Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels

Ki-Bum Won; Byoung Kwon Lee; Ran Heo; Hyung-Bok Park; Fay Y Lin; Martin Hadamitzky; Yong-Jin Kim; Ji Min Sung; Edoardo Conte; Daniele Andreini; Gianluca Pontone; Matthew J Budoff; Ilan Gottlieb; Eun Ju Chun; Filippo Cademartiri; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Jonathon A Leipsic; Sang-Eun Lee; Sanghoon Shin; Jung Hyun Choi; Renu Virmani; Habib Samady; Kavitha Chinnaiyan; Daniel S Berman; Jagat Narula; Jeroen J Bax; James K Min; Hyuk-Jae Chang

doi:10.1016/j.jacasi.2021.10.010

Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels

JACC Asia. 2022 Apr 12;2(3):311-319. doi: 10.1016/j.jacasi.2021.10.010. eCollection 2022 Jun.

Authors

Ki-Bum Won^{1

2

3}, Byoung Kwon Lee⁴, Ran Heo^{3

5}, Hyung-Bok Park^{3

6}, Fay Y Lin⁷, Martin Hadamitzky⁸, Yong-Jin Kim⁹, Ji Min Sung^{2

3}, Edoardo Conte¹⁰, Daniele Andreini¹⁰, Gianluca Pontone¹⁰, Matthew J Budoff¹¹, Ilan Gottlieb¹², Eun Ju Chun¹³, Filippo Cademartiri¹⁴, Erica Maffei¹⁵, Hugo Marques¹⁶, Pedro de Araújo Gonçalves^{16

17}, Jonathon A Leipsic¹⁸, Sang-Eun Lee^{3

19}, Sanghoon Shin^{3

19}, Jung Hyun Choi²⁰, Renu Virmani²¹, Habib Samady²², Kavitha Chinnaiyan²³, Daniel S Berman²⁴, Jagat Narula²⁵, Jeroen J Bax²⁶, James K Min⁷, Hyuk-Jae Chang^{2

3}

Affiliations

¹ Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea.
² Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
³ Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea.
⁴ Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea.
⁶ Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea.
⁷ Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA.
⁸ Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
⁹ Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
¹⁰ Centro Cardiologico Monzino, IRCCS, Milan, Italy.
¹¹ Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA.
¹² Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.
¹³ Seoul National University Bundang Hospital, Sungnam, South Korea.
¹⁴ Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy.
¹⁵ Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.
¹⁶ UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.
¹⁷ Nova Medical School, Lisbon, Portugal.
¹⁸ Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea.
²⁰ Department of Cardiology, Pusan University Hospital, Busan, South Korea.
²¹ Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA.
²² Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
²³ Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA.
²⁴ Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA.
²⁵ Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York, USA.
²⁶ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

Abstract

Background: Despite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited.

Objectives: The authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA).

Methods: A total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm³/year) was defined as total PVC divided by the interscan period.

Results: Baseline total plaque volume (mm³) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P = 0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β = -0.114) in overall participants (P < 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β = -2.401; P = 0.004).

Conclusions: Serial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).

Keywords: CCTA, coronary computed tomographic angiography; CV, cardiovascular; PVC, plaque volume changes; atherosclerosis; coronary computed tomography angiography; hemoglobin; Δ hemoglobin, hemoglobin level changes.

Associated data

ClinicalTrials.gov/NCT02803411