Assessment of Aortic Atheromatous Plaque and Stiffness by 64-Slice Computed Tomography is Useful for Identifying Patients With Coronary Artery Disease

Abstract

therosclerosis consists of 2 pathological processes: atherosis characterized by morphologic atheromatous lesions in the intima, and sclerosis characterized by an increase in the stiffness of the vessel walls. Whereas in the past, computed tomography (CT) of the coronary arteries could detect only calcifications, multislice CT (MSCT) can now achieve sufficiently high spatial and temporal resolutions to allow visualization of stenoses 1 and plaques in the coronary arteries. 2,3 Aortic stiffness has not been readily taken into account for the evaluation of coronary artery disease (CAD), although both in vitro and in vivo studies have shown that MSCT provides a sufficiently accurate determination of aortic luminal dimension, cross-sectional area, and wall thickness to measure the distensibility and stiffness of the aorta. 4,5 Aortic stiffness is known to increase with age, 6 but it also correlates with various diseases such as CAD 7 and hyperCirculation Journal Vol.72, December 2008 tension, 8 or hypercholesterolemia. 6 So far, atherosis and sclerosis of the descending thoracic aorta (DTA) have been observed and analyzed during transesophageal echocardiography (TEE) performed for indications other than CAD. 6,9 Sclerosis could also be estimated by the brachial-ankle pulse wave velocity (baPWV), which has the disadvantage of giving only an average estimation over a large vascular bed.In contrast, for patients who already have an indication for coronary angiography (CAG) by MSCT, which is noninvasive, it would be a clinically important advantage if the same MSCT data could be used to gain additional information about CAD through analysis of the aorta at multiple locations. A time-resolved, ECG-gated CT technique to derive aortic distensibility from cyclic cross-sectional area changes has already been validated in a phantom set-up with porcine aortic specimens. 4 Ganten et al reported a negative correlation between abdominal aortic distensibility and aging with the use of this method, albeit using 4-or 16-slice CT. 5 Distensibility, however, depends on blood pressure, whereas stiffness is considered to be independent of blood pressure. 10,11 The diagnostic accuracy of MSCT for detecting coronary artery stenoses has been reported by many investigators, with very high specificity and very high negative predictive values. However, the positive predictive values have been relatively low. Most previous studies did not consist of consecutive patients and most studies excluded images that were unsatisfactory for interpretation. It should also be noted that patients with high heart rates or severe coronary calcification were excluded from the analyses. MSCT scans Background With multislice computed tomography (MSCT) it is possible to visualize the coronary arteries, as well as the aorta, in a single computed tomography scan. Using MSCT, atherosis and sclerosis of the descending thoracic aorta (DTA) were quantified and differences between patients with and without coronary artery disease (CAD) were analyzed. Methods and Resu...

Combined Assessment of Carotid Vulnerable Plaque, Renal Insufficiency, Eosinophilia, and hs-CRP for Predicting Risky Aortic Plaque of Cholesterol Crystal Embolism

“…Our patients with CCE also had carotid plaques with similar vulnerable features as the aortic plaques. It is well known that cardiovascular events are associated with unstable plaque in the carotid arteries and thoracic aorta, [23][24][25] and we confirmed in the present study that vulnerable carotid plaques are a surrogate marker of systemic plaque instability.…”

Epicardial adipose tissue thickness predicts descending thoracic aorta atherosclerosis shown by multidetector computed tomography

“…Additionally the relationship between atherosclerosis of DTA and coronary atherosclerosis detected by MDCT was shown in previous studies [24,2]. However this is the first study investigating the association between aortic atherosclerosis and EAT which is an emerging area of investigation in the pathogenesis of atherosclerosis and clinical implications.…”

Effects of Medical Treatment on the Prognosis and Risk of Embolic Events in Patients with Severe Aortic Plaque

“…The beneficial effects of antiplatelet drugs are also related to the ability of these drugs to prevent concomitant medical problems due to plaque rupture. Patients with severe aortic plaque have been reported to have a high prevalence of coronary artery disease and other atherosclerotic diseases 3,[27][28][29][30] . Statins and antiplatelet drugs may be effective in reducing the mortality rate of systemic atherosclerotic diseases, presence of other conditions requiring anticoagulation, such as a history of atrial fibrillation or mechanical valve replacement, and warfarin does not necessarily have to be discontinued for the simple reason that a patient has severe aortic plaque.…”