Carotid plaque regression following 6-month statin therapy assessed by 3T cardiovascular magnetic resonance: comparison with ultrasound intima media thicknessReport as inadecuate

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Journal of Cardiovascular Magnetic Resonance

, 13:37

First Online: 03 August 2011Received: 17 March 2011Accepted: 03 August 2011


BackgroundCardiovascular magnetic resonance CMR allows volumetric carotid plaque measurement that has advantage over 2-dimensional ultrasound US intima-media thickness IMT in evaluating treatment response. We tested the hypothesis that 6-month statin treatment in patients with carotid plaque will lead to plaque regression when measured by 3 Tesla CMR but not by IMT.

MethodsTwenty-six subjects 67 ± 2 years, 7 females with known carotid plaque > 1.1 mm and coronary or cerebrovascular atherosclerotic disease underwent 3T CMR T1, T2, proton density and time of flight sequences and US at baseline and following 6 months of statin therapy 6 had initiation, 7 had increase and 13 had maintenance of statin dosing. CMR plaque volume PV was measured in the region 12 mm below and up to 12 mm above carotid flow divider using software. Mean posterior IMT in the same region was measured. Baseline and 6-month CMR PV and US IMT were compared. Change in lipid rich-necrotic core LR-NC and calcification plaque components from CMR were related to change in PV.

ResultsLow-density lipoprotein cholesterol decreased 86 ± 6 to 74 ± 4 mg-dL, p = 0.046. CMR PV decreased 5.8 ± 2% 1036 ± 59 to 976 ± 65 mm, p = 0.018. Mean IMT was unchanged 1.12 ± 0.06 vs. 1.14 ± 0.06 mm, p = NS. Patients with initiation or increase of statins had -8.8 ± 2.8% PV change p = 0.001 while patients with maintenance of statin dosing had -2.7 ± 3% change in PV p = NS. There was circumferential heterogeneity in CMR plaque thickness with greatest thickness in the posterior carotid artery, in the region opposite the flow divider. Similarly there was circumferential regional difference in change of plaque thickness with significant plaque regression in the anterior carotid region in region of the flow divider. Change in LR-NC R = 0.62, p = 0.006 and calcification R = 0.45, p = 0.03 correlated with PV change.

ConclusionsSix month statin therapy in patients with carotid plaque led to reduced plaque volume by 3T CMR, but ultrasound posterior IMT did not show any change. The heterogeneous spatial distribution of plaque and regional differences in magnitude of plaque regression may explain the difference in findings and support volumetric measurement of plaque. 3T CMR has potential advantage over ultrasound IMT to assess treatment response in individuals and may allow reduced sample size, duration and cost of clinical trials of plaque regression.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-37 contains supplementary material, which is available to authorized users.

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Author: Raymond Q Migrino - Mark Bowers - Leanne Harmann - Robert Prost - John F LaDisaJr


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