Author + information
Depressed LV systolic function (LVEF) can carry a worse prognosis in the progression of atherosclerosis and increases the risk of unfavorable cardiovascular outcomes. The aim of the present study was to compare the clinical and coronary plaque characteristics of patients with depressed and normal LVEF using optical coherence tomography (OCT).
Methods and Results
We identified 125 patients who underwent coronary angiography and OCT from the Texas Heart Institute (THI) OCT registry. Depressed LVEF was defined as ejection fraction < 50%. A total of 92 patients were in the normal LVEF group and 33 patients were in the depressed LVEF group. Compared with the normal LVEF group, patients with depressed LVEF were more males (8 % versus 92% respectively, p=0.01), had less dyslipidemia (79% versus 21%, p=0.002), had less chronic kidney disease (55% versus 15%, p=0.04) and less tobacco use (63% versus 37%, p=0.03). Within the group with LVEF < 50%, the culprit plaque was similar regarding calcification, cholesterol crystals, neovessels and macrophages in those patients with and without plaque disruption. Thin cap fibro atheroma (TCFA) was significantly different between the presence versus absence of plaque rupture (p=0.01). In patients with diabetes (DM) and LVEF< 50%, those not on insulin therapy had significantly higher rates of plaque disruption (p=0.02). In the logistic regression model, in patients with LVEF<50%, only a previous episode of heart failure was an independent risk factors for plaque rupture.
Compared with normal LVEF patients, the patients with depressed LVEF and plaque rupture had a higher prevalence of TCFA. In patients with LVEF<50% and DM, those not on insulin therapy had higher rates of plaque disruption. Our logistic regression model demonstrated that only a previous episode of heart failure was an independent risk factor for a plaque rupture in patients with LVEF < 50%.