Background/Purpose:

Accelerated atherosclerosis leading to premature coronary artery disease remains the major cause of late death in SLE. Positive remodeling index and presence of low attenuation noncalcified plaque (<30 Haunsfield units) are characteristic vessel changes in unstable coronary plaques. We sought to characterize noncalcified plaque lesions in patients with systemic lupus erythematosus and to identify high risk lesions.

Methods:

A total of 66 patients who met the ACR or SLICC classification criteria for SLE had CT angiogram studies. Of these, 30 patients had two CT angiogram studies. Coronary plaque area was measured by manual tracing for the difference between the area within the external elastic membrane and the area of the vessel lumen at the site of maximal luminal narrowing as observed on a cross-sectional coronary CT angiography image. Each noncalcified plaque detected within the vessel wall was evaluated with the minimum CT density and vascular remodeling index (RI). Total low density plaque volume per patient and low density/high density noncalcified plaque ratio were then compared by patient characteristics which included age, sex, ethnicity, BMI, smoking, SLEDAI, PGA, anti-dsDNA, low complement, current prednisone, current hydroxychloroquine, current NSAID use, history of cardiovascular event, hypertension, lupus anticoagulant, anticardiolipin, hypercholesterolemia, and methotrexate use.

Results:

All patients had at least one plaque with a positive remodeling index (>10%), and 83.1%(n=271) of total identified plaques had a positive remodeling index. Low density noncalcified plaque volume was associated with age (p<0.01) and body mass index (p<0.01). African Americans had significantly more (p<0.05) low density noncalcified plaque compared to patients of other ethnicities. The low density/high density noncalcified plaque ratio did not correlate with any patient characteristics and was on average 46% (SD=10). There were only 5 cardiovascular events in the studied group and there were no differences in remodeling index or low density noncalcified plaque observed in this group, but the number of events was small.

Conclusion:

Positive remodeling index and low attenuation noncalcified plaques are common in patients with lupus and are significantly more likely to be seen among African American patients, patients with a BMI>30, and age over 60. These characteristic vessel changes, seen in unstable coronary plaques, may identify patients at need for more frequent noninvasive cardiac monitoring.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/positive-remodeling-index-and-low-attenuation-non-calcified-coronary-plaques-markers-of-vulnerable-coronary-plaques-in-systemic-lupus/