Coronary plaque volume burden and composition in patients with non-hemodynamically significant coronary artery plaques and systemic inflammation

Abstract Introduction Atherosclerotic coronary disease is a leading cause of morbidity and mortality worldwide. Systemic inflammation can affect plaque composition and thus increase cardiovascular risk. Identifying plaque characteristics in these patients could be useful to learn how inflammation (identified by easy to access parameters, like high ferritin and CRP) affects plaque composition in these challenging patients. Purpose We aimed to evaluate the association of systemic inflammation identified by high ferritin and/or high C-reactive protein (CRP) with coronary plaque volume and composition in patients with non-hemodynamically significant coronary artery plaques (stenosis <50%). Methods We prospectively recruited 109 patients referred for noninvasive CT angiography (from November 2023 to January 2024) with suspected coronary artery disease. 20 had totally/partially non-calcified, non-significant coronary plaques (stenosis <50%). Plaque volume was measured. Plaque components were stablished as calcified (>200 UH), lipidic (<60 UH) and fibrous (60-200 UH). Systemic inflammation was identified when ferritin was >300 ng/mL and/or C-reactive protein CRP was >5 mg/L, according to our laboratory high normal limits. CT scan images were acquired with a 128 detectors dual-layer CT scan with prospective-retrospective/synchronization. Intravascular iodine-based contrast agent was administered. Results Mean age was 60 ± 11 years old and 75% of patients were men. 55% had high blood pressure, 65% were current or previous smokers and 40% had dyslipidemia (35% received statins). 10% were diabetic. There were no difference between groups for these characteristics. We analyzed 33 plaques. Fibrous plaque volume was found to be significantly higher in patients with high ferritin (66.9 vs 32.5 mm3; p = 0.04) and in patients with high CRP (78.7 vs 36.4 mm3; p = 0.05). The percentage of fibrous plaque tended to be higher in patients with higher ferritin and CRP (54.9 vs 38.9; p = 0.06 and 60.6 vs 40.7%; p = 0.07, respectively). Conclusions Systemic inflammation affecting coronary plaque composition in non-hemodynamically significant coronary atherosclerotic disease can by identified by high ferritin and high CRP levels. It is associated with higher fibrous plaque volumes. This finding suggest that systemic inflammation can associate more vulnerable plaques and might benefit from more aggressive management of non-hemodynamically significant atherosclerosis.TableFigure