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Osborne-Grinter M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman D, Slomka PJ, Newby DE, Dweck MR, Dey D, Williams MC. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial. Eur Heart J Cardiovasc Imaging 2022; 23:1210-1221. [PMID: 34529050 PMCID: PMC9612790 DOI: 10.1093/ehjci/jeab135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. METHODS AND RESULTS In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1-9 AU), low (10-99 AU), moderate (100-399 AU), high (400-999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS (P < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. CONCLUSION In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque.
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Affiliation(s)
- Maia Osborne-Grinter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Jacek Kwiecinski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- NIHR Leicester Biomedical Research Centre and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Shirjel Alam
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Amanda Hunter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Anoop S V Shah
- Department of non-communicable disease epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tania Pawade
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | - Chengjia Wang
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
| | | | - Giles Roditi
- Institute of Cardiovascular & Medical Sciences, Glasgow University, Glasgow, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | | | - Edward D Nicol
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building,49 Little France Crescent, Edinburgh, EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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102
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Jonas RA, Weerakoon S, Fisher R, Griffin WF, Kumar V, Rahban H, Marques H, Karlsberg RP, Jennings RS, Crabtree TR, Choi AD, Earls JP. Interobserver variability among expert readers quantifying plaque volume and plaque characteristics on coronary CT angiography: a CLARIFY trial sub-study. Clin Imaging 2022; 91:19-25. [PMID: 35986973 DOI: 10.1016/j.clinimag.2022.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The difference between expert level (L3) reader and artificial intelligence (AI) performance for quantifying coronary plaque and plaque components is unknown. OBJECTIVE This study evaluates the interobserver variability among expert readers for quantifying the volume of coronary plaque and plaque components on coronary computed tomographic angiography (CCTA) using an artificial intelligence enabled quantitative CCTA analysis software as a reference (AI-QCT). METHODS This study uses CCTA imaging obtained from 232 patients enrolled in the CLARIFY (CT EvaLuation by ARtificial Intelligence For Atherosclerosis, Stenosis and Vascular MorphologY) study. Readers quantified overall plaque volume and the % breakdown of noncalcified plaque (NCP) and calcified plaque (CP) on a per vessel basis. Readers categorized high risk plaque (HRP) based on the presence of low-attenuation-noncalcified plaque (LA-NCP) and positive remodeling (PR; ≥1.10). All CCTAs were analyzed by an FDA-cleared software service that performs AI-driven plaque characterization and quantification (AI-QCT) for comparison to L3 readers. Reader generated analyses were compared among readers and to AI-QCT generated analyses. RESULTS When evaluating plaque volume on a per vessel basis, expert readers achieved moderate to high interobserver consistency with an intra-class correlation coefficient of 0.78 for a single reader score and 0.91 for mean scores. There was a moderate trend between readers 1, 2, and 3 and AI with spearman coefficients of 0.70, 0.68 and 0.74, respectively. There was high discordance between readers and AI plaque component analyses. When quantifying %NCP v. %CP, readers 1, 2, and 3 achieved a weighted kappa coefficient of 0.23, 0.34 and 0.24, respectively, compared to AI with a spearman coefficient of 0.38, 0.51, and 0.60, respectively. The intra-class correlation coefficient among readers for plaque composition assessment was 0.68. With respect to HRP, readers 1, 2, and 3 achieved a weighted kappa coefficient of 0.22, 0.26, and 0.17, respectively, and a spearman coefficient of 0.36, 0.35, and 0.44, respectively. CONCLUSION Expert readers performed moderately well quantifying total plaque volumes with high consistency. However, there was both significant interobserver variability and high discordance with AI-QCT when quantifying plaque composition.
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Affiliation(s)
- Rebecca A Jonas
- Department of Internal Medicine, Thomas Jefferson University Medical Center, Philadelphia, PA, USA
| | - Shaneke Weerakoon
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Rebecca Fisher
- Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - William F Griffin
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Vishak Kumar
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Hugo Marques
- Centro Hospitalar Universitario de Lisboa Central - Servico de Radiologia do Hospital de Santa Marta, Lisboa, Portugal; Nova Medical School - Faculdade de Ciencias Medicas -, Lisboa, Portugal
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | | | | | - Andrew D Choi
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
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Yang S, Hoshino M, Koo BK, Yonetsu T, Zhang J, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen S, Tanaka N, Matsuo H, Kubo T, Chang HJ, Kakuta T, Narula J. Relationship of Plaque Features at Coronary CT to Coronary Hemodynamics and Cardiovascular Events. Radiology 2022; 305:578-587. [PMID: 35972355 DOI: 10.1148/radiol.213271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Plaque assessments with coronary CT angiography (CCTA) and coronary flow indexes have prognostic implications. Purpose To investigate the association and additive prognostic value of plaque burden and characteristics at CCTA with coronary pressure and flow. Materials and Methods Data of patients with coronary artery disease who underwent CCTA within 90 days before physiologic assessments at tertiary cardiovascular centers between January 2011 and December 2018 were retrospectively analyzed, which included fractional flow reserve (FFR), resting distal coronary artery pressure (Pd)-to-aortic pressure (Pa) ratio (hereafter, Pd/Pa), coronary flow reserve (CFR), hyperemic flow (1/hyperemic mean transit time [Tmn]), resting flow (1/resting Tmn), and index of microcirculatory resistance (IMR). Four high-risk plaque (HRP) attributes at CCTA defined high disease burden (plaque burden, ≥70%; minimum lumen area, <4 mm2) and adverse plaque (low-attenuation plaque, positive remodeling). Their lesion-specific relationships with coronary hemodynamic parameters and major adverse cardiovascular events (MACE) were investigated using a generalized estimating equation and marginal Cox model. Results Among 406 lesions from 335 patients (mean age, 67 years ± 10 [SD]; 259 men), high disease burden is predicted by FFR (odds ratio [OR], 0.55; P < .001), resting Pd/Pa (OR, 0.47; P < .001), CFR (OR, 0.85; P = .004), and hyperemic flow (OR, 0.91; P = .03), and adverse plaque by FFR (OR, 0.67; P < .001), resting Pd/Pa (OR, 0.69; P = .001), hyperemic flow (OR, 0.76; P = .006), resting flow (OR, 0.54; P = .001), and IMR (OR, 1.27; P = .008). High disease burden (hazard ratio [HR], 4.0; P = .004) and adverse plaque (HR, 2.7; P = .02) were associated with a higher risk of MACE (n = 27) over median 2.9-year follow-up. In six lesion subsets with normal flow or pressure, at least three HRP attributes predicted a higher MACE rate (HR range, 2.6-6.3). Conclusion High-risk plaque features and plaque burden at coronary CT angiography were associated with cardiovascular events independent of coronary hemodynamic parameters. Clinical trial registration no. NCT04037163 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leipsic and Tzimas in this issue.
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Affiliation(s)
- Seokhun Yang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Masahiro Hoshino
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Bon-Kwon Koo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Taishi Yonetsu
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jinlong Zhang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Doyeon Hwang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Eun-Seok Shin
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Joon-Hyung Doh
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Chang-Wook Nam
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jianan Wang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Shaoliang Chen
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Nobuhiro Tanaka
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Hitoshi Matsuo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Takashi Kubo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Hyuk-Jae Chang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Tsunekazu Kakuta
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
| | - Jagat Narula
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea (S.Y., B.K.K., D.H.); Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (M.H., T. Kakuta); Institute on Aging, Seoul National University, Seoul, Korea (B.K.K.); Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (T.Y.); Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China (J.Z., J.W.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (E.S.S.); Division of Cardiology, Ulsan Hospital, Ulsan, Korea (E.S.S.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.W.N.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.C.); Department of Cardiology, Tokyo Medical University, Tokyo, Japan (N.T.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Wakayama Medical University, Wakayama, Japan (T. Kubo); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea (H.J.C.); and Icahn School of Medicine at Mount Sinai, New York, NY (J.N.)
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104
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Harnessing imaging biomarkers to refine individualized cardiovascular disease risk: a case-based discussion. Coron Artery Dis 2022; 33:574-579. [PMID: 35942620 DOI: 10.1097/mca.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditional models of cardiovascular risk assessment rely on population-level risk factors and may not accurately capture individualized risk. Imaging biomarkers such as plaque characterization and pericoronary fat inflammation may offer refined risk prediction and allow physicians to personalize care-plans for cardiovascular disease prevention. The integration of plaque morphology and pericoronary inflammation into clinical care is highlighted using a case-based discussion. This article reviews the existing body of evidence supporting the use of novel biomarkers in an individualized comprehensive risk assessment algorithm.
