Author + information
- Received July 26, 2017
- Revision received October 18, 2017
- Accepted October 18, 2017
- Published online January 17, 2018.
- Leif-Christopher Engel, MDa,b,
- Ulf Landmesser, MDa,b,c,
- Kevin Gigengack, MSa,
- Thomas Wurster, MDa,
- Constantina Manes, MDa,
- Georg Girke, MDa,
- Milosz Jaguszewski, MDa,
- Carsten Skurk, MDa,
- David M. Leistner, MDa,
- Alexander Lauten, MDa,
- Andreas Schuster, MD, PhD, MBAd,e,
- Bernd Hamm, MDh,
- Rene M. Botnar, PhDf,g,
- Marcus R. Makowski, MD, PhDh,∗ ( and )
- Boris Bigalke, MD, MBAa,∗∗ ()
- aKlinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
- bBerlin Institute of Health, Berlin, Germany
- cDZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- dDepartment of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
- eDepartment of Cardiology and Pulmonology, German Centre for Cardiovascular Research Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK) Partner Site, Göttingen, Germany
- fDivision of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
- gPontificia Universidad Católica de Chile Escuela de Ingeniería, Santiago, Chile
- hKlinik für Radiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
- ↵∗Address for correspondence:
Dr. Marcus Makowski, Department of Radiology and Cardiology, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Hindenburgdamm Str. 30, D-12203, Berlin, Germany.
- ↵∗∗Dr. Boris Bigalke, Department of Radiology and Cardiology, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Hindenburgdamm Str. 30, D-12203, Berlin, Germany.
Objectives This study sought to investigate the potential of the noninvasive albumin-binding probe gadofosveset-enhanced cardiac magnetic resonance (GE-CMR) for detection of coronary plaques that can cause acute coronary syndromes (ACS).
Background ACS are frequently caused by rupture or erosion of coronary plaques that initially do not cause hemodynamically significant stenosis and are therefore not detected by invasive x-ray coronary angiography (XCA).
Methods A total of 25 patients with ACS or symptoms of stable coronary artery disease underwent GE-CMR, clinically indicated XCA, and optical coherence tomography (OCT) within 24 h. GE-CMR was performed approximately 24 h following a 1-time application of gadofosveset-trisodium. Contrast-to-noise ratio (CNR) was quantified within coronary segments in comparison with blood signal.
Results A total of 207 coronary segments were analyzed on GE-CMR. Segments containing a culprit lesion in ACS patients (n = 11) showed significant higher signal enhancement (CNR) following gadofosveset-trisodium application than segments without culprit lesions (n = 196; 6.1 [3.9 to 16.5] vs. 2.1 [0.5 to 3.5]; p < 0.001). GE-CMR was able to correctly identify culprit coronary lesions in 9 of 11 segments (sensitivity 82%) and correctly excluded culprit coronary lesions in 162 of 195 segments (specificity 83%). Additionally, segmented areas of thin-cap fibroatheroma (n = 22) as seen on OCT demonstrated significantly higher CNR than segments without coronary plaque or segments containing early atherosclerotic lesions (n = 185; 9.2 [3.3 to 13.7] vs. 2.1 [0.5 to 3.4]; p = 0.001).
Conclusions In this study, we demonstrated for the first time the noninvasive detection of culprit coronary lesions and thin-cap fibroatheroma of the coronary arteries in vivo by using GE-CMR. This method may represent a novel approach for noninvasive cardiovascular risk prediction.
Dr. Makowski has received financial support from Deutsche Forschungsgemeinschaft grant 5943/31/41/91. Dr. Botnar was supported by British Heart Foundation grants PG/10/044/28343 and RG/12/1/29262. Dr. Engel is a participant in the Berlin Institute of Health Charité Clinician Scientist Program funded by Charité-Universitätsmedizin Berlin and Berlin Institute of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Engel and Landmesser contributed equally to this work and are joint first authors. Drs. Makowski and Bigalke contributed equally to this work, and are joint senior authors.
- Received July 26, 2017.
- Revision received October 18, 2017.
- Accepted October 18, 2017.
- 2018 American College of Cardiology Foundation
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