Association of C-Reactive Protein With Dense Calcium and Fibro-Fatty Plaque on Intravascular Ultrasound Virtual Histology in Critical Limb-Threatening Ischemia Patients

In CLTI patients, dense calcium and fibro-fatty plaque areas are negatively correlated in IVUS-VH data. The CRP levels are positively correlated with dense calcium lesion area and negatively correlated with fibro-fatty plaque lesion area in CLTI patients. These findings are consistent with research in coronary arteries. This study did not find correlations between IVUS-VH data and other clinical outcomes; however, a larger data set and longer follow-up may provide new insights in the future.Clinical ImpactThis study provides insights into plaque phenotyping in chronic limb-threatening ischemia (CLTI) by demonstrating correlations between C-reactive protein (CRP) levels and specific intravascular ultrasound-virtual histology (IVUS-VH) plaque components (dense calcium and fibro-fatty tissue). This suggests that CRP, a readily available biomarker, may reflect underlying plaque morphology in peripheral arteries, similar to coronary findings. Clinically, these results highlight the potential of integrating systemic inflammatory markers with advanced imaging for more comprehensive risk assessment. Although not yet predictive of long-term outcomes, this integrative approach represents a step toward personalized therapy in CLTI and encourages future research into interventions targeting specific plaque compositions.