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105
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Munnur RK, Cheng K, Laggoune J, Talman A, Muthalaly R, Nerlekar N, Baey YW, Nogic J, Lin A, Cameron JD, Seneviratne S, Wong DTL. Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2022; 12:415-425. [PMID: 36033222 PMCID: PMC9412217 DOI: 10.21037/cdt-21-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022]
Abstract
Background Computed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up. Methods Retrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up. Results A total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (−) patients and patients with no plaques (20.5% vs. 1.6% vs. 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (−) patients (8.6%), HRP (−)/OS (+) patients (1.8%) and HRP (−)/OS (−) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008). Conclusions The presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.
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Affiliation(s)
- Ravi K Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jordan Laggoune
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Rahul Muthalaly
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Yi-Wei Baey
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia.,South Australian Health Medical Research Institute (SAHMRI), Adelaide, Australia
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106
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van den Hoogen IJ, Stuijfzand WJ, Gianni U, van Rosendael AR, Bax AM, Lu Y, Tantawy SW, Hollenberg EJ, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Gonçalves PDA, Hadamitzky M, Kim YJ, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Lee SE, Al'Aref SJ, Baskaran L, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Berman DS, Chang HJ, Narula J, Min JK, Bax JJ, Lin FY, Shaw LJ. Early versus late acute coronary syndrome risk patterns of coronary atherosclerotic plaque. Eur Heart J Cardiovasc Imaging 2022; 23:1314-1323. [PMID: 35904766 DOI: 10.1093/ehjci/jeac114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicenter study, we enrolled patients who underwent a clinically indicated baseline CCTA and experienced ACS during follow-up. Separate core laboratories performed blinded adjudication of ACS events and quantification of CCTA including compositional plaque volumes by Hounsfield units (HU): calcified plaque >350 HU, fibrous plaque 131-350 HU, fibrofatty plaque 31-130 HU and necrotic core <30 HU. In 234 patients (mean age 62 ± 12 years, 36% women), early and late ACS occurred in 129 and 105 patients after a mean of 395 ± 622 days, respectively. Patients with early ACS had a greater maximal diameter stenosis and maximal cross-sectional plaque burden as compared to patients with late ACS (P < 0.05). Larger total, fibrous, fibrofatty, and necrotic core volumes were observed in the early ACS group (P < 0.05). Findings for total, fibrous, fibrofatty, and necrotic core volumes were reproduced in an external validation cohort (P < 0.05). CONCLUSIONS Volumetric differences in composition of coronary atherosclerosis exist between ACS patients according to their timing antecedent to the acute event. These data support that a large burden of non-calcified plaque on CCTA is strongly associated with near-term plaque instability and ACS risk.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Sara W Tantawy
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Faculty of Medicine, Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Emma J Hollenberg
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | - Fabian Plank
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Lohendran Baskaran
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiovascular Medicine, National Heart Centre, Singapore
| | - Ibrahim Danad
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jagat Narula
- 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, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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107
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Ichikawa K, Miyoshi T, Ohno Y, Osawa K, Nakashima M, Nishihara T, Miki T, Toda H, Yoshida M, Ito H. Association between High Pericoronary Adipose Tissue Computed Tomography Attenuation and Impaired Flow-Mediated Dilation of the Brachial Artery. J Atheroscler Thromb 2022; 30:364-376. [PMID: 35753780 PMCID: PMC10067336 DOI: 10.5551/jat.63580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) is a noninvasive biomarker for pericoronary inflammation and is associated with cardiac mortality. We aimed to investigate the association between PCAT attenuation and endothelial dysfunction assessed using flow-mediated dilation (FMD). METHODS A total of 119 outpatients who underwent both coronary CTA and FMD measurements were examined. PCAT attenuation values were assessed at the proximal 40-mm segments of all three major coronary arteries on coronary CTA. Endothelial function was assessed using FMD. Patients were then classified into two groups: those with endothelial dysfunction (FMD <4%, n=44) and those without endothelial dysfunction (FMD ≥ 4%, n=75). RESULTS In all three coronary arteries, PCAT attenuation was significantly higher in patients with endothelial dysfunction than in those without endothelial dysfunction. Multivariate logistic regression analysis revealed that PCAT attenuation in the right coronary artery (odds ratio [OR]=1.543; 95% confidence interval [CI]=1.004-2.369,p=0.048) and left anterior descending artery (OR=1.525, 95% CI=1.004-2.369, p=0.049) was an independent predictor of endothelial dysfunction. Subgroup analysis of patients with adverse CTA findings (significant stenosis and/or high-risk plaque) and those with coronary artery calcium score >100 showed that high PCAT attenuation in all three coronary arteries was a significant predictor of endothelial dysfunction. CONCLUSION High PCAT attenuation was significantly associated with FMD-assessed endothelial dysfunction in patients with suspected coronary artery disease. Our results suggest that endothelial dysfunction is one of the pathophysiological mechanisms linking pericoronary inflammation to cardiac mortality.
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Affiliation(s)
- Keishi Ichikawa
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Yuko Ohno
- Department of Medical technology, Kawasaki University of Medical Welfare
| | - Kazuhiro Osawa
- Department of General Internal Medicine 3, Kawasaki Medical School General Medicine Center
| | - Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Takahiro Nishihara
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Takashi Miki
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Masatoki Yoshida
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
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108
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Dawson LP, Layland J. High-Risk Coronary Plaque Features: A Narrative Review. Cardiol Ther 2022; 11:319-335. [PMID: 35731471 PMCID: PMC9381667 DOI: 10.1007/s40119-022-00271-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Advances in coronary plaque imaging over the last few decades have led to an increased interest in the identification of novel high-risk plaque features that are associated with cardiovascular events. Existing practices focus on risk stratification and lipid monitoring for primary and secondary prevention of cardiac events, which is limited by a lack of assessment and treatment of vulnerable plaque. In this review, we summarize the multitude of studies that have identified plaque, haemodynamic and patient factors associated with risk of acute coronary syndrome. Future progress in multi-modal imaging strategies and in our understanding of high-risk plaque features could expand treatment options for coronary disease and improve patient outcomes.
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Affiliation(s)
- Luke P Dawson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jamie Layland
- Department of Medicine, Monash University, Clayton campus, Melbourne, VIC, Australia. .,Department of Cardiology, Peninsula Health, 2 Hastings Rd, Frankston, VIC, 3199, Australia.
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Nadjiri J, Koppara T, Kafka A, Weis F, Rasper M, Gassert FG, von Schacky CE, Pfeiffer D, Laugwitz KL, Makowski MR, Ibrahim T. Coronary plaque characterization assessed by delayed enhancement dual-layer spectral CT angiography and optical coherence tomography. Int J Cardiovasc Imaging 2022; 38:2491-2500. [DOI: 10.1007/s10554-022-02638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
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110
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Andreini D, Melotti E, Vavassori C, Chiesa M, Piacentini L, Conte E, Mushtaq S, Manzoni M, Cipriani E, Ravagnani PM, Bartorelli AL, Colombo GI. Whole-Blood Transcriptional Profiles Enable Early Prediction of the Presence of Coronary Atherosclerosis and High-Risk Plaque Features at Coronary CT Angiography. Biomedicines 2022; 10:biomedicines10061309. [PMID: 35740331 PMCID: PMC9219643 DOI: 10.3390/biomedicines10061309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 12/10/2022] Open
Abstract
Existing tools to estimate cardiovascular (CV) risk have sub-optimal predictive capacities. In this setting, non-invasive imaging techniques and omics biomarkers could improve risk-prediction models for CV events. This study aimed to identify gene expression patterns in whole blood that could differentiate patients with severe coronary atherosclerosis from subjects with a complete absence of detectable coronary artery disease and to assess associations of gene expression patterns with plaque features in coronary CT angiography (CCTA). Patients undergoing CCTA for suspected coronary artery disease (CAD) were enrolled. Coronary stenosis was quantified and CCTA plaque features were assessed. The whole-blood transcriptome was analyzed with RNA sequencing. We detected highly significant differences in the circulating transcriptome between patients with high-degree coronary stenosis (≥70%) in the CCTA and subjects with an absence of coronary plaque. Notably, regression analysis revealed expression signatures associated with the Leaman score, the segment involved score, the segment stenosis score, and plaque volume with density <150 HU at CCTA. This pilot study shows that patients with significant coronary stenosis are characterized by whole-blood transcriptome profiles that may discriminate them from patients without CAD. Furthermore, our results suggest that whole-blood transcriptional profiles may predict plaque characteristics.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20121 Milan, Italy
- Correspondence: (D.A.); (G.I.C.); Tel.: +39-0258002577 (D.A.); +39-0258002464 (G.I.C.)
| | - Eleonora Melotti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Chiara Vavassori
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20121 Milan, Italy
| | - Mattia Chiesa
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
| | - Luca Piacentini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Department of Biomedical Sciences for Health, University of Milan, 20121 Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Martina Manzoni
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Eleonora Cipriani
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Paolo M. Ravagnani
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20121 Milan, Italy
| | - Gualtiero I. Colombo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.M.); (C.V.); (M.C.); (L.P.); (E.C.); (S.M.); (M.M.); (E.C.); (P.M.R.); (A.L.B.)
