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CLINICAL RESEARCH: ATHEROMA COMPOSITION AND METABOLIC SYNDROME

Impact of Metabolic Syndrome on Tissue Characteristics of Angiographically Mild to Moderate Coronary Lesions

Integrated Backscatter Intravascular Ultrasound Study

Tetsuya Amano, MD, PhD^_*,_*, Tatsuaki Matsubara, MD, PhD, Tadayuki Uetani, MD, PhD^_*, Michio Nanki, MD, PhD^_*, Nobuyuki Marui, MD, PhD^_*, Masataka Kato, MD^_*, Kosuke Arai, MD^_*, Kiminobu Yokoi, MD^_*, Hirohiko Ando, MD^_*, Hideki Ishii, MD, Hideo Izawa, MD, PhD and Toyoaki Murohara, MD, PhD

^_* Department of Cardiology, Chubu-Rosai Hospital, Nagoya, Japan
Department of Internal Medicine, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Manuscript received August 31, 2006; revised manuscript received October 30, 2006, accepted November 6, 2006.

^_* Reprint requests and correspondence: Dr. Tetsuya Amano, Chubu-Rosai Hospital, Cardiology, Kohmei 1-10-6, Minato-ku, Nagoya 455-8530, Japan. (Email: amanot{at}med.nagoya-u.ac.jp).

Objectives: We assessed the impact of metabolic syndrome (MetS) on the tissue characteristics of coronary plaques using integrated backscatter intravascular ultrasound (IB-IVUS).

Background: Metabolic syndrome is associated with the increasing risk of cardiovascular disease.

Methods: We identified MetS by the definition of the National Cholesterol Education Program in Adult Treatment Panel III criterion. Non-target coronary lesions with mild to moderate stenosis were measured by conventional and IB-IVUS parameters using 40-MHz (motorized pullback 0.5 mm/s) intravascular catheter. A total of 20 IB-IVUS images were recorded at an interval of 0.5 mm for 10 mm length in each plaque. The 3-dimensional analyses were performed using commercially available software.

Results: The prevalence of MetS was 61 patients (50%) with 73 lesions (49%) among 122 patients with 148 lesions. Patients with MetS showed a significant increase in percentage lipid area (38 ± 19% vs. 30 ± 19%, p = 0.02) and percentage lipid volume (39 ± 17% vs. 33 ± 17%, p = 0.03), and they also showed a significant decrease in percentage of fibrous volume (57 ± 14% vs. 61 ± 13%, p = 0.03). Multivariate regression analysis after adjustment for potentially confounding risk factors showed that MetS remains correlated independently with the percentage of lipid volume (r = 0.223, p = 0.01). Logistic regression analysis after adjusting for confounding and non-MetS coronary risk factors showed that MetS (odds ratio 4.00, 95% confidence interval 1.33 to 12.0, p = 0.01) is proved to be an independent predictor of the lipid-rich plaque.

Conclusions: Metabolic syndrome is associated with lipid-rich plaques, contributing to the increasing risk of plaque vulnerability.

Abbreviations and Acronyms   ACS = acute coronary syndrome   AMI = acute myocardial infarction   ATP = Adult Treatment Panel   CSA = cross-sectional area   CVD = coronary vessel disease   EEM = external elastic membrane   %FV = percentage of fibrous volume   IB-IVUS = integrated backscatter intravascular ultrasound   IVUS = intravascular ultrasound   LCSA = lumen cross-sectional area   %LV = percentage of lipid volume   MetS = metabolic syndrome   NCEP = National Cholesterol Education Program   PCI = percutaneous coronary intervention   QCA = quantitative coronary angiography   3D = three-dimensional   UAP = unstable angina pectoris

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