CAD-RADS may underestimate coronary plaque progression as detected by serial CT angiography

Abstract

Aims We wished to assess whether different clinical definitions of coronary artery disease (CAD) [segment stenosis and involvement score (SSS, SIS), Coronary Artery Disease—Reporting and Data System (CAD-RADS)] affect which patients are considered to progress and which risk factors affect progression. Methods and results We enrolled 115 subsequent patients (60.1 ± 9.6 years, 27% female) who underwent serial coronary computed tomography angiography (CTA) imaging with >1year between the two examinations. CAD was described using SSS, SIS, and CAD-RADS. Linear mixed models were used to investigate the effects of risk factors on the overall amount of CAD and the effect on annual progression rate of different definitions. Coronary plaque burdens were SSS 4.63 ± 4.06 vs. 5.67 ± 5.10, P < 0.001; SIS 3.43 ± 2.53 vs. 3.89 ± 2.65, P < 0.001; CAD-RADS 0:8.7% vs. 0.0% 1:44.3% vs. 40.9%, 2:34.8% vs. 40.9%, 3:7.0% vs. 9.6% 4:3.5% vs. 6.1% 5:1.7% vs. 2.6%, P < 0.001, at baseline and follow-up, respectively. Overall, 53.0%, 29.6%, and 28.7% of patients progressed over time based on SSS, SIS, and CAD-RADS, respectively. Of the patients who progressed based on SSS, only 54% showed changes in CAD-RADS. Smoking and diabetes increased the annual progression rate of SSS by 0.37/year and 0.38/year, respectively (both P < 0.05). Furthermore, each year increase in age raised SSS by 0.12 [confidence interval (CI) 0.05–0.20, P = 0.001] and SIS 0.10 (CI 0.06–0.15, P < 0.001), while female sex was associated with 2.86 lower SSS (CI −4.52 to −1.20, P < 0.001) and 1.68 SIS values (CI −2.65 to −0.77, P = 0.001). Conclusion CAD-RADS could not capture the progression of CAD in almost half of patients with serial CTA. Differences in CAD definitions may lead to significant differences in patients who are considered to progress, and which risk factors are considered to influence progression.

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

“…Coronary CT angiography (CCTA) is the primary imaging modality for the non-invasive anatomical assessment of coronary artery disease (1)(2)(3)(4)(5). CCTA provides an excellent visualization of atherosclerotic plaques and enables the characterization of certain coronary plaque types (2,(6)(7)(8)(9)(10). While macrocalcified plaques are considered to be relatively stable, low attenuation plaques, positive remodeling, the napkin ring sign, and spotty calcifications on CCTA have been associated with plaque instability (6, 7, 11).…”

Characterizing the Heart and the Myocardium With Photon-Counting CT

“…They often do not cause luminal narrowing; therefore, they may not be noticeable with ICA. Thus, CCTA plays a prominent role in their diagnosis 55 …”

Multimodality Imaging in Ischemic Chronic Cardiomyopathy

“…In terms of follow up of patients with ICC, CAD-RADS classification may underestimate the progression of disease [16]. Szilveszter et al, in a cohort of 115 patients, evaluated the progression of CAD disease by analyzing the segment stenosis (SSS), segment involvement score (SIS) and CAD-RADS [16].…”

“…In terms of follow up of patients with ICC, CAD-RADS classification may underestimate the progression of disease [16]. Szilveszter et al, in a cohort of 115 patients, evaluated the progression of CAD disease by analyzing the segment stenosis (SSS), segment involvement score (SIS) and CAD-RADS [16]. Data obtained from the analysis with different models showed that it was possible to observe the progression of disease in 53%, 29.6% and 28.7% based on SSS, SIS and CAD-RADS, respectively.…”

“…Data obtained from the analysis with different models showed that it was possible to observe the progression of disease in 53%, 29.6% and 28.7% based on SSS, SIS and CAD-RADS, respectively. [16] In particular, only 54% of patients showed progression based on CAD-RADS score [16]. Despite the importance of CAD-RADS in terms of stenosis classification, treatment planning and prognostic stratification, the data showed that it is necessary to evaluate its role in terms of follow up of patients with ICC.…”