- Correspondence: (D.A.); (G.I.C.); Tel.: +39-0258002577 (D.A.); +39-0258002464 (G.I.C.)
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Wang J, Chen HW, Zhou LJ, Zhang XP, Chen BX, Chen KD, Fang XM. Prediction of acute myocardial infarction by multi-parameter coronary computed tomography angiography. Clin Radiol 2022; 77:458-465. [PMID: 35400504 DOI: 10.1016/j.crad.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/28/2022] [Indexed: 12/29/2022]
Abstract
AIM To investigate the performance of multi-parameter coronary computed tomography angiography (CCTA), including stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from CCTA (FFRct), to predict acute myocardial infarction (AMI) and build a combined model. MATERIALS AND METHODS Thirty patients with AMI 90 days after CCTA and 120 matched patients without AMI were enrolled retrospectively. Multiple CCTA parameters were analysed and compared. Independent risk factors were obtained through univariate and multivariate regression analyses, after which a multi-parameter model was built. RESULTS A total of 150 patients were analysed successfully. The multi-parameter CCTA model (area under the curve, 0.944; p<0.001) had a higher predictive value than each single parameter (p<0.001, all). Independent risk factors were intra-plaque dye penetration (IDP; odds ratio [OR], 8.373; p=0.002), lipid plaque volume (LPV; OR, 1.263; p<0.001), and FFRct ≤0.83 (OR, 8.092; p=0.001). CONCLUSION This one-stop multi-parameter CCTA model, comprising IDP, LPV, and FFRct as independent risk factors, has good performance to predict AMI.
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Affiliation(s)
- J Wang
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - H-W Chen
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - L-J Zhou
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - X-P Zhang
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - B-X Chen
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - K-D Chen
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - X-M Fang
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China.
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Shining a Light on Plaque Vulnerability and Treatment. JACC Cardiovasc Imaging 2022; 15:1322-1324. [DOI: 10.1016/j.jcmg.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
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113
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Carrabba N, Pontone G, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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van Driest FY, Bijns CM, van der Geest RJ, Broersen A, Dijkstra J, Scholte AJHA, Jukema JW. Utilizing (serial) coronary computed tomography angiography (CCTA) to predict plaque progression and major adverse cardiac events (MACE): results, merits and challenges. Eur Radiol 2022; 32:3408-3422. [PMID: 34997285 DOI: 10.1007/s00330-021-08393-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/24/2021] [Accepted: 10/07/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To present an overview of studies using serial coronary computed tomography angiography (CCTA) as a tool for finding both quantitative (changes) and qualitative plaque characteristics as well as epicardial adipose tissue (EAT) volume changes as predictors of plaque progression and/or major adverse cardiac events (MACE) and outline the challenges and advantages of using a serial non-invasive imaging approach for assessing cardiovascular prognosis. METHODS A literature search was performed in PubMed, Embase, Web of Science, Cochrane Library and Emcare. All observational cohort studies were assessed for quality using the Newcastle-Ottawa Scale (NOS). The NOS score was then converted into Agency for Healthcare Research and Quality (AHRQ) standards: good, fair and poor. RESULTS A total of 36 articles were analyzed for this review, 3 of which were meta-analyses and one was a technical paper. Quantitative baseline plaque features seem to be more predictive of MACE and/or plaque progression as compared to qualitative plaque features. CONCLUSIONS A critical review of the literature focusing on studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. Significant questions regarding the clinical implications of these specific quantitative and qualitative plaque features as well as the challenges of using serial CCTA have yet to be resolved in studies using this imaging technique. KEY POINTS • Use of (serial) CCTA can identify plaque characteristics and plaque changes as well as changes in EAT volume that are predictive of plaque progression and/or major adverse events (MACE) at follow-up. • Studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. • Ultimately, serial CCTA is a promising technique for the evaluation of cardiovascular prognosis, yet technical details remain to be refined.
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Affiliation(s)
- F Y van Driest
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C M Bijns
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - R J van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Broersen
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A J H A Scholte
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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115
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Pezel T, Sideris G, Dillinger JG, Logeart D, Manzo-Silberman S, Cohen-Solal A, Beauvais F, Devasenapathy N, Laissy JP, Henry P. Coronary Computed Tomography Angiography Analysis of Calcium Content to Identify Non-culprit Vulnerable Plaques in Patients With Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:876730. [PMID: 35498013 PMCID: PMC9051337 DOI: 10.3389/fcvm.2022.876730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022] Open
Abstract
Background Aside from the culprit plaque, the presence of vulnerable plaques in patients with acute coronary syndrome (ACS) may be associated with future cardiac events. A link between calcification and plaque rupture has been previously described. Aim To assess whether analysis of the calcium component of coronary plaques using CT angiography, coronary computed tomographic angiography (CCTA) can help to detect additional vulnerable plaques in patients with non-ST elevation myocardial infarction (NSTEMI). Materials And Methods Cross sectional study of consecutive patients referred for NSTEMI from 30 July to 30 August 2018 with CCTA performed before coronary angiography with systematic optical coherence tomography (OCT) analysis of all coronary arteries within 24 h of clinical onset of NSTEMI. Three types of plaques were defined: culprit plaques defined by angiography (vulnerable culprit plaques–VCP) – plaques with a fibrous cap thickness < 65 microns or thrombus in OCT (vulnerable non-culprit plaque–VNCP) – plaques with a fibrous cap thickness ≥ 65 microns in OCT (stable plaque–SP). Results A total of 134 calcified plaques were identified in 29 patients (73% male, 59 ± 14 years) with 29(22%) VCP, 28(21%) VNCP and 77(57%) SP. Using CCTA analysis of the calcium component, factors associated with vulnerable plaques were longer calcification length, larger calcification volume, lower calcium mass, higher Agatston score plaque-specific (ASp), presence of spotty calcifications and an intimal position in the wall. In multivariate analysis, ASp, calcification length and spotty calcifications were independently associated to vulnerable plaques. There was no difference between VCP and VNCP. Conclusions CCTA analysis of calcium component of the plaque could help to identify additional vulnerable plaques in NSTEMI patients.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- Department of Radiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- *Correspondence: Théo Pezel,
| | - Georgios Sideris
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Damien Logeart
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Florence Beauvais
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | | | - Jean-Pierre Laissy
- Department of Radiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisiere Hospital, Assistance Publique – Hôpitaux de Paris (APHP), University of Paris, Paris, France
- Patrick Henry,
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Yamamoto A, Nagao M, Ando K, Nakao R, Sakai A, Watanabe E, Momose M, Sato K, Fukushima K, Sakai S, Hagiwara N. Myocardial Flow Reserve in Coronary Artery Disease with Low Attenuation Plaque: Coronary CTA and 13N-ammonia PET Assessments. Acad Radiol 2022; 29 Suppl 4:S17-S24. [PMID: 33281040 DOI: 10.1016/j.acra.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Physiological measurements from coronary angiography show that coronary stenosis with necrotic core plaque reduces coronary flow reserve (CFR). Myocardial flow reserve (MFR) estimated by 13N-ammonia PET (NH3-PET) is a different index from CFR. Low attenuation plaque (LAP) on coronary CTA (CCTA) contains necrotic core, but the link between LAP and MFR has not been elucidated. We aimed to investigate the influence of LAP on MFR in coronary artery disease (CAD). MATERIALS AND METHODS The study included 105 consecutive patients who underwent NH3-PET and CCTA within 3 months. Nonevaluable coronary arteries due to severe calcification and stent implants were excluded. Finally, 290 major vessels were retrospectively analyzed. Coronary arteries were divided into mild (1%-49%), moderate (50%-69% stenosis), and severe (≥70% stenosis) groups. Coronary plaques were classified either LAP (including soft tissue CT value <30 HU) or completely classified plaques. MFR for the major vessels were calculated and MFR <2.0 was considered a significant decrease. Comparison of MFR between territories with and without LAP, and the effect of plaque characteristics on MFR was analyzed. RESULTS MFR was significantly lower for territories with LAP than with calcified plaques or no plaque (2.1 ± 0.7, 2.4 ± 0.7, and 2.3 ± 0.7; p < 0.05). There was no difference between calcified plaque and no plaque territories (p = 0.79). Multivariate logistic analysis for plaque characteristics and stenosis severity revealed that LAP and severe stenosis were independent predictors for territories with MFR <2.0 with odds ratios of 3.1 (95% confidence interval, 1.2-8.1) and 3.0 (95% confidence interval, 1.7-5.3). CONCLUSION LAP reduced MFR compared with calcified plaque or no plaque in CAD. LAP is an independent predictor of the territory with MFR <2.0.
