scholarly journals Coronary Artery Microcalcification: Imaging and Clinical Implications

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 125 ◽  
Author(s):  
Federico Vancheri ◽  
Giovanni Longo ◽  
Sergio Vancheri ◽  
John S. H. Danial ◽  
Michael Y. Henein
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Disease Activity ◽  
Atherosclerotic Plaque ◽  
Coronary Artery Calcification ◽  
Early Stage ◽  
Significant Coronary Artery Disease ◽  
Necrotic Core ◽  
Plaque Burden ◽  
Clinical Implications

Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.

scholarly journals Epicardial Adipose Tissue Volume Is Associated with High Risk Plaque Profiles in Suspect CAD Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Dongkai Shan ◽  
Guanhua Dou ◽  
Junjie Yang ◽  
Xi Wang ◽  
Jingjing Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
High Risk ◽  
Atherosclerotic Plaque ◽  
Plaque Burden ◽  
Multivariable Logistic Regression Analysis ◽  
Plaque Composition ◽  
Coronary Syndrome ◽  
Risk Predictor ◽  
Noncalcified Plaque

Objective. To explore the association between EAT volume and plaque precise composition and high risk plaque detected by coronary computed tomography angiography (CCTA). Methods. 101 patients with suspected coronary artery disease (CAD) underwent CCTA examination from March to July 2019 were enrolled, including 70 cases acute coronary syndrome (ACS) and 31 cases stable angina pectoris (SAP). Based on CCTA image, atherosclerotic plaque precise compositions were analyzed using dedicated quantitative software. High risk plaque was defined as plaque with more than 2 high risk features (spotty calcium, positive remolding, low attenuation plaque, napkin-ring sign) on CCTA image. The association between EAT volume and plaque composition was assessed as well as the different of correlation between ACS and SAP was analyzed. Multivariable logistic regression analysis was used to explore whether EAT volume was independent risk factors of high risk plaque (HRP). Results. EAT volume in the ACS group was significantly higher than that of the SAP group ( 143.7 ± 49.8  cm3 vs. 123.3 ± 39.2  cm3, P = 0.046 ). EAT volume demonstrated a significant positive correlation with total plaque burden ( r = 0.298 , P = 0.003 ), noncalcified plaque burden ( r = 0.245 , P = 0.013 ), lipid plaque burden ( r = 0.250 , P = 0.012 ), and homocysteine ( r = 0.413 , P ≤ 0.001 ). In ACS, EAT volume was positively correlated with total plaque burden ( r = 0.309 , P = 0.009 ), noncalcified plaque burden ( r = 0.242 , P = 0.044 ), and lipid plaque burden ( r = 0.240 , P = 0.045 ); however, no correlation was observed in SAP. Patients with HRP have larger EAT volume than those without HRP ( 169 ± 6.2  cm3 vs. 130.6 ± 5.3  cm3, P = 0.002 ). After adjustment by traditional risk factors and coronary artery calcium score (CACS), EAT volume was an independent risk predictor of presence of HRP (OR: 1.018 (95% CI: 1.006-1.030), P = 0.004 ). Conclusions. With the increasing EAT volume, more dangerous plaque composition burdens increase significantly. EAT volume is a risk predictor of HRP independent of convention cardiovascular risk factors and CACS, which supports the potential impact of EAT on progression of coronary atherosclerotic plaque.

Aortic arch calcification is strongly associated with coronary artery calcification

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 106-114 ◽  
Author(s):  
Adem Adar ◽  
Hakan Erkan ◽  
Tayyar Gokdeniz ◽  
Aysegul Karadeniz ◽  
Ismail G. Cavusoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Aortic Arch ◽  
Chest Radiography ◽  
Coronary Artery Calcification ◽  
Independent Predictor ◽  
Study Group ◽  
Discriminative Performance ◽  
Sensitivity Specificity ◽  
Aortic Arch Calcification

Background: We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low‐ and high‐risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC). Patients and methods: Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64‐slice MDCT scanner for the evaluation of CAC score. A four‐point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior‐anterior chest radiography images. Results: The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67 %) were male. AAC grades (r = 0.676, p < 0.0001) and age (r = 0.518, p < 0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95 % CI 4.25 to 29.52). An AAC grade of ≥ 2 was the strongest independent predictor of a high‐risk CAC score (OR: 27.42, 95 % CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of ≥ 100 (AUC = 0.892, P < 0.0001), and ≥ 400 (AUC = 0.894, P < 0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84 % and 89 %, respectively, for a CAC score of < 100. An AAC grade of ≥ 2 predicted a CAC score of ≥400 with a sensitivity, specificity and accuracy of 68 %, 98 % and 95 %, respectively. Conclusions: AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low‐ and high‐risk CAC scores.

