External authors:

• Reza Hajhosseiny ( Imperial College London , King's College London )
• Adam Hartley ( Imperial College London )
• Graham Cole ( Imperial College London )
• Camilla Munoz ( King's College London )
• Amarjit Sethi ( Imperial College London )
• Rasha Al-Lamee ( Imperial College London )
• Saud Khawaja ( Imperial College London )
• Sameer Zaman ( Imperial College London )
• James Howard ( Imperial College London )
• Deepa Gopalan ( Imperial College London )
• Ben Ariff ( Imperial College London )
• Raffi Kaprielian ( Imperial College London )
• Radhouene Neji ( King's College London )
• Karl Kunze ( King's College London , Siemens United Kingdom )
• Amit Kaura ( Imperial College London )
• Ramzi Khamis ( Imperial College London )

Abstract:

Background Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection. Objectives To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods 41 patients with suspected NSTEMI were recruited. Invasive coronary angiography +/- intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST. Results The mean +/- standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 +/- 0.14 vs. 0.67 +/- 0.18 vs. 0.35 +/- 0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P = 0.05 and P = 0.04, respectively). Conclusion iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.