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Ogata S, Nagatomo D, Mizoguchi K, Teshima T, Hotta A. [Can Echocardiography Adjust Corrected Contrast Injection Condition in Coronary CT Angiography?]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:484-491. [PMID: 35321993 DOI: 10.6009/jjrt.2022-1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purposes were to search which factor of cardiac function in echocardiography correlates with the CT value, to correct contrast injection conditions with cardiac function in addition to suppress error in the contrast effect between patients, and to achieve the target CT value (350 HU) in coronary computed tomography angiography (CCTA). METHODS In 112 patients (conventional group), the contrast material was administered at a fractional dose (FD) of 21 mgI/kg/s. We measured the aortic CT value in the coronary origin part. In 112 patients (correction group), the contrast material was administered at corrected injection conditions with the most correlated functional factor and CT value. RESULTS The CT value of the conventional group was an average of 400.8±51.5 HU. The most correlated factor with the CT value was stroke volume [SV (r=-0.555)]. The CT value of the conventional group was an average of 360±46 HU. The case of the aim CT level was improved from 46% to 74%. In the correction group, the average value of FD was 18.5 mgI/kg/s. This enabled the reduction of the contrast material in 95% of patients. CONCLUSION The best correlation was obtained between the CT value of coronary arteries and SV. The contrast medium injection conditions were corrected for cardiac function in addition to body weight. As a result, we were able to control the CCTA target CT value of 300 to 400 HU at our hospital.
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Affiliation(s)
- Sho Ogata
- Department of Radiology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Atsushi Hotta
- Department of Radiology, Saiseikai Fukuoka General Hospital
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118
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Wang J, Zhou L, Chen H, Zeng S, Wu Q, Fang X. Predicting major adverse cardiac events based on multi-parameter coronary computed tomography angiography. Med Phys 2022; 49:3612-3623. [PMID: 35320875 DOI: 10.1002/mp.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To build a nomogram model to improve the prediction of major adverse cardiac events (MACE) using multi-parameter coronary computed tomography angiography (CCTA). METHODS All patients underwent CCTA. Those who developed MACE 90 days later but within 2 years between January 2008 and December 2018 were retrospectively enrolled as MACE group, while those without MACE were 1:1 propensity score matched in the control group. CCTA stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from computed tomography angiography (FFRct) were analyzed and compared between the two groups. The independent risk factors for predicting MACE were obtained through univariate and multivariate regression analysis, after which multi-parameter models were built to predict MACE. Finally, the nomogram for predicting MACE was created using the independent risk factors from multivariate regression analysis. RESULTS A total of 483 vessels in 260 patients were successfully analyzed. The combination of CCTA stenosis, plaque qualitative-quantitative characteristics, and FFRct (AUC = 0.922, P<0.001) showed a higher predictive value compared to CCTA stenosis alone, FFRct alone, plaque qualitative-quantitative characteristics alone, CCTA stenosis combined with plaque qualitative-quantitative characteristics, and CCTA stenosis combined with FFRct (all P <0.001). Independent risk factors were CCTA stenosis ≥50%, low attenuation plaque, positive remodeling, napkin ring sign, lipid plaque volume proportion, and FFRct. Subsequently, a nomogram was created using these independent risk factors. CONCLUSIONS The multi-parameter CCTA model has improved performance in predicting MACE. Nomogram for predicting MACE, which includes these factors, represents a practical and easy-to-use method in the clinical setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jie Wang
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Lijuan Zhou
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Hongwei Chen
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Shangyu Zeng
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Qiuxiang Wu
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Xiangming Fang
- Department of Medical Imaging, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
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Jebari-Benslaiman S, Galicia-García U, Larrea-Sebal A, Olaetxea JR, Alloza I, Vandenbroeck K, Benito-Vicente A, Martín C. Pathophysiology of Atherosclerosis. Int J Mol Sci 2022; 23:ijms23063346. [PMID: 35328769 PMCID: PMC8954705 DOI: 10.3390/ijms23063346] [Citation(s) in RCA: 214] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
Atherosclerosis is the main risk factor for cardiovascular disease (CVD), which is the leading cause of mortality worldwide. Atherosclerosis is initiated by endothelium activation and, followed by a cascade of events (accumulation of lipids, fibrous elements, and calcification), triggers the vessel narrowing and activation of inflammatory pathways. The resultant atheroma plaque, along with these processes, results in cardiovascular complications. This review focuses on the different stages of atherosclerosis development, ranging from endothelial dysfunction to plaque rupture. In addition, the post-transcriptional regulation and modulation of atheroma plaque by microRNAs and lncRNAs, the role of microbiota, and the importance of sex as a crucial risk factor in atherosclerosis are covered here in order to provide a global view of the disease.
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Affiliation(s)
- Shifa Jebari-Benslaiman
- Department of Biochemistry and Molecular Biology, Universidad del País Vasco UPV/EHU, 48940 Leioa, Bizkaia, Spain; (S.J.-B.); (I.A.); (K.V.)
- Biofisika Institute (UPV/EHU, CSIC), Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain; (U.G.-G.); (A.L.-S.)
| | - Unai Galicia-García
- Biofisika Institute (UPV/EHU, CSIC), Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain; (U.G.-G.); (A.L.-S.)
- Fundación Biofisika Bizkaia, Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain
| | - Asier Larrea-Sebal
- Biofisika Institute (UPV/EHU, CSIC), Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain; (U.G.-G.); (A.L.-S.)
- Fundación Biofisika Bizkaia, Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain
| | | | - Iraide Alloza
- Department of Biochemistry and Molecular Biology, Universidad del País Vasco UPV/EHU, 48940 Leioa, Bizkaia, Spain; (S.J.-B.); (I.A.); (K.V.)
- Inflammation & Biomarkers Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Bizkaia, Spain
| | - Koen Vandenbroeck
- Department of Biochemistry and Molecular Biology, Universidad del País Vasco UPV/EHU, 48940 Leioa, Bizkaia, Spain; (S.J.-B.); (I.A.); (K.V.)
- Inflammation & Biomarkers Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Bizkaia, Spain
- Ikerbasque, Basque Foundation for Science, 48013 Bilbao, Bizkaia, Spain
| | - Asier Benito-Vicente
- Department of Biochemistry and Molecular Biology, Universidad del País Vasco UPV/EHU, 48940 Leioa, Bizkaia, Spain; (S.J.-B.); (I.A.); (K.V.)
- Biofisika Institute (UPV/EHU, CSIC), Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain; (U.G.-G.); (A.L.-S.)
- Correspondence: (A.B.-V.); (C.M.); Tel.: +34-946-01-2741 (C.M.)
| | - César Martín
- Department of Biochemistry and Molecular Biology, Universidad del País Vasco UPV/EHU, 48940 Leioa, Bizkaia, Spain; (S.J.-B.); (I.A.); (K.V.)
- Biofisika Institute (UPV/EHU, CSIC), Barrio Sarriena s/n., 48940 Leioa, Bizkaia, Spain; (U.G.-G.); (A.L.-S.)
- Correspondence: (A.B.-V.); (C.M.); Tel.: +34-946-01-2741 (C.M.)
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Yan H, Zhao N, Geng W, Hou Z, Gao Y, Lu B. Pericoronary fat attenuation index and coronary plaque quantified from coronary computed tomography angiography identify ischemia-causing lesions. Int J Cardiol 2022; 357:8-13. [PMID: 35306030 DOI: 10.1016/j.ijcard.2022.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between pericoronary fat attenuation index (FAI), plaque characteristics, and lesion-specific ischemia identified by fractional flow reserve (FFR) remains unclear. METHODS Coronary computed tomography angiography (CCTA) stenosis, FAI, plaque characteristics, FFR derived from computed tomography (FFRCT) and FFR were assessed in 280 vessels of 247 patients. Stenosis ≥50% was considered obstructive. Optimal thresholds of FAI and plaque variables were defined by the area under the receiver-operating characteristics curve (AUC) analysis. Ischemia was defined by FFR ≤ 0.80. RESULTS FAI ≥ -71.9 HU, low-attenuation plaque (LAP) ≥ 49.62 mm3 and aggregate plaque volume (APV) ≥ 28.91% predicted ischemia independent of other plaque characteristics. The addition of FAI ≥ -71.9 HU improved discrimination (AUC, 0.720 vs. 0.674, P = 0.035) and reclassification abilities (category-free net reclassification index [NRI], 0.470, P < 0.001; relative integrated discrimination improvement [IDI], 0.047, P < 0.001) of ischemia compared with stenosis evaluation alone, with further discrimination (AUC, 0.772 vs. 0.720, P = 0.028) and reclassification abilities (NRI, 0.385, P = 0.001; relative IDI, 0.077, P < 0.001) of ischemia by adding information regarding LAP ≥49.62 mm3 + APV ≥ 28.91%. And the diagnostic performance of combination approach was comparable to that of FFRCT alone (AUC, 0.772 vs. 0.762, P = 0.771). CONCLUSIONS Stenosis severity, FAI, plaque characteristics predicted lesion-specific ischemia. The combination of FAI and plaque assessment improved the discrimination of ischemia compared with stenosis assessment alone.