scholarly journals Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis

2021 ◽  
Author(s):  
Mohammed Nooruddin Meah ◽  
Michelle C. Williams
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
High Risk ◽  
Atherosclerotic Plaque ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Calcium Score ◽  
Coronary Plaque ◽  
Coronary Computed Tomography ◽  
Low Attenuation Plaque

Background The capabilities of coronary computed tomography angiography (CCTA) have advanced significantly in the past decade. Its capacity to detect stenotic coronary arteries safely and consistently has led to a marked decline in invasive diagnostic angiography. However, CCTA can do much more than identify coronary artery stenoses. Method This review discusses applications of CCTA beyond coronary stenosis assessment, focusing in particular on the visual and quantitative analysis of atherosclerotic plaque. Results Established signs of visually assessed high-risk plaque on CT include positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, which correlate with the histological thin-cap fibroatheroma. Recently, quantification of plaque subtypes has further improved the assessment of coronary plaque on CT. Quantitatively assessed low-attenuation plaque, which correlates with the necrotic core of the thin-cap fibroatheroma, has demonstrated superiority over stenosis severity and coronary calcium score in predicting subsequent myocardial infarction. Current research aims to use radiomic and machine learning methods to further improve our understanding of high-risk atherosclerotic plaque subtypes identified on CCTA. Conclusion Despite rapid technological advances in the field of coronary computed tomography angiography, there remains a significant lag in routine clinical practice where use is often limited to lumenography. We summarize some of the most promising techniques that significantly improve the diagnostic and prognostic potential of CCTA. Key Points:  Citation Format

scholarly journals Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Nonobstructive Coronary Artery Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yipu Ding ◽  
Zinuan Liu ◽  
Guanhua Dou ◽  
Xia Yang ◽  
Xi Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Prognostic Value ◽  
Risk Scores ◽  
Plaque Burden ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Nonobstructive Coronary Artery Disease ◽  
Artery Disease

Background and Objective. Atherosclerotic extent was proved to be associated with adverse cardiac events. Risk scores derived by coronary computed tomography angiography (CCTA) could identify high-risk group among patients with nonobstructive coronary artery disease (CAD), but the ability is still uncertain in the presence of diabetes mellitus (DM). The purpose of this study was to investigate the prognostic value of the atherosclerotic extent shown by CCTA in diabetic patients with nonobstructive CAD. Methods and Results. 813 DM patients (mean age 58.9 ± 9.9 years, 48.1% male) referred for CCTA due to suspected CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 major adverse cardiovascular events (MACEs) (6.15%) were experienced, including 2 cardiovascular deaths, 14 nonfatal myocardial infarctions, 27 unstable anginas requiring hospitalization, and 7 strokes. Three groups were defined based on coronary stenosis combined with Leiden score as normal, nonobstructive Leiden < 5 , and nonobstructive Leiden ≥ 5 . Cox models were used to assess the prognosis of plaque burden within these groups. An incremental incidence of MACE rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of Leiden ≥ 5 showed a higher risk than Leiden < 5 (HR: 1.88, 95% CI: 1.03-3.42, p = 0.039 ). Similar results were observed when segment involvement score (SIS) was used for sensitivity analysis. Conclusion. Atherosclerotic extent was associated with the prognosis of DM patients with nonobstructive coronary artery disease, highlighting the importance of better risk stratification and management.

scholarly journals The Relationship between Coronary Artery Wall Shear Strain and Plaque Morphology: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 91 ◽  
Author(s):  
Artan Bajraktari ◽  
Ibadete Bytyçi ◽  
Michael Y. Henein
Keyword(s):  
Coronary Artery ◽  
Shear Strain ◽  
Meta Analysis ◽  
Calcium Score ◽  
Necrotic Core ◽  
Plaque Burden ◽  
Plaque Morphology ◽  
Wall Shear ◽  
The Impact ◽  
The Relationship

Background and Aim: Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD). Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD. Results: In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD −1.16 [−1.84 to −0.49, p = 0.0007]), lower plaque burden (WMD −12.7 [−21.4 to −4.01, p = 0.04]), and lower necrotic core area (WMD −0.32 [−0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD −0.79 [−1.88 to 0.30, p = 0.02]) and smaller fibro-fatty area (WMD −0.22 [−0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD −0.17 [−0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS. Conclusions: High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.

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