Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

Abstract

© 2014 The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V. All rights reserved. Purpose To emphasis the role of MSCT utilizing the remodeling index in assessment of positive coronary remodeling which was associated with plaque rupture and vulnerability. Methods and material Studied group included 35 patients with positive coronary remodeling. One lesion per patient was assessed, either a solitary lesion or the most significant one. All patients were subjected to history taking and radiological evaluation using a contrast-enhanced 64 MSCT then post processed. Assessment of the plaque causing positive remodeling regarding the site, number (single, kissing, or multiple), relative composition and predominant type in H.U. was performed. Specific measurements at the reference and remodeling segment were taken. Calculation of remodeling index was done. Two comparative groups were made between subjects with remodeling index (RI) < 1.5 and RI ≥ 1.5. Results A strong correlation was noted between lipid plaque area, plaque cross sectional area and multiplicity of plaques with remodeling index (p value < 0.001). There was no correlation between the RI with either the patient coronary risk factors or symptomatology. Conclusion Previous studies had shown that most acute coronary syndromes were initiated by sudden changes of mildly stenotic lesions, commonly found in positively remodeled vessels. Promising comparative results between MSCT and IVUS allowed consideration of MDCT as a useful tool in the noninvasive detection of potentially threatening coronary lesions. In our study, RI ≥ 1.5 showed a strong correlation between the lipid plaque area, multiplicity of the plaques, and cross sectional area which were prognostic factors for plaque rupture and vulnerability, and thus, early detection of coronary artery disease. Modulation and prevention of positive remodeling by statin could promote to start medical treatment especially in cases where RI exceeds 1.5 and their follow up non-invasively by MDCT to detect reversal of remodeling and response of treatment.