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Affiliation(s)
- Hankun Yan
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Na Zhao
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenlei Geng
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhihui Hou
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Gao
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
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Nozaki YO, Fujimoto S, Kawaguchi YO, Aoshima C, Kamo Y, Sato H, Kudo H, Takamura K, Kudo A, Takahashi D, Hiki M, Dohi T, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve. J Cardiol 2022; 80:14-21. [DOI: 10.1016/j.jjcc.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
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Williams MC, Earls JP, Hecht H. Quantitative assessment of atherosclerotic plaque, recent progress and current limitations. J Cardiovasc Comput Tomogr 2022; 16:124-137. [PMID: 34326003 DOI: 10.1016/j.jcct.2021.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.
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Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - James P Earls
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Han D, Lin A, Kuronuma K, Tzolos E, Kwan AC, Klein E, Andreini D, Bax JJ, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Al-Mallah MH, de Araújo Gonçalves P, Danad I, Gransar H, Lu Y, Lee JH, Lee SE, Baskaran L, Al’Aref SJ, Yoon YE, Van Rosendael A, Budoff MJ, Samady H, Stone PH, Virmani R, Achenbach S, Narula J, Chang HJ, Min JK, Lin FY, Shaw LJ, Slomka PJ, Dey D, Berman DS. Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome-Causing Culprit Lesions. JAMA Cardiol 2022; 7:309-319. [PMID: 35080587 PMCID: PMC8792800 DOI: 10.1001/jamacardio.2021.5705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown. OBJECTIVE To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions describing location and vessel geometry add to plaque morphology and burden for identifying culprit lesion precursors associated with future ACS. DESIGN, SETTING, AND PARTICIPANTS This substudy of ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a multicenter nested case-control cohort study, included patients with ACS and a culprit lesion precursor identified on baseline CCTA (n = 116) and propensity score-matched non-ACS controls (n = 116). Data were collected from July 20, 2012, to April 30, 2017, and analyzed from October 1, 2020, to October 31, 2021. EXPOSURES Coronary lesions were evaluated for the following 3 AGCs: (1) distance from the coronary ostium to lesion; (2) location at vessel bifurcations; and (3) vessel tortuosity, defined as the presence of 1 bend of greater than 90° or 3 curves of 45° to 90° using a 3-point angle within the lesion. MAIN OUTCOMES AND MEASURES Association between lesion-level AGCs and risk of future ACS-causing culprit lesions. RESULTS Of 548 lesions, 116 culprit lesion precursors were identified in 116 patients (80 [69.0%] men; mean [SD], age 62.7 [11.5] years). Compared with nonculprit lesions, culprit lesion precursors had a shorter distance from the ostium (median, 35.1 [IQR, 23.6-48.4] mm vs 44.5 [IQR, 28.2-70.8] mm), more frequently localized to bifurcations (85 [73.3%] vs 168 [38.9%]), and had more tortuous vessel segments (5 [4.3%] vs 6 [1.4%]; all P < .05). In multivariable Cox regression analysis, an increasing number of AGCs was associated with a greater risk of future culprit lesions (hazard ratio [HR] for 1 AGC, 2.90 [95% CI, 1.38-6.08]; P = .005; HR for ≥2 AGCs, 6.84 [95% CI, 3.33-14.04]; P < .001). Adverse geometric characteristics provided incremental discriminatory value for culprit lesion precursors when added to a model containing stenosis severity, adverse morphological plaque characteristics, and quantitative plaque characteristics (area under the curve, 0.766 [95% CI, 0.718-0.814] vs 0.733 [95% CI, 0.685-0.782]). In per-patient comparison, patients with ACS had a higher frequency of lesions with adverse plaque characteristics, AGCs, or both compared with control patients (≥2 adverse plaque characteristics, 70 [60.3%] vs 50 [43.1%]; ≥2 AGCs, 92 [79.3%] vs 60 [51.7%]; ≥2 of both, 37 [31.9%] vs 20 [17.2%]; all P < .05). CONCLUSIONS AND RELEVANCE These findings support the concept that CCTA-derived AGCs capturing lesion location and vessel geometry are associated with risk of future ACS-causing culprit lesions. Adverse geometric characteristics may provide additive prognostic information beyond plaque assessment in CCTA.
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Affiliation(s)
- Donghee Han
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Lin
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Keiichiro Kuronuma
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan C. Kwan
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eyal Klein
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeroen J. Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan
| | - Benjamin J. W. Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A. Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Fabian Plank
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Todd C. Villines
- Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland
| | - Mouaz H. Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Ji-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Sang-Eun Lee
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | | | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Yeonyee E. Yoon
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Alexander Van Rosendael
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA (University of California, Los Angeles), Torrance, California
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter H. Stone
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland
| | | | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Fay Y. Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Leslee J. Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York
| | - Piotr J. Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S. Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
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Zhang M, Xie Z, Long H, Ren K, Hou L, Wang Y, Xu X, Lei W, Yang Z, Ahmed S, Zhang H, Zhao G. Current advances in the imaging of atherosclerotic vulnerable plaque using nanoparticles. Mater Today Bio 2022; 14:100236. [PMID: 35341094 PMCID: PMC8943324 DOI: 10.1016/j.mtbio.2022.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/13/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023]
Abstract
Vulnerable atherosclerotic plaques of the artery wall that pose a significant risk of cardio-cerebral vascular accidents remain the global leading cause of morbidity and mortality. Thus, early delineation of vulnerable atherosclerotic plaques is of clinical importance for prevention and treatment. The currently available imaging technologies mainly focus on the structural assessment of the vascular wall. Unfortunately, several disadvantages in these strategies limit the improvement in imaging effect. Nanoparticle technology is a novel diagnostic strategy for targeting and imaging pathological biomarkers. New functionalized nanoparticles that detect hallmarks of vulnerable plaques are promising for advance further control of this critical illness. The review aims to address the current opportunities and challenges for the use of nanoparticle technology in imagining vulnerable plaques.
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Identification of Risk Factors for Coronary Artery Disease in Asymptomatic Patients with Type 2 Diabetes Mellitus. J Clin Med 2022; 11:jcm11051226. [PMID: 35268317 PMCID: PMC8910834 DOI: 10.3390/jcm11051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated. Results: Current smoking (OR, 4.069; 95% C.I., 1.578–10.493, p = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337–51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683–14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223–26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days. Conclusions: In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.
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Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part II. Eur Heart J Cardiovasc Imaging 2022; 23:e136-e161. [PMID: 35175348 PMCID: PMC8944330 DOI: 10.1093/ehjci/jeab292] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Abstract
Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised.
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Affiliation(s)
- Gianluca Pontone
- Corresponding author. Tel: +39 02 58002574; Fax: +39 02 58002231. E-mail:
| | | | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
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Manubolu VS, Roy SK, Budoff MJ. Prognostic Value of Serial Coronary CT Angiography in Atherosclerotic Plaque Modification: What have we learnt? CURRENT CARDIOVASCULAR IMAGING REPORTS 2022; 15:1. [PMID: 35300492 PMCID: PMC8923615 DOI: 10.1007/s12410-022-09564-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review To provide an update and to outline the status of coronary computer tomography angiography (CCTA) in evaluation of coronary plaques and discuss the relevance of serial CCTA in guiding cardiovascular risk stratification and anti- atherosclerotic medical therapy. Recent Findings Coronary CTA is now the imaging modality of choice in monitoring changes in coronary plaque. It has been used in innumerable clinical trials which have demonstrated the benefits of several therapeutic agents and has excellent correlation with previously used invasive imaging modalities. It is safe, fast, less cumbersome, and a cost-effective testing method compared to other invasive imaging modalities for coronary plaque analysis. Summary The emergence of a noninvasive imaging modality such as CCTA, now permits quantification not only of plaque burden but also allows for further distinction of plaque components and identification of vulnerable plaques. Application of these findings continues to extend the prospect of coronary CTA in evaluation and management of atherosclerotic coronary artery disease (CAD) in clinical practice. In the future artificial intelligence and machine learning will play a significant role in plaque analysis allowing for high accuracy and reproducibility which will lead to a substantial increase in the utilization of coronary CTA.
