Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study

Conte, Edoardo; Annoni, Andrea; Pontone, Gianluca; Mushtaq, Saima; Guglielmo, Marco; Baggiano, Andrea; Volpato, Valentina; Agalbato, Cecilia; Bonomi, Alice; Veglia, Fabrizio; Formenti, Alberto; Fiorentini, Cesare; Bartorelli, Antonio L.; Pepi, Mauro; Andreini, Daniele

doi:10.1093/ehjci/jew200

Cited by 66 publications

(55 citation statements)

References 24 publications

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“…26 In these terms, a recent CCTA study of non-obstructive CAD, with a follow-up of 100 months, confirmed positive remodeling, napkin-ring sign, increased plaque burden, and the presence of low attenuation as being associated with acute coronary syndromes (ACS). 27 As reported in large studies, the presence of multiple high-risk features proved to involve a greater-than-additive risk, as the presence of remodeling index (RI) and low-attenuation plaques (LAP) involved a 22% probability of ACS development over a 27-month follow-up, and the presence of three high-risk features led to a 60% probability of ACS development in the same follow-up time frame. 28,29 Besides noninvasive imaging, diagnostic techniques for vulnerable plaque detection include serologic markers, as atherosclerosis is known as a chronic immunoinflammatory disease.…”

mentioning

confidence: 89%

Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Mitra¹,

Hodaş

Szabó³

et al. 2019

Journal of Interdisciplinary Medicine

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With coronary artery disease (CAD) projected to remain the leading cause of global mortality, prevention strategies seem to be the only effective approach able to reduce the burden and improve mortality and morbidity. At this moment, diagnostic strategies focus mainly on symptomatic patients, ignoring the occurrence of major cardiovascular events as the only manifestation of CAD. As two thirds of fatal myocardial infarction are resulting from plaque rupture, an approach based on the "vulnerable plaque" concept is mandatory in order to improve patient diagnosis, treatment, and, by default, prognosis. Given that the main studies focus on a plaque-centered approach, this is a prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be "vulnerable" by developing acute cardiovascular events.

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mentioning

confidence: 89%

Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Mitra¹,

Hodaş

Szabó³

et al. 2019

Journal of Interdisciplinary Medicine

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“…Coronary plaques were defined as having an area greater than 1 square millimeter visible at least in two mutually perpendicular orientations [20]. Obstructive coronary stenosis was defined as a coronary plaque causing luminal stenosis ≥50%.…”

Section: Ccta Image Analysismentioning

confidence: 99%

“…As shown in Fig. 1, a high-risk plaque had at least one of the following characteristics [6,20]: (1) Spotty calcification: defined as the presence of calcification with a diameter < 3 mm in the CCTA field, the length did not exceed 1.5 times the diameter of the lumen, and the width did not exceed 2/3 of the lumen diameter. (2) Low attenuation: plaque attenuation was assessed using a Hounsfield Unit (HU).…”

Section: Ccta Image Analysismentioning

confidence: 99%

Prevalence of high-risk coronary plaques in patients with and without metabolic syndrome and the relationship with prognosis

Luo

Han

et al. 2020

BMC Cardiovasc Disord

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Background: Metabolic syndrome (MS) is a disorder, characterized by clusters of cardiovascular risk factors such as central obesity, insulin resistance, dyslipidemia and hypertension. Patients with MS may have a higher plaque burden that increases their risk of major adverse cardiovascular events (MACEs). This study aimed to analyze the prevalence of high-risk coronary plaques in patients with and without MS by coronary computed tomography angiography (CCTA) and to investigate the relationship between MS, high-risk coronary plaques, and their prognosis. Methods: This was a retrospective cohort study of 1136 patients who underwent CCTA due to chest pain without obstructive heart disease (≥50% coronary stenosis) between January 2014 and December 2015 in our hospital. The relationships between high risk coronary plaques, MS, and other clinical factors were assessed. Multicollinearity analysis was performed to identify the collinearity between the variables. The proportional hazard assumption was checked and using Schoenfeld residual test. Cox proportional hazards model and Kaplan-Meier survival analysis assessed the relationship between MS, high-risk coronary plaques and MACEs.Results: High-risk plaques were more frequent in the MS group than non-MS group (P = 0.004). MS (HR = 2.128, 95%CI: 1.524-2.970, P < 0.001), presence of high-risk plaques (HR = 11.059, 95%CI: 7.749-57.232, P < 0.001) and high sensitivity C-reactive protein (hsCRP) (HR = 1.629, 95%CI: 1.128-2.352, P = 0.009) were related with an increased risk of MACEs in patients with risk factors for coronary heart disease. In patients with high-risk plaques, MS (HR = 2.265, 95%CI: 1.629-3.150, P < 0.001) and hsCRP (HR = 1.267, 95%CI: 1.191-1.348, P = 0.004) were related with an increased risk of MACEs. Kaplan-Meier analysis showed differences in MACEs between the MS and non-MS groups in the whole population and those with high-risk plaques (both P < 0.0001).Conclusions: High-risk plaques were more common in patients with MS. MS and the presence of high-risk plaques were independent risk factors for MACEs.

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“…It is noteworthy that all of its derived parameters regarding plaque characterization have emerged as significant and independent predictors of events in multiple studies. For example, a recent coronary CT study, with a follow‐up of almost 100 months, confirmed that, in nonobstructive disease, positive remodeling, increased plaque burden, low attenuation, and napkin‐ring sing presence are all associated with cardiac events. In addition, a plaque volume of 3 mm 3 /mm of vessel wall has been identified as an appropriate cutoff for prediction of adverse events .…”

Section: Detecting the Vulnerable Plaquementioning

confidence: 99%

Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives

Stefanadis

Antoniou

Tsiachris

et al. 2017

JAHA

213

148

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Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study

Abstract: High-risk plaque characteristics at CCTA (PRI > 1.4, PB > 0.7, LAP, and NRS) seem to be promising for risk stratification of patients with non-obstructive CAD.

Cited by 66 publications

References 24 publications

Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Prevalence of high-risk coronary plaques in patients with and without metabolic syndrome and the relationship with prognosis

Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives

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