Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging the AQUAMARINE Pilot Study

Teruo Noguchi, Atsushi Tanaka, Tomohiro Kawasaki, Yoichi Goto, Yoshiaki Morita, Yasuhide Asaumi, Kazuhiro Nakao, Reiko Fujiwara, Kunihiro Nishimura, Yoshihiro Miyamoto, Masaharu Ishihara, Hisao Ogawa, Nobuhiko Koga, Jagat Narula, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Background Coronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR). Objectives This pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR. Methods Prospective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed. Results In the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001). Conclusions Statin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition.

Original languageEnglish
Pages (from-to)245-256
Number of pages12
JournalJournal of the American College of Cardiology
Issue number3
Publication statusPublished - 2015 Jul 21
Externally publishedYes


  • atherosclerosis
  • cardiac magnetic resonance
  • coronary artery disease
  • vulnerable plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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