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Affiliation(s)
| | - Sion K. Roy
- Lundquist Institute, Department of Cardiology, Torrance, CA, USA
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130
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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, De Maeseneer M, De Mey J. Paradoxical changes of coronary computed tomography derived fractional flow reserve. Echocardiography 2022; 39:398-403. [DOI: 10.1111/echo.15307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/28/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology Universitair Ziekenhuis Brussel Brussels Belgium
| | - Kaoru Tanaka
- Department of Radiology Universitair Ziekenhuis Brussel Brussels Belgium
| | - Yuji Nagatomo
- Department of Cardiology National Defense Medical College Hospital Tokorozawa Japan
| | - Dries Belsack
- Department of Radiology Universitair Ziekenhuis Brussel Brussels Belgium
| | | | - Johan De Mey
- Department of Radiology Universitair Ziekenhuis Brussel Brussels Belgium
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Baggiano A, Italiano G, Guglielmo M, Fusini L, Guaricci AI, Maragna R, Giacari CM, Mushtaq S, Conte E, Annoni AD, Formenti A, Mancini ME, Andreini D, Rabbat M, Pepi M, Pontone G. Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging. J Clin Med 2022; 11:jcm11030477. [PMID: 35159929 PMCID: PMC8836710 DOI: 10.3390/jcm11030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
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Affiliation(s)
- Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianpiero Italiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124 Bari, Italy;
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Saima Mushtaq
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Edoardo Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Andrea Daniele Annoni
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Alberto Formenti
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Maria Elisabetta Mancini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mark Rabbat
- Division of Cardiology, Department of Medicine and Radiology, Loyola University of Chicago, Chicago, IL 60660, USA;
- Division of Cardiology, Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Correspondence: ; Tel.: +39-02-5800-2574; Fax: +39-02-5800-2231
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Sun JT, Sheng XC, Feng Q, Yin Y, Li Z, Ding S, Pu J. Pericoronary Fat Attenuation Index Is Associated With Vulnerable Plaque Components and Local Immune-Inflammatory Activation in Patients With Non-ST Elevation Acute Coronary Syndrome. J Am Heart Assoc 2022; 11:e022879. [PMID: 35023363 PMCID: PMC9238519 DOI: 10.1161/jaha.121.022879] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The pericoronary fat attenuation index (FAI) is assessed using standard coronary computed tomography angiography, and it has emerged as a novel imaging biomarker of coronary inflammation. The present study assessed whether increased pericoronary FAI values on coronary computed tomography angiography were associated with vulnerable plaque components and their intracellular cytokine levels in patients with non-ST elevation acute coronary syndrome. Methods and Results A total of 195 lesions in 130 patients with non-ST elevation acute coronary syndrome were prospectively included. Lesion-specific pericoronary FAI, plaque components and other plaque features were evaluated by coronary computed tomography angiography. Local T cell subsets and their intracellular cytokine levels were detected by flow cytometry. Lesions with pericoronary FAI values >-70.1 Hounsfield units exhibited spotty calcification (43.1% versus 25.0%, P=0.015) and low-attenuation plaques (17.6% versus 4.2%, P=0.016) more frequently than lesions with lower pericoronary FAI values. Further quantitative plaque compositional analysis showed that increased necrotic core volume (Pearson's r=0.324, P<0.001) and fibrofatty volume (Pearson's r=0.270, P<0.001) were positively associated with the pericoronary FAI, and fibrous volume (Pearson's r=-0.333, P<0.001) showed a negative association. An increasing proinflammatory intracellular cytokine profile was found in lesions with higher pericoronary FAI values. Conclusions The pericoronary FAI may be a reliable indicator of local immune-inflammatory response activation, which is closely related to plaque vulnerability. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04792047.
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Affiliation(s)
- Jia Teng Sun
- Department of Cardiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xin Cheng Sheng
- Department of Cardiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Qi Feng
- Department of Radiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yan Yin
- Department of Radiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Zheng Li
- Department of Cardiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Song Ding
- Department of Cardiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jun Pu
- Department of Cardiology Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
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133
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Yan H, Gao Y, Zhao N, Geng W, Hou Z, An Y, Zhang J, Lu B. Change in Computed Tomography-Derived Fractional Flow Reserve Across the Lesion Improve the Diagnostic Performance of Functional Coronary Stenosis. Front Cardiovasc Med 2022; 8:788703. [PMID: 35097009 PMCID: PMC8792740 DOI: 10.3389/fcvm.2021.788703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study sought to evaluate the diagnostic performance of change in computed tomography-derived fractional flow reserve (CT-FFR) across the lesion (ΔCT-FFR) for identifying ischemia lesions with FFR as the reference standard.Methods: Patients who underwent coronary CT angiography (CCTA) and FFR measurement within 1 week from December 2018 to December 2019 were retrospectively enrolled. CT-FFR within 2 cm distal to the lesion, ΔCT-FFR and plaque characteristics were analyzed. The diagnostic accuracy of CCTA (coronary stenosis ≥ 50%), CT-FFR ≤ 0.80, and ΔCT-FFR ≥ 0.15 (based on the largest Youden index) were assessed with FFR as the reference standard. The relationship between plaque characteristics and ΔCT-FFR was analyzed.Results: The specificity of ΔCT-FFR and CT-FFR were 70.8 and 67.4%, respectively, which were both higher than CCTA (39.3%) (both P < 0.001), while there were no statistical significance in sensitivity among the three (84.5, 77.4, 88.1%, respectively; P = 0.08). The area under the curves (AUCs) of ΔCT-FFR and CT-FFR were 0.803 and 0.743, respectively, which were both higher than that of CCTA (0.637) (both P < 0.05), and the AUC of ΔCT-FFR was higher than that of CT-FFR (P < 0.001). Multivariable analysis showed that low-attenuation plaque (LAP) volume (odds ratio [OR], 1.006) and plaque length (OR, 1.021) were independently correlated with ΔCT-FFR (both P < 0.05).Conclusions: CT-FFR and ΔCT-FFR and here especially the ΔCT-FFR could improve the diagnostic performance of ischemia compared with CCTA alone. LAP volume and plaque length were the independent risk factors of ΔCT-FFR.
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134
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Sugiura J, Soeda T, Kyodo A, Nakamura T, Okamura A, Nogi K, Hashimoto Y, Ueda T, Watanabe M, Saito Y. Clinical Course of Optical Coherence Tomography-Detected Lipid-Rich Coronary Plaque After Optimal Medical Therapy. Circ Rep 2022; 4:29-37. [PMID: 35083386 PMCID: PMC8710641 DOI: 10.1253/circrep.cr-21-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background:
The aim of this study was to evaluate optical coherence tomography (OCT)-detected lipid-rich coronary plaques (LRCPs) with coronary computed tomography angiography (CCTA) 10 months after optimal medical therapy (OMT). Methods and Results:
Baseline OCT detected 28 LRCPs in non-culprit lesions. High-risk plaque features (HRPFs), such as positive remodeling, very low attenuation plaques, napkin-ring sign, and spotty calcification, were observed in 67.9%, 67.9%, 21.4%, and 64.3% of LRCPs, respectively, at the 10-month follow-up CCTA. Lesions with ≥3 HRPFs were defined as high-risk LRCPs (n=12); the remaining were defined as low-risk LRCPs (n=16). The maximum lipid arc on baseline OCT was larger in high- than low-risk LRCPs (221±62° vs. 179±44°, respectively; P=0.04). Receiver operating characteristic curve analysis indicated that a maximum lipid arc >154° on baseline OCT was the optimal cut-off value to predict high-risk LRCPs 10 months after OMT. Patients with high-risk LRCPs had worse clinical outcomes, defined as a composite of cardiac death, target lesion-related myocardial infarction, and target lesion-related revascularization, during follow-up than those with low-risk LRCPs (33.3% vs. 0%; P=0.01). Conclusions:
A high-risk LRCP at follow-up CCTA was correlated with a larger maximum lipid arc on baseline OCT. Further aggressive treatment for patients with large LRCPs may reduce vulnerable plaque features and prevent future cardiac events.
