Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art

Abstract

Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features’ extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.

The correlation of pericoronary adipose tissue with coronary artery disease and left ventricular function

“…In recent years, the pericoronary fat attenuation index (FAI), which is measured using coronary CT angiography (CCTA) images, can be used to reflect pericoronary inflammation [2,3]. Recent studies have shown that pericoronary adipose tissue (PCAT) participates in the process of coronary inflammation and is significantly related to the type of plaque and degree of stenosis [4][5][6].…”

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study

“…The amalgam of anatomical, functional and biological information accrued by CCTA offers a multifaceted risk stratification of patients for targeted prevention strategies. 58 …”

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

“…The most notorious HRP feature is the NRS, which is currently considered the CCTA hallmark of the vulnerable atherosclerotic plaque [ 84 ]. Studies employing CCTA and intracoronary imaging have shown that the NRS is predominantly found in high-risk lesions such as in thin cap fibroatheroma (44% vs. only 4% in non-thin cap fibroatheroma).…”