Coronary Plaque Burden at Coronary CT Angiography in Asymptomatic Men and Women

Abstract

q RSNA, 2015 Purpose:To assess the relationship between total, calcified, and noncalcified coronary plaque burdens throughout the entire coronary vasculature at coronary computed tomographic (CT) angiography in relationship to cardiovascular risk factors in asymptomatic individuals with low-to-moderate risk. Materials and Methods:This HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Two hundred two subjects were recruited to an ongoing prospective study designed to evaluate the effect of HMG-CoA reductase inhibitors on atherosclerosis. Eligible subjects were asymptomatic individuals older than 55 years who were eligible for statin therapy. Coronary CT angiography was performed by using a 320-detector row scanner. Coronary wall thickness and plaque were evaluated in all epicardial coronary arteries greater than 2 mm in diameter. Images were analyzed by using dedicated software involving an adaptive lumen attenuation algorithm. Total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length. Multivariable regression analysis was performed to determine the relationship between risk factors and plaque indexes. Results:The mean age of the subjects was 65.5 years 6 6.9 (standard deviation) (36% women), and the median coronary artery calcium (CAC) score was 73 (interquartile range, 1-434). The total coronary plaque index was higher in men than in women (42.06 mm 2 6 9.22 vs 34.33 mm 2 6 8.35; P , .001). In multivariable analysis controlling for all risk factors, total plaque index remained higher in men than in women (by 5.01 mm 2 ; P = .03) and in those with higher simvastatin doses (by 0.44 mm 2 /10 mg simvastatin dose equivalent; P = .02). Noncalcified plaque index was positively correlated with systolic blood pressure (b = 0.80 mm 2 /10 mm Hg; P = .03), diabetes (b = 4.47 mm 2 ; P = .03), and low-density lipoprotein (LDL) cholesterol level (b = 0.04 mm 2 /mg/dL; P = .02); the association with LDL cholesterol level remained significant (P = .02) after additional adjustment for the CAC score. Conclusion:LDL cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk.q RSNA, 2015

Personalized Statin Therapy and Coronary Atherosclerotic Plaque Burden in Asymptomatic Low/Intermediate-Risk Individuals

“…In this study, plaque size more than one-third of a segment length was present in about half of the subjects (47%). Noncalcified plaque was the most prevalent (84%), whereas calcified plaque was seen in 16% of subjects, findings similar to those reported by Rodriguez et al [38]. These numbers reflect the underlying burden of coronary disease in asymptomatic subjects, which is much larger than might be expected given the modest amount of calcified plaque.…”

“…In a retrospective study of asymptomatic Korean adults, coronary plaque and stenosis (> 50%) was present in 43 and 10%, respectively [37]. In another study of asymptomatic individuals with low to moderate risk, noncalcified plaque accounted for more than half of total plaque, irrespective of the CAC score [38]. In our study, CCTA detected at least one coronary vessel with a significant luminal stenosis (> 50%) in 11% of subjects, similar to the South Korean study [37].…”

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

“…Moreover, in the study by Inaba et al, diabetes patients possessed greater TPVs at baseline than non-diabetes patients. Diabetes is likely to be associated with greater overall plaque burden [14,32e35], in particular, non-calcified plaque volumes [36]. The presence of higher plaque burden may affect rapid atherosclerosis development since the presence of CAD by itself facilitates plaque progression [37e40].…”

Coronary Plaque Progression and Regression in Asymptomatic African American Chronic Cocaine Users With Obstructive Coronary Stenoses: A Preliminary Study

“…The software has been validated against IVUS [Park et al, 2015], and was used extensively in clinical studies [Rodriguez et al, 2015; Papadopoulou et al, 2012; Ferencik et al, 2015; Auscher et al, 2015]. …”

“…Automated longitudinal contouring of the inner lumen and outer wall was performed and results were manually adjusted when clear deviations were noted. Results of automated contouring of the inner lumen and outer wall were also reviewed on transverse reconstructed cross-sections of the artery on a section-by-section basis at 0.5-mm increments [Rodriguez et al, 2015]. Lumen attenuation was adaptively corrected on an individual-scan basis by using gradient filters in combination with the intensity values in the arteries, allowing for comparison between data sets [Park et al, 2015].…”