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Affiliation(s)
| | | | | | | | | | | | | | - Tomoya Ueda
- Cardiovascular Medicine, Nara Medical University
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135
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Dawson LP, Lum M, Nerleker N, Nicholls SJ, Layland J. Coronary Atherosclerotic Plaque Regression: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:66-82. [PMID: 34991791 DOI: 10.1016/j.jacc.2021.10.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022]
Abstract
Over the last 3 decades there have been substantial improvements in treatments aimed at reducing cardiovascular (CV) events. As these treatments have been developed, there have been parallel improvements in coronary imaging modalities that can assess plaque volumes and composition, using both invasive and noninvasive techniques. Plaque progression can be seen to precede CV events, and therefore, many studies have longitudinally assessed changes in plaque characteristics in response to various treatments, aiming to demonstrate plaque regression and improvements in high-risk features, with the rationale being that this will reduce CV events. In the past, decisions surrounding treatments for atherosclerosis have been informed by population-based risk scores for initiation in primary prevention and low-density lipoprotein cholesterol levels for titration in secondary prevention. If outcome data linking plaque regression to reduced CV events emerge, it may become possible to directly image plaque treatment response to guide management decisions.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Peninsula Health, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Victoria, Australia
| | - Mark Lum
- Monash University, Melbourne, Victoria, Australia
| | - Nitesh Nerleker
- Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Monash Health, Clayton, Victoria, Australia; The Baker Institute, Melbourne, Victoria, Australia
| | - Stephen J Nicholls
- Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Monash Health, Clayton, Victoria, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
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Salih M, Yousif E, Elnour E, Zidan MM, Abukonna A, Yousef M, Govindappa SC, Alshammari MT, Alyahyawi AR, Alshammari QT. Morphologic Characterization of Atherosclerotic Plaque of Coronary Arteries Diseases by Multidetector Computed Tomography (MDCT). PHARMACOPHORE 2022. [DOI: 10.51847/w8eispcooo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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137
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Yoon YE. Clinical Utility of Coronary Computed Tomography Angiography, Beyond the Gatekeeper for Invasive Coronary Angiography. Korean Circ J 2022; 52:826-828. [PMID: 36347518 PMCID: PMC9643571 DOI: 10.4070/kcj.2022.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yeonyee Elizabeth Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Dai X, Hou Y, Tang C, Lu Z, Shen C, Zhang L, Zhang J. Long-term prognostic value of the serial changes of CT-derived fractional flow reserve and perivascular fat attenuation index. Quant Imaging Med Surg 2022; 12:752-765. [PMID: 34993116 DOI: 10.21037/qims-21-424] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND To investigate the serial changes of computed tomography (CT) fractional flow reserve (CT-FFR) and fat attenuation index (FAI), and explore their relationships with long-term clinical outcomes. METHODS Consecutive symptomatic patients with an intermediate pretest probability of coronary artery disease 1-4 were prospectively enrolled if coronary CT angiography (CCTA) revealed at least 1 lesion with 30-70% stenosis on major epicardial arteries. Follow-up CCTA was performed at 1 to 1.5-year intervals. All patients were further followed up after the second CCTA until September 2019. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) grade, high-risk plaque features, lesion-specific CT-FFR, and FAI were measured for prognosis analysis. RESULTS A total of 263 patients were included in the analysis, and 38 major adverse cardiac events (MACEs) occurred. In the MACE group, the lesion-specific CT-FFR decreased significantly at the follow-up CCTA [0.80 (0.74-0.90) versus 0.85 (0.76-0.93); P=0.01], whereas the FAI did not notably increase (-70.4±8.9 versus -71.3±7.1 HU; P=0.436). In the non-MACE group, lesion-specific CT-FFR increased markedly [0.91 (0.84-0.95) versus 0.90 (0.82-0.94); P<0.001], while the FAI decreased substantially (-74.0±10.8 versus -72.4±11.5 HU; P=0.004). Decreased CT-FFR (adjusted overall hazard ratio =2.455; P=0.023) and increased FAI (adjusted hazard ratio =2.956; P=0.002) were the strongest independent predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value (Concordance statistic =0.716; P=0.003; over conventional clinical and imaging parameters (Concordance statistic =0.762; P=0.004). CONCLUSIONS Decreased CT-FFR and increased FAI at follow-up CCTA were the 2 strongest predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value over conventional clinical and imaging parameters for risk stratification. In addition, decreased CT-FFR provided incremental predictive value for MACEs from 15 months after second CCTA, while increased FAI added prognostic value from the second CCTA onwards.
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Affiliation(s)
- Xu Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunxiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chengxing Shen
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yu Y, Ding X, Yu L, Dai X, Wang Y, Zhang J. Increased coronary pericoronary adipose tissue attenuation in diabetic patients compared to non-diabetic controls: a propensity score matching analysis. J Cardiovasc Comput Tomogr 2022; 16:327-335. [DOI: 10.1016/j.jcct.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/28/2022]
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Sato Y, Kawai H, Hoshino M, Matsumoto S, Hayakawa M, Sadato A, Sarai M, Motoyama S, Takahashi H, Naruse H, Ishii J, Toyama H, Ozaki Y, Nakahara I, Hirose Y, Izawa H. Relationship between epicardial adipose tissue and coronary artery stenoses on computed tomography in patients scheduled for carotid artery revascularization. J Cardiol 2021; 79:588-595. [PMID: 34974941 DOI: 10.1016/j.jjcc.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to clarify the relationship between epicardial adipose tissue (EAT) volume and the presence of severe stenoses (SS) on coronary computed tomography angiography (CTA) for risk stratification of the patients with carotid artery stenoses. METHODS We prospectively performed CTA for 125 consecutive patients (72.4 ± 8.1 years, 85% men) without a history of coronary artery disease (CAD), who were scheduled for carotid artery revascularization from 2014 to 2020. SS was defined as ≥70% luminal stenosis on CTA. EAT was quantified automatically as the total volume of tissue with -190 to -30 HU. RESULTS Of 125 patients, 76 had SS. Between the patients with and without SS, there were significant differences in coronary artery calcium score (CACS), left ventricular ejection fraction (LVEF), dyslipidemia, and EAT, despite no differences in carotid echocardiography findings. After adjustment for age, gender, and dyslipidemia, EAT was an independent factor associated with SS (p=0.011), as well as CACS and LVEF. The addition of EAT to a baseline model including age, gender, dyslipidemia, LVEF, and CACS achieved both net reclassification improvement (0.505, p=0.003) and integrated discrimination improvement (0.059, p=0.003). CONCLUSIONS In patients with carotid stenoses, EAT is associated with CAD and is useful for additional risk stratification. Epicardial fat may have a specific role in the development of CAD in patients with suspected systemic atherosclerosis.
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Affiliation(s)
- Yoshihiro Sato
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, Aichi, Japan.
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan
| | | | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University, Aichi, Japan
| | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Junnichi Ishii
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Aichi, Japan
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142
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Matsumoto H, Xie Y, Li D, Shinke T. Non-lipid-rich low attenuation plaque with intraplaque haemorrhage assessed by multimodality imaging: a case report. Eur Heart J Case Rep 2021; 5:ytab460. [PMID: 34993403 PMCID: PMC8728716 DOI: 10.1093/ehjcr/ytab460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/13/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022]
Abstract
Background The lipid-rich necrotic core is a major pathological hallmark of acute coronary syndrome. Low attenuation plaque (LAP) on coronary computed tomography angiography (CCTA), defined as plaque CT attenuation of <30 Hounsfield units, is commonly believed to correspond to the lipid component. This report presents a non-lipid-rich LAP with intraplaque haemorrhage of the left main coronary artery (LM), as assessed by CCTA, near-infrared spectroscopy (NIRS), and non-contrast magnetic resonance imaging (MRI) using coronary atherosclerosis T1-weighted characterization with integrated anatomical reference technique, recently developed by our group. Case summary A 75-year-old woman presented with chest discomfort on exertion. Coronary computed tomography angiography revealed severe stenosis of the mid-left circumflex coronary artery and minimal stenosis with a large eccentric LM plaque. The LM lesion had an LAP, with a minimum plaque attenuation of 25 Hounsfield units. On non-contrast T1-weighted MRI, a high-intensity plaque with a plaque-to-myocardium signal intensity ratio of 3.02 was observed within the vessel wall, indicating intraplaque haemorrhage. Near-infrared spectroscopy categorized the lesion as non-lipid-rich, with a maximum lipid core burden index in 4 mm of 169. Discussion Intraplaque haemorrhage is a key feature of plaque instability, which is different from the lipid-rich necrotic core. Non-contrast T1-weighted MRI is ideal for detecting intraplaque haemorrhage with short T1 values. The imaging findings suggest that LAP on CCTA may represent not only lipid-rich plaques but also intraplaque haemorrhage. Magnetic resonance imaging provides a unique insight into plaque vulnerability from a different perspective than lipid assessment. Multimodality imaging, including MRI, facilitates the understanding of complicated plaque morphologies. Keywords Atherosclerosis • Case report • Computed tomography • Intraplaque haemorrhage • Lipid-rich plaque • Magnetic resonance imaging • Near-infrared spectroscopy-intravascular ultrasound
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Affiliation(s)
- Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan
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143
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Lopez-Mattei JC, Yang EH, Ferencik M, Baldassarre LA, Dent S, Budoff MJ. Cardiac Computed Tomography in Cardio-Oncology: JACC: CardioOncology Primer. JACC CardioOncol 2021; 3:635-649. [PMID: 34988472 PMCID: PMC8702811 DOI: 10.1016/j.jaccao.2021.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer patients and survivors have elevated cardiovascular risk when compared with noncancer patients. Cardio-oncology has emerged as a new subspecialty to comanage and address cardiovascular complications in cancer patients such as heart failure, atherosclerotic cardiovascular disease (ASCVD), valvular heart disease, pericardial disease, and arrhythmias. Cardiac computed tomography (CT) can be helpful in identifying both clinical and subclinical ASCVD in cancer patients and survivors. Radiation therapy treatment planning CT scans and cancer staging/re-staging imaging studies can quantify calcium scores which can identify pre-existing subclinical ASCVD. Cardiac CT can be helpful in the evaluation of cardiac tumors and pericardial diseases, especially in patients who cannot tolerate or have a contraindication to cardiac magnetic resonance. In this review, we describe the optimal utilization of cardiac CT in cancer patients, including risk assessment for ASCVD and identification of cancer treatment-related cardiovascular toxicity.
