• Valentina Andova University Clinic of cardiology, Faculty of Medicine “St.Cyril&Methodius”, Skopje, R.of North Macedonia
  • Planinka Zafirovska Zan Mitrev Clinic, Skopje, R.of North Macedonia
  • Elizabeta Srbinovska-Kostovska University Clinic of cardiology, Faculty of Medicine “St.Cyril&Methodius”, Skopje, R.of North Macedonia
  • Ljubica Georgievska-Ismail University Clinic of cardiology, Faculty of Medicine “St.Cyril&Methodius”, Skopje, R.of North Macedonia


 It was confirmed that coronary artery plaque [CAP] and its larger burden may influence myocardial perfusion independent of presence of significant coronary artery stenosis.The aim of our study was to examine the role of CAP as predictor of coronary artery disease [CAD] presence  using pharmacological stress echocardiography [SE]. We prospectively assessed 61 consecutive patients with symptoms implying CAD who underwent dipyridamole or dobutamine SE and coronary angiography. Conventional 2D echocardiographic wall motion score index [WMSI] as well as global LV longitudinal strain using speckle tracking [GLS%] were measured at rest and peak stress. Out of 61 patients, 25/41.0% had normal coronary arteries, 18/29.5% had obstructive CAD and 18/29.5% had nonobstructive CAD with CAP. In patients with CAP, GLS% at maximal SE showed worsening in comparison to those with and without CAD who showed insignificant lower GLS% or better function after SE [p=0.057]. Presence of CAP [OR=8.358; 95%CI 1.929-36.216;p=0.005] and worsening of WMSI at maximal SE [OR=190.5; 95%CI 2.517-14426.687;p=0.017] appeared as independent predictors of CAD presence, while worse values of GLS% at maximal SE [OR=1.155; 95%CI 0.999-1.334;p=0.051] as well change [increase] of the number of segments with LS< 12% at maximal SE [OR=0.755; 95%CI 0.602-0.946;p=0.015] appeared as independent predictors of CAP presence. Coronary artery plaque presence appeared as independent predictor of CAD as well as worse values of GLS%

Key words:coronary artery plaque, coronary artery disease, stress echocardiography, LV systolic longitudinal strai




1.Maas AHEM, Milasinovic D, Berry C, Escaned J. Microvascular angina: Diagnosis, assessment, and treatment. EMJ Int Cardiol. 2019;7[Suppl 1]2-17.
2.Claudio CP, Quesada O, Pepine CJ, Merz CNB. Why names matter for women: MINOCA/INOCA [myocardial infarction/ischemia and no obstructive coronary artery disease]. Clinical Cardiology 2018;41:185-93.
3.Herscovici R, Sedalk T, Wei J, et al. Ischemia and no obstructive coronary artery disease [INOCA]: What is the risk? J Am Heart Assoc. 2018;7:e008868.
4.Eskerud I, Gerdts E, Nordrehaug JE, and Lonnebakken MT. Global coronary artery plaque area is associated with myocardial hypoperfusion in women with non-ST elevation myocardial infarction. J Women’s Health 2015;24:367-73.
5. Gaur S, Øvrehus KA, Dey D, et al. Coronary plaque quantifcation and fractional flow reserve by coronary computed tomography angiography identify ischemia-causing lesions. Eur Hear J 2016;37:1220-7.
6. Stolzmann P, Donati OF, Desbiolles L, et al. Coronary artery plaque and myocardial ischemia. Eur Radiol 2011;21:1628-34.
7.Shah S, Bellam N, Leipsic J, et al for the CONFIRM [COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry] Investigators. Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease. J Nucl Cardiol. 2014; 21:453-66.
8.Williams MC, Moss AJ, Dweck M, et al. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART study. J Am Coll Cardiol 2019;73:291-30.
9. Sicari R, Nihoyannopoulos P, Evangelista A, et al on behalf of the European Association of Echocardiography. Stress echocardiography expert consensus statement. Eur J Echocardiogr 2008;9:415-37.
10. Suzuki K, Hirano Y, Yamada H, et al. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018;16:105-29.
11. Pellikka PA, Nagueh SF, Elhendy AA, et al. American Society of Echocardiography Recommendations for Performance, Interpretation, and Application of Stress Echocardiography. J Am Soci Echocardiog 2007; 20:1021-41.
12. Sicari R and Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease Cardiovasc Ultrasound 2017; 15:7.
13. Feigenbaum H, Mastouri R, Sewada S. A practical approach to using strain echocardiography to evaluate the left ventricle. Circ J 2012;76:1550-5.
14. Mor-Avi V, Lang RM, Badano LP, et al. Current and еvolving еchocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE Consensus Statement on methodology and indications. J Am Soc Echocardiogr 2011;24:277-313.
15. Sianos G, Morel M, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of artery disease. Euro Interv 2005;1:219-27.
16. Berman DS, Hachamovitch R, Shaw LJ, et al. Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease. J Nucl Med 2006; 47:1107-18.
17. Bauer RW, Thilo C, Chiaramida SA, et al. Noncalcified atherosclerotic plaque burden at coronary CT angiography: A better predictor of ischemia at stress myocardial perfusion imaging than calcium score and stenosis severity. AJR 2009; 193:410-8.
18. Stolzmann P, Donati OF, Desbiolles L, et al. Coronary artery plaques and myocardial ischemia. Eur Radiol 2011;21:1628-34.
19. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res 2014;114:1852-66.
20. Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007;50:319-26.
21. Burke AP, Kolodgie FD, Farb A, et al. Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression. Circulation 2001; 103:934-40
22. Erbel R, Heusch G. Coronary microembolization. J Am Coll Cardiol 2000; 36:22-4
23. Heusch G, Schulz R. Perfusion-contraction match and mismatch. Basic Res Cardiol 2001; 96:1-10
24. Reynolds HR, Srichai MB, Iqbal SN, et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124:1414-25.
25. Lee BK, Lim HS, Fearon WF, et al. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation 2015;131:1054-60.
26. Khuddus MA, Pepine CJ, Handberg EM, et al. An intravascular ultrasound analysis in women experiencing chest pain in the absence of obstructive coronary artery disease: a substudy from the National Heart, Lung and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation [WISE]. J Interv Cardiol. 2010;23:511-19.
27. Schindler TH, Nitzsche E, Magosaki N, et al. Regional myocardial perfusion defect during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation. Heart 2003; 89:517-26.
28. Pepine CJ, Ferdinand KJ, Shaw LJ, et al. for the American College of Cardiology Cardiovascular Disease in Women Committee [ACC CVD in Women]. Emergence of nonobstructive coronary artery disease: A Woman's problem and need for change in definition on angiography. J Am Coll Cardiol 2015;66:1918-33.
29. Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 2009;54:49-57.
30. Versteylen MO, Kietselaer BL, Dagnelie PC, et al. Additive value of semiautomated quantifcation of coronary artery disease using cardiac computed tomographic angiography to predict future acute coronary syndrome. J Am Coll Cardiol 2013;61:2296–305.
31. Thomsen C, Abdulla J. Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2016;17:120-9.
32. Williams MC, Moss AJ, Dweck M, et al. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART Study. J Am Coll Cardiol 2019;73:291-301.
33. Rahman H, Corcoran D, Aetesam-ur-Rahman M, et al. Diagbosis of patients with angina and non-obstructive coronary disease in the catheter laboratory. Heart 2019;105:1536-42.
34. Meijboom WB, Van Mieghem CAG, van Pelt N, et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 2008;52:636 -43.
35. Park H-B, Heo R, ó Hartaigh B, et al. Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional fow reserve. J Am Col Cardiol Img 2015;8:1–10.
36. Lu C, Picano E, Pingitore A, et al. Complex coronary artery lesion morphology influences results of stress echocardiography. Circulation 1995;91:1669–75.
37. Pomar F, Cosin J, Portoles M,et al. Functional and ultrastructural alterations of canine myocardium subjected to very brief coronary occlusions. Eur Heart J 1995;16:1482 – 90.
How to Cite
ANDOVA, Valentina et al. THE ROLE OF CORONARY ARTERY PLAQUE IN PREDICTION OF CORONARY ARTERY DISEEASE USING PHARMACOLOGICAL-STRESS ECHOCARDIOGRAPHY. Journal of Morphological Sciences, [S.l.], v. 3, n. 1, p. 3-11, july 2020. ISSN 2545-4706. Available at: <>. Date accessed: 20 jan. 2022.