coronary artery disease (CAD) who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-angiography). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability, respectively. Results Overall 29 coronary segments from 14 patients were examined. Segments containing lesions with a QFR <0.8 (n = 9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a lesions without significant stenosis (lesion-QFR>0.8; n = 19) (5.32 (4.47–7.02) vs. 2.42 (1.04–5.11); p = 0.042). No differences in signal enhancement were seen on native T1-weighted CMR (2.2 (0.68–6.75) vs. 2.09 (0.91–6.57), p = 0.412). 66.7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions. Conclusion The findings of this pilot study suggest that signal enhancement on albumin-binding probe-enhanced CMR but not on T1-weighted CMR is associated with hemodynamically relevant coronary lesions.

Original language	English
Article number	e0228292
Journal	PLoS ONE
Volume	15
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0228292
State	Published - 1 Jan 2020
Externally published	Yes

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10.1371/journal.pone.0228292

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Engel, L. C., Landmesser, U., Abdelwahed, Y. S., Jaguszewski, M., Gigengack, K., Wurster, T. H., Skurk, C., Manes, C., Schuster, A., Noutsias, M., Hamm, B., Botnar, R. M., Makowski, M. R., & Bigalke, B. (2020). Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures. PLoS ONE, 15(1), Article e0228292. https://doi.org/10.1371/journal.pone.0228292

@article{38202226aa4444ea93a5425d168c10f5,

title = "Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures",

abstract = "Background There is limited knowledge about morphological molecular-imaging-derived parameters to further characterize hemodynamically relevant coronary lesions. Objective The aim of this study was to describe and differentiate specific parameters between hemodynamically significant and non-significant coronary lesions using various invasive and noninvasive measures. Methods This clinical study analyzed patients with symptoms suggestive of coronary artery disease (CAD) who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-angiography). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability, respectively. Results Overall 29 coronary segments from 14 patients were examined. Segments containing lesions with a QFR <0.8 (n = 9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a lesions without significant stenosis (lesion-QFR>0.8; n = 19) (5.32 (4.47–7.02) vs. 2.42 (1.04–5.11); p = 0.042). No differences in signal enhancement were seen on native T1-weighted CMR (2.2 (0.68–6.75) vs. 2.09 (0.91–6.57), p = 0.412). 66.7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions. Conclusion The findings of this pilot study suggest that signal enhancement on albumin-binding probe-enhanced CMR but not on T1-weighted CMR is associated with hemodynamically relevant coronary lesions.",

author = "Engel, {Leif Christopher} and Ulf Landmesser and Abdelwahed, {Youssef S.} and Milosz Jaguszewski and Kevin Gigengack and Wurster, {Thomas Heinrich} and Carsten Skurk and Costantina Manes and Andreas Schuster and Michel Noutsias and Bernd Hamm and Botnar, {Rene M.} and Makowski, {Marcus R.} and Boris Bigalke",

note = "Publisher Copyright: {\textcopyright} 2020 Engel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2020",

month = jan,

day = "1",

doi = "10.1371/journal.pone.0228292",

language = "English",

volume = "15",

journal = "PLoS ONE",

issn = "1932-6203",

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number = "1",

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Engel, LC, Landmesser, U, Abdelwahed, YS, Jaguszewski, M, Gigengack, K, Wurster, TH, Skurk, C, Manes, C, Schuster, A, Noutsias, M, Hamm, B, Botnar, RM, Makowski, MR & Bigalke, B 2020, 'Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures', PLoS ONE, vol. 15, no. 1, e0228292. https://doi.org/10.1371/journal.pone.0228292

TY - JOUR

T1 - Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures

AU - Engel, Leif Christopher

AU - Landmesser, Ulf

AU - Abdelwahed, Youssef S.

AU - Jaguszewski, Milosz

AU - Gigengack, Kevin

AU - Wurster, Thomas Heinrich

AU - Skurk, Carsten

AU - Manes, Costantina

AU - Schuster, Andreas

AU - Noutsias, Michel

AU - Hamm, Bernd

AU - Botnar, Rene M.

AU - Makowski, Marcus R.

AU - Bigalke, Boris

N1 - Publisher Copyright: © 2020 Engel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background There is limited knowledge about morphological molecular-imaging-derived parameters to further characterize hemodynamically relevant coronary lesions. Objective The aim of this study was to describe and differentiate specific parameters between hemodynamically significant and non-significant coronary lesions using various invasive and noninvasive measures. Methods This clinical study analyzed patients with symptoms suggestive of coronary artery disease (CAD) who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-angiography). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability, respectively. Results Overall 29 coronary segments from 14 patients were examined. Segments containing lesions with a QFR <0.8 (n = 9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a lesions without significant stenosis (lesion-QFR>0.8; n = 19) (5.32 (4.47–7.02) vs. 2.42 (1.04–5.11); p = 0.042). No differences in signal enhancement were seen on native T1-weighted CMR (2.2 (0.68–6.75) vs. 2.09 (0.91–6.57), p = 0.412). 66.7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions. Conclusion The findings of this pilot study suggest that signal enhancement on albumin-binding probe-enhanced CMR but not on T1-weighted CMR is associated with hemodynamically relevant coronary lesions.

AB - Background There is limited knowledge about morphological molecular-imaging-derived parameters to further characterize hemodynamically relevant coronary lesions. Objective The aim of this study was to describe and differentiate specific parameters between hemodynamically significant and non-significant coronary lesions using various invasive and noninvasive measures. Methods This clinical study analyzed patients with symptoms suggestive of coronary artery disease (CAD) who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-angiography). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability, respectively. Results Overall 29 coronary segments from 14 patients were examined. Segments containing lesions with a QFR <0.8 (n = 9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a lesions without significant stenosis (lesion-QFR>0.8; n = 19) (5.32 (4.47–7.02) vs. 2.42 (1.04–5.11); p = 0.042). No differences in signal enhancement were seen on native T1-weighted CMR (2.2 (0.68–6.75) vs. 2.09 (0.91–6.57), p = 0.412). 66.7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions. Conclusion The findings of this pilot study suggest that signal enhancement on albumin-binding probe-enhanced CMR but not on T1-weighted CMR is associated with hemodynamically relevant coronary lesions.

UR - http://www.scopus.com/inward/record.url?scp=85078777169&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0228292

DO - 10.1371/journal.pone.0228292

M3 - Article

C2 - 32004345

AN - SCOPUS:85078777169

SN - 1932-6203

VL - 15

JO - PLoS ONE

JF - PLoS ONE

IS - 1

M1 - e0228292

ER -

Comprehensive multimodality characterization of hemodynamically significant and non-significant coronary lesions using invasive and noninvasive measures

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