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Affiliation(s)
| | - Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Department of Medicine and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
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144
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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145
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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146
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease. Int J Cardiol 2021; 343:187-193. [PMID: 34454964 DOI: 10.1016/j.ijcard.2021.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Computed-tomography (CT) derived fractional-flow-reserve (FFRCT) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFRCT at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFRCT decline below the pathological value of 0.80 in no-apparent CAD. METHODS A total of 150 consecutive patients who had both CT angiography coupled to FFRCT analysis and invasive angiogram showing < 20% coronary stenosis were included. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT > 0.80 (n = 317) and FFRCT ≤ 0.80 (n = 114). ΔFFRCT was defined as the change in FFRCT from proximal to distal vessel. Vessel morphology (vessel length and lumen volume) and plaque characteristics [low-attenuation plaque volume, intermediate-attenuation (IAP) plaque volume, and calcified plaque volume] were evaluated. RESULTS FFRCT decreased from proximal to distal for the three major vessels in both FFRCT > 0.80 and FFRCT ≤ 0.80. Compared to FFRCT > 0.80, IAP volume was significantly higher in all three major vessels in FFRCT ≤ 0.80. ΔFFRCT was correlated with vessel length and lumen volume in FFRCT > 0.80, whereas ΔFFRCT was correlated with IAP volume in FFRCT ≤ 0.80. IAP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤ 0.80. CONCLUSIONS The presence of IAP is a major predictor of gradual decrease of FFRCT below 0.80 in no-apparent CAD vessels. Vessel morphology and plaque characteristics should be considered when interpreting FFRCT.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Vincent Michiels
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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147
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Motoyama S, Nagahara Y, Sarai M, Kawai H, Miyajima K, Sato Y, Matsumoto R, Takahashi H, Naruse H, Ishii J, Ozaki Y, Izawa H. Effect of Omega-3 Fatty Acids on Coronary Plaque Morphology - A Serial Computed Tomography Angiography Study. Circ J 2021; 86:831-842. [PMID: 34776470 DOI: 10.1253/circj.cj-21-0615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Omega-3 fatty acids have been proposed to be useful in the prevention of cardiac events. High-risk plaque (HRP) and plaque progression on serial coronary computed tomography angiography (CTA) have been suggested to be the predecessor of acute coronary syndrome (ACS). The purpose of this study was to investigate whether addition of omega-3 fatty acids to statin therapy for secondary prevention would lead to change in plaque characteristics detected by using serial CTA.Methods and Results:This study enrolled 210 patients with ACS: no eicosapentaenoic acid (EPA)/ docosahexaenoic acid (DHA; EPA/DHA), low-dose EPA+DHA, high-dose EPA+DHA, and high-dose EPA alone. HRP was significantly more frequent in patients with plaque progression (P=0.0001). There was a significant interaction between plaque progression and EPA dose regardless of the DHA dose; 20.3% in EPA-none (no EPA/DHA), 15.7% in EPA-low (low-dose EPA+DHA), and 5.6% in EPA-high (high-dose EPA+DHA and high-dose EPA alone). On multivariate logistic regression analysis, HRP (OR 6.44, P<0.0001), EPA-high (OR 0.13, P=0.0004), and Rosvastatin (OR 0.24, P=0.0079) were the independent predictors for plaque progression. In quantitative analyses (n=563 plaques), the interval change of low attenuation plaque (LAP) volume was significantly different based on EPA dose; LAP was significantly increased in the EPA-none group and significantly decreased in the EPA-high group. CONCLUSIONS In patients with ACS, addition of high-dose EPA (EPA-high) to statin therapy, compared to statin therapy without EPA, was associated with a lower rate of plaque progression.
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Affiliation(s)
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | | | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University
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148
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Computed Tomography Coronary Plaque Characteristics Predict Ischemia Detected by Invasive Fractional Flow Reserve. J Thorac Imaging 2021; 36:360-366. [PMID: 32701769 DOI: 10.1097/rti.0000000000000543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Coronary computed tomography angiography (CCTA) plaque quantification has been proposed to be of incremental value in the prediction of ischemia, although prior studies have shown conflicting results. We aimed to determine whether CCTA plaque features assessed on a commercial vendor platform predict invasive fractional flow reserve (FFR)/instantaneous wave-free ratio (IFR). METHODS Consecutive patients who underwent CCTA for evaluation of suspected stable coronary artery disease followed by invasive coronary physiology testing within 60 days at a single academic center were identified retrospectively. Semiautomated plaque quantification of the vessel proximal to the location of FFR/IFR measurement was carried out in TeraRecon, along with simple visual assessment for high-risk plaque features of positive remodeling, spotty calcification, low-attenuation plaque (LAP), and lesion length. Ischemia was defined by FFR ≤0.80 or IFR ≤0.89. RESULTS A total of 134 patients (62% male, mean age 62±10 y) were included in this study. On univariate logistic regression, the following visual plaque analysis parameters were predictive of ischemia: positive remodeling (odds ratio [OR] with 95% confidence interval [CI]: 4.96; 2.25-10.95; P<0.001), lesion length (OR for every 1 mm with 95% CI: 1.24; 1.14-1.34; P<0.001), spotty calcification (OR with 95% CI: 6.67; 1.67-26.64; P=0.007), and LAP (OR with 95% CI: 30; 3.78-246; P=0.001). None of the semiautomated plaque quantification parameters, such as noncalcified plaque volume or LAP volume, were predictive of ischemia. On stepwise multivariable logistic regression, lesion length (OR with 95% CI: 1.25; 1.14-1.37; P<0.0001) and LAP (OR with 95% CI: 43; 4.4-438; P=0.001) were significant predictors of ischemia, improving the area under the curve of CCTA from 0.53 to 0.87. CONCLUSIONS Simple visual plaque assessment for high-risk plaque features improved the performance of CCTA to predict ischemia. Semiautomated plaque quantification performed on a commercial vendor platform was not predictive of ischemia.
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149
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Abstract
PURPOSE OF REVIEW Multicenter studies showed that the characterization of coronary atherosclerosis by coronary computed tomography (CT) angiography (CCTA) provides independent and incremental prognostic value above and beyond traditional measures of coronary artery disease (CAD) and is able to identify patients at risk of future event. Aim of the present review is to expound the major imaging plaque features associated with increased risk of coronary event and to review the data supporting the usefulness of CCTA as tool for plaque assessment and for monitoring the changes in atherosclerotic burden. RECENT FINDINGS The evaluation of coronary atherosclerosis, including the measurement of imaging risk scores (e.g. CT-adapted Leaman score) was demonstrated as independent long-term predictor of acute coronary events. In particular, qualitative (remodelling index, low-attenuation plaque, napkin-ring sign, small spotty calcifications) and quantitative (plaque burden, total-, noncalcific- and fibrofatty plaque volume) plaque features were associated with increased risk. CCTA was also demonstrated to accurately quantify plaque volume vs. intravascular ultrasound and findings from PARADIGM and EVAPORATE studies supported the use of CCTA as noninvasive tool to follow the effect of medication on plaque progression/regression. Finally, interesting relationship between plaque features, coronary physiology and biomarkers have been described. SUMMARY Latest guidelines on the management of patients with stable CAD recommended CCTA in Class I of evidence, particularly when 'information on atherosclerosis are desired', underlining the usefulness of CCTA to characterize and quantify the atherosclerotic burden.
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150
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Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:743538. [PMID: 34660742 PMCID: PMC8517134 DOI: 10.3389/fcvm.2021.743538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a comprehensive, non-invasive and cost-effective imaging assessment approach, which can provide the ability to identify the characteristics and morphology of high-risk atherosclerotic plaques associated with acute coronary syndrome (ACS). The development of CCTA and latest advances in emerging technologies, such as computational fluid dynamics (CFD), have made it possible not only to identify the morphological characteristics of high-risk plaques non-invasively, but also to assess the hemodynamic parameters, the environment surrounding coronaries and so on, which may help to predict the risk of ACS. In this review, we present how CCTA was used to characterize the composition and morphology of high-risk plaques prone to ACS and the current role of CCTA, including emerging CCTA technologies, advanced analysis, and characterization techniques in prognosticating the occurrence of ACS.
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Affiliation(s)
- Guanyu Lu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiehao Ou